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C. M. Deuter, I. Koetter, I. Guenaydin, N. Stuebiger, M. Zierhut; Interferon Alfa-2a for the Treatment of Chronic Refractory Cystoid Macular Edema in Non-Infectious Uveitis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3907.
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To evaluate the efficacy of interferon (IFN) alfa-2a for the treatment of long lasting refractory cystoid macular edema (CME) in non-infectious uveitis.
Retrospective analysis of a consecutive interventional case series. IFN alfa-2a was administered at an initial dose of 3 or 6 million IU (depending on bodyweight) per day subcutaneously. Afterwards IFN alfa-2a was tapered slowly over six months and discontinued finally if possible. If CME relapsed IFN alfa-2a was reinstituted in a dose of 3 million IU every second day and tapered slowly again in order to evaluate the lowest maintenance dose to keep remission. Control of treatment efficacy was performed by OCT.
26 eyes of 15 patients (5 male, 10 female; mean age 50.1 years, 19-74 years) with CME (mean duration 64.6 months, 16-132 months) due to non-infectious intermediate (n=12) or posterior (n=3) uveitis were analyzed. Ineffective pre-treatment consisted of systemic steroids and acetazolamide (all patients) and at least one additional immunosuppressive drug (13 patients). IFN alfa-2a showed effective (= complete resorption of CME within four weeks, able to taper IFN) in 17 eyes (65.4%), partially effective (= incomplete resorption of CME, unable to taper IFN) in 5 eyes (19.2%) and not effective (= no response or recurrence of CME due to preexisting or newly developed auto-antibodies against IFN) in 4 eyes (15.4%). In 8 patients (15 eyes) IFN alfa-2a was discontinued after six months in complete remission of CME. One of these patients was lost to follow-up then. In the other 7 patients (13 eyes) IFN alfa-2a had to be reinstituted due to a relapse of CME. However, all 7 patients responded again. During a mean follow-up period of 23.1 months (4 patients 33-36 months, 3 patients 3-14 months) since restart of therapy we were able in all 7 patients to taper IFN alfa-2a to maintenance doses between 3 million IU every third day and 1 million IU every tenth day without a recurrence of CME in any of the 13 eyes. Treatment with IFN alfa-2a was generally well tolerated by the patients. Common side effects such as flu-like symptoms and increased liver enzymes were dose-dependent and did not necessitate cessation of treatment.
Our data show IFN alfa-2a as an effective and well tolerated treatment for otherwise therapy resistant CME in non-infectious uveitis. Whether and when IFN alfa-2a can be stopped without further relapses of CME is one of the questions that have to be answered in the future.
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