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M. Zierhut, C. M. Deuter, N. Stuebiger, D. Doycheva; Mycophenolate Mofetil for the Therapy of Macular Edema in Uveitis - 5 Years Results. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5261.
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Mycophenolate mofetil (MMF) has been shown to be an effective immunosuppressive agent for the treatment of uveitis by reducing the inflammation. The aim of our study was to analyse the long term effect of this drug on cystoid macula edema (CME) in uveitis.
Medical records of uveitis patients treated with MMF were retrospectively reviewed. Only patients with a follow-up period of at least 5 years were included in the study. We defined 2 groups: A: CME before begin with MMF (n=24); B: CME during MMF therapy (n=14). All patients were treated with a combination therapy consisting of MMF, corticosteroids, acetacolamid (MCA). In case of unresponsiveness Adalimumab, Interferon-alpha (IFN) or intravitreal steroid-implant (Retisert) were used. Major outcome parameters were OCT measured CME and visual acuity (VA).
A total of 60 uveitis patients with a follow-up time of 5 or more years after initiation of MMF treatment were evaluated. Of these, 38 (63%) had a CME. In group A 13 showed complete resolution (55%), 1 only partial response to MCA. Of the 10 others 6 showed complete response after use of Adalimumab (2) or Interferon alpha (3) or intravitreal steroid implant (1). In total group A showed 79% complete, 21% partial response. In group B 11 of 14 patients (79%) showed complete response to the MCA, while 3 needed other therapy (Adalimumab 2 (one with complete, one with partial response), IFN alpha in 1 patient with complete response). Therefore group B in total showed 93% complete and 7% partial response. VA in group A was stable or improved in 19 patients (79.5%), reduced in 5 (20.5%). VA in group B was stable or improved in 10 (71%), reduced in 4 patients (29%).
MMF has been shown to be an effective steroid-sparing agent in the therapy of uveitis. The evaluation of this drug for 5 years regarding uveitic CME shows 2 groups. In group A (CME before MMF treatment) MCA treatment resulted in 55% complete resolution, showing that MMF also seems to maintain the good effect of corticosteroid/acetazolamide after reduction. But MMF alone was not able to prevent CME in all patients. So, group B consisted of the patients who had developed CME during MMF treatment. Here MCA was completely effective in 79%. The data show that CME can be treated with MMF (in the acute situation with corticosteroids and acetazolamide), and in case patients develop a new CME, this treatment also is highly effective.
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