title: Association of systemic steroids and mycophenolate mofetil as rescue therapy for uveitic choroidal neovascularization unresponsive to the traditional immunosuppressants: interventional case series.
abstract: To study the efficacy of systemic steroids (SS) associated with mycophenolate mofetil (MMF) for the control of juxta/sub-foveal uveitic choroidal neovascularization (CNV) unresponsive to the traditional immunosuppressive agents. Patients with juxta/sub-foveal uveitic CNV unresponsive to the traditional immunosuppressive drugs were treated with SS and MMF. The study was designed as a prospective, consecutive, open-label, interventional case series. Visual gain and loss were defined as improving or worsening of two or more lines of best-corrected visual acuity (BCVA), respectively. CNV size outcome was dichotomized as "increased" or "stable/reduced", if increased >200 μm(2), or reduced ≥ 200 μm(2) or not modified by 200 μm(2), respectively. Nine cases (12 eyes) have been considered; ages ranged from 27 to 56 years. The mean follow-up time was 18.2 ± 2.9 months (min: 14 months, max: 23 months). At base-line, the mean BCVA was 0.3 ± 0.17, improving up to 0.57 ± 0.25 and to 0.63 ± 0.22 (P < 0.001, paired t-test) at the 6 and 12-month follow-ups, respectively. At the last follow-up, all the patients had stable/improved BCVA (P < 0.0001, Fisher's exact test) and stable/reduced lesion size (P < 0.0001, Fisher's exact test). None of the patients complained of any severe adverse event during the treatment. The combination of SS and MMF seems to be a promising strategy in order to control uveitic CNVs unresponsive to the traditional immunosuppressive agents. Further studies are needed to validate the data of this case series.
authors.affiliation: The Eye Clinic, Azienda Ospedaliero Universitaria-Ospedali Riuniti di Ancona, Via Conca 71, 60100, Torrette-Ancona, Italy. doctor_blacks@hotmail.com
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Neri
authors.forename: Mara
authors.initials: M
authors.lastname: Manoni
authors.forename: Cinzia
authors.initials: C
authors.lastname: Fortuna
authors.forename: Marta
authors.initials: M
authors.lastname: Lettieri
authors.forename: Cesare
authors.initials: C
authors.lastname: Mariotti
authors.forename: Alfonso
authors.initials: A
authors.lastname: Giovannini
mesh_terms: D000284:Administration, Oral; D000328:Adult; D020256:Choroidal Neovascularization / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011239:Prednisolone / Q000008:administration & dosage; D016879:Salvage Therapy; D014605:Uveitis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone; D009173:Mycophenolic Acid; D008775:Methylprednisolone