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C.M. Deuter, I. Koetter, N. Stuebiger, I. Guenaydin, M. Zierhut; Behçet's Disease: Visual Prognosis After Treatment With Interferon Alfa–2a . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2840.
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Purpose: Visual prognosis of ocular Behçet's disease (BD) has been shown to be poor, especially in the case of involvement of the posterior eye segment. Irrespective of immunosuppressive treatment a visual acuity (VA) of 0.1 or less occurs in up to 74% of patients within 5–10 years of ocular BD. In open studies interferon alfa–2a (IFN alfa–2a), an immunomodulatory cytokine, has shown very effective in the treatment of severe ocular BD. Moreover first results recently published by our group suggested that IFN alfa–2a may be superior to conventional immunosuppressants, especially regarding visual prognosis. Now we present the analysis of VA development in 17 patients with ocular BD who completed a follow–up period of at least five years after initiation of treatment with IFN alfa–2a. Methods: In our retrospective study we analysed 30 eyes of 17 consecutive patients (male:female = 11:6) with complete BD (according to the diagnostic criteria of the ISG) who were treated with IFN alfa–2a. Patients had to have an active panuveitis and / or retinal vasculitis which had to be refractory to at least one immunosuppressive treatment and / or systemic steroids. We compared VA before initiation of IFN–therapy and after achieving remission of ocular disease to VA at the end of a follow–up period of at least five years (60 months). Results: Mean follow–up time was 80.3 months (SD 18.0 months; 60–122 months). During follow–up 18 eyes (60.0 %) showed an improvement of VA, in 12 eyes (40.0 %) VA remained stable. There was no decrease of VA in any eye. If VA in remission of ocular disease (6 months after initiation of IFN–treatment) will be compared to VA at the end of follow–up, 27 eyes (90.0 %) showed an improvement or stabilisation. A VA of 0.1 or less was present in 8 eyes (26.7%) before initiation of IFN therapy, but only in 3 eyes (10.0%) at the end of follow–up. Not one of the eyes with useful VA before initiation of IFN showed a loss of VA to 0.1 or less during follow–up. No procedures for improvement of VA (e.g. cataract surgery or vitrectomy) were performed during follow–up period. Conclusions: In our retrospective study IFN alfa–2a showed highly effective in recovering and preserving good visual function in patients with severe ocular BD. Thus our current data emphasize our previous results that IFN alfa–2a improves visual prognosis in these patients compared to conventional immunosuppressants. Therefore we recommend an early change to IFN alfa–2a treatment, if in a patient with ocular BD conventional immunosuppressants fail.
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