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M.D. Becker, T. Hudde, C. Fiehn, B. Storch-Hagenlocher, B. Wildemann, M. Trieschmann, A. Heiligenhaus; Interferon as a Treatment for Uveitis with Severe Retinal Vasculitis Associated with Multiple Sclerosis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2402.
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Purpose: Besides optic neuritis (ON), multiple sclerosis (MS) may also involve the eye in the form of a bilateral uveitis. Interferon has been shown to have beneficial effects in patients with MS and/or ON. As shown in the model of experimental autoimmune encephalitis and uveitis (EAE), the neurological and ophthalmological manifestations seem to share similar pathogenic mechanisms. Aim of this pilot study was to evaluate the efficacy of interferon for MS-associated uveitis. Methods: We included 9 patients (8 female, 1 male) with proven MS and associated uveitis from 3 uveitis centers. Median age was 48 years (range 33-56). 7 patients were treated with interferon-ß and 2 with interferon-α. Visual acuity, cell count in the aqueous humor and vitreous, as well as posterior segment vasoproliferative changes and presence of cystoid macula edema (CME) were documented. All patients had bilateral and 4 had granulomatous uveitis. 7 had retinal vasculitis, and 3 having CME. 4 patients had suffered from ON in the past. Five patients had vasoproliferative changes at the posterior pole. Results: All patients received high-dose corticosteroids initially. 3 patients had immunosuppressive treatment consecutively (2 methotrexate, 1 azathioprine). A median of 2 years (range 1-24) after the onset of uveitis, patients were put on interferon therapy (7 interferon-ß, 2 interferon-α). Median duration of treatment was 8 months (range 2-27). All patients except one (who ceased interferon-ß due to side effects) were continued on interferon. Visual acuity (comparing V/A before therapy and at last follow-up) improved by 2,6 ± 1,9 lines OD and 1,3 ± 0,9 lines OS (3 patients had ON OS). Aqueous cell count improved by 0,9 ±0,7 grades (median 1) OU. Vitreous cell count improved by 0,7 ± 1,1 (median 1) OD and 0,9 ± 1,4 (median 0,8) OS to 1+ cells. Side effects were noted in 3 patients (elevation of liver enzymes, depression). At the last follow-up (median observation time 10 months, range 5-31 months), no vasoproliferative changes or CME (except in 1 pt.) were noted of any of the patients. Conclusions: Treatment of MS-associated uveitis with interferon appears to have beneficial effects especially in patients with partial resistance to corticosteroids or posterior segment vasoproliferative changes.
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