Interferon Alpha-2a: an effective therapeutic option in patients with refractory uveitic cystoid macular edema

Abstract

Purpose :
Cystoid macular edema (CME) represents one of the most serious and challenging complications in uveitis and tends to increase in frequency with the duration of inflammation. The treatment of CME is unsatisfactory, although in some patients, it responds well to conventional therapy. Interferon-alfa 2 a, thanks to its role in promoting tissue homeostasis, could be considered a potent therapeutic agent in retinal vasculitis with macular edema, characterized by leakage of the vascular endothelium. The aim of this study is to test the efficacy of interferon alpha 2a in the treatment of refractory uveitic cystoid macular edema (CME).

Methods :
A retrospective chart review was conducted of patients attending the uveitis clinic at Arcispedale Santa Maria Nuova, Reggio Emilia, Italy, with a diagnosis of refractory uveitic CME who started IFN-alfa-2a therapy from November 2013 to July 2017. Patients with at least 3 months of IFN therapy were included. IFN alfa-2a was administered at an initial dosage of 3 million IU per day, then tapered to a maintenance dosage of 3 million IU every other day. The efficacy of IFN therapy was tested by comparing the visual acuity and central macular thickness (CMT) at the beginning and at the end of follow-up.

Results : Twenty-eight patients (13 males and 15 females, mean age of 46 ± 17 yrs) were included in the analysis. Patients presented a median follow-up of 11 months (IQR:6-21). The median duration of therapy was 12 months (IQR:7-24). After a median follow-up of 11 months, both visual acuity (△_RE=0.092±0.25, p=.08 & △_LE=0.12±0.26, p=.03) and CMT improved significantly in both eyes (△_RE=93±210 mm, p=.046 & △_LE=155±198 mm, p=.001).

Conclusions : IFN alfa-2a could be included in the therapeutic algorithm of longstanding, recurrent post-uveitic CME with or without retinal vasculitis as it leads to significant reduction of CME and improvement of vision.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.