mycophenolic-acid and Chorioretinitis

To describe differences in the clinical characteristics of birdshot retinochoroidopathy (BSRC) patients diagnosed early and later in life.. This is a retrospective cohort study. Age was primarily analyzed and 50 years of age at diagnosis was selected as a cut-off point.. A total of 144 patients (288 eyes) were included; 68 with early-onset and 76 with late-onset BSRC. The younger group had a statistically significant higher rate of more severe iritis (p = 0.04); an average number of non-steroidal immunosuppressants and biologic agents (NSIB) (p = 0.04); and a prolonged time to initiation of NSIB (p = 0.01). There were only four patients (3%) who had >0.5+ cells in the anterior chamber.. Patients with early-onset BSRC carried a higher risk for anterior segment inflammation, had a more prolonged delay to initiation of treatment with NSIB, and required a greater number of NSIBs to achieve remission.

Topics: Adult; Age Distribution; Age of Onset; Aged; Anti-Inflammatory Agents, Non-Steroidal; Biological Factors; Birdshot Chorioretinopathy; Chorioretinitis; Cyclosporine; Early Diagnosis; Female; Humans; Immunosuppressive Agents; Infliximab; Iritis; Male; Middle Aged; Mycophenolic Acid; Retrospective Studies; Risk Factors; Visual Acuity; Young Adult

Progressive outer retinal necrosis syndrome (PORN) is a severe clinical variant of necrotizing herpetic chorioretinitis, which occurs almost exclusively in patients with advanced acquired immunodeficiency syndrome (AIDS). To date, only a few cases of PORN have been reported in patients, mostly among those who were immunocompromised. To our knowledge, only one case of PORN in a patient with systemic lupus erythematosus (SLE) has been described. We report the case of a 44-year old HIV-negative patient with lupus nephritis, whom was being treated by mycophenolate mophetil (MMF), arechin and prednisone. After 14 months of MMF therapy, the patient revealed PORN symptoms; and several months later, the patient developed Type B primary central nervous system lymphoma (PCNSL). PORN is usually compared to acute retinal necrosis (ARN) syndrome, because of having the same causative agent: varicella zoster virus (VZV). There are also some similarities in clinical findings. Our observation supports the hypothesis that PORN symptoms in HIV-negative patients can be an intermediate form between ARN and PORN, and can vary according to the patient's immune status.

Topics: Adult; Antiviral Agents; Central Nervous System Neoplasms; Chloroquine; Chorioretinitis; Fatal Outcome; Female; Herpes Zoster; Herpesvirus 3, Human; HIV Seronegativity; Humans; Lupus Erythematosus, Systemic; Lymphoma; Magnetic Resonance Imaging; Mycophenolic Acid; Prednisone; Retinal Necrosis Syndrome, Acute; Visual Acuity

To assess the long-term efficacy and tolerability of both derivatives of mycophenolic acid, mycophenolate mofetil (MMF) and mycophenolate sodium (MPS), in the therapy of patients with birdshot chorioretinopathy (BSCR).. Retrospective analysis of 24 patients (48 eyes) with BSCR, treated with MMF or MPS with a follow-up of at least 1 year. The main outcome measures included control of inflammation, steroid-sparing potential and side effects. Secondary outcome measure was the development of retinal function during the therapy measured by best-corrected visual acuity (BCVA), visual field and/or electroretinography (ERG).. Twelve patients (50%) were treated with MMF and 12 patients (50%) with MPS. Control of intraocular inflammation, defined as complete lack of clinical and angiographic signs of inflammatory activity, was achieved in 16 of 24 patients (67%). The angiographic signs of activity were significantly reduced during the follow-up (p<0.05). No significant difference was found in the mean BCVA, the visual field and the ERG parameters during the treatment compared with the baseline (p>0.05). In 20 out of 21 patients (95%) who received systemic corticosteroids, the corticosteroids could be tapered to a daily dose of ≤10 mg (rate 0.26/patient-year). Drug-related side effects occurred in 12 patients (50%, rate 0.16/patient-year). In four patients (17%), a therapy switch from MMF to MPS was undertaken due to gastrointestinal discomfort.. Derivatives of mycophenolic acid are effective and safe drugs for the treatment of BSCR. In cases with gastrointestinal side effects, a therapy switch from MMF to MPS should be considered.

Topics: Adult; Aged; Birdshot Chorioretinopathy; Chorioretinitis; Electroretinography; Female; Fluorescein Angiography; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Retina; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Visual Fields

To evaluate the success of single-agent immunosuppression for patients with the posterior uveitides, birdshot chorioretinitis, multifocal choroiditis with panuveitis, and punctate inner choroiditis.. Retrospective case series.. setting: Tertiary care uveitis practices. population: Patients initiated on immunomodulatory therapy. intervention: Patients were treated with prednisone 1 mg/kg and mycophenolate 2 g daily. Prednisone was tapered after 1 month. Immunosuppression was escalated to mycophenolate 3 g daily, with addition of a second agent, as needed, to achieve treatment success. outcome measure: Treatment success, defined as no disease activity with prednisone dose ≤10 mg daily, at 6, 12, and 24 months.. Twenty-seven patients were followed. Mean presentation and 2-year follow-up acuities were 20/41 and 20/42, respectively. For birdshot chorioretinitis, mean (±standard deviation) quantitative Goldmann visual field scores improved from 761 ± 69 degrees (IV/4 isopter) and 496 ± 115 degrees (I/4 isopter) at presentation to 784 ± 57 degrees and 564 ± 125 degrees, respectively. Prednisone was successfully tapered in 95% of patients; mean prednisone doses at 1 and 2 years were 5.3 ± 4.1 and 5.7 ± 4.8 mg/day, respectively. At 2 years, prednisone was discontinued in 11% of patients. Treatment success was achieved in 74% of patients on 1 immunosuppressant, and in an additional 21% of patients on 2 agents, for an overall 95% success rate at 2 years.. Posterior uveitides can be treated with 1 agent in most patients, but the data suggest a need to escalate therapy to higher mycophenolate doses, and in one fifth of cases to add a second agent to maintain disease suppression with acceptably low prednisone doses.

Topics: Adolescent; Adult; Aged; Azathioprine; Chorioretinitis; Choroiditis; Drug Therapy, Combination; Electroretinography; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Multifocal Choroiditis; Mycophenolic Acid; Panuveitis; Prednisone; Retrospective Studies; Tacrolimus; Visual Acuity; Visual Fields

To retrospectively report a 12-month follow up for combined therapy with systemic cyclosporine A (CSA) and mycophenolate mofetil (MM) in treatment of patients with birdshot retinochoroidopathy (BSRC).. Ninety-eight eyes of patients who received CSA and MM for the treatment of BSRC were included in the study.. All patients were followed for at least five visits during the study, or until treatment failure, or loss of follow-up. Clinical data were analysed using a Student paired t-test, Wilcoxon signed-rank test, McNemar's test, and Kaplan -Meier survival curve. Side effects related to therapy were also recorded. Main outcome measures included best-corrected logarithm of the minimum angle of resolution visual acuity, vitreous inflammation, fluorescein angiography pathologic features, and electroretinogram recordings.. Vitreous inflammation scores at baseline and at 1 year were statistically significantly reduced in both eyes (p<0.001; p=0.001). The presence of angiographic leakage at the 1-year follow-up was significantly reduced (p=0.004). However, the presence of cystoid macular oedema (p=0.32) and comparison of electroretinogram 30-Hz amplitude revealed no significant reduction between baseline and 1-year values for either eye (p=0.61, p=0.87); nonetheless, 30-Hz implicit times were statistically significantly shorter at the end of follow-up for both eyes (p<0.001, p=0.035). Thirty-one patients (67.4%) achieved inflammation control at the 1-year endpoint. Side effects were transient, and resolved after lowering or withholding IMT for a few weeks in the majority of patients.. These results suggest that combined IMT with CSA and MM for BSRC is well tolerated and associated with long-term control of inflammation.

Topics: Adult; Aged; Birdshot Chorioretinopathy; Chorioretinitis; Cyclosporine; Drug Therapy, Combination; Electroretinography; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Retrospective Studies; Treatment Outcome; Visual Acuity

To describe a case of cytomegalovirus (CMV) viremia and colitis in a patient on mycophenolate mofetil (MMF) monotherapy for birdshot chorioretinopathy.. Case report.. Retrospective chart review.. Treatment with MMF 1.5 g twice daily for 5 years led to leucopenia and a CD4 count of 299, which resulted in active CMV infection.. Treatment with MMF alone may put otherwise immune-competent individuals at risk for opportunistic CMV infection. Greater awareness of this association may allow for better monitoring, earlier detection, and treatment of future cases.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Birdshot Chorioretinopathy; CD4 Lymphocyte Count; Chorioretinitis; Colitis; Cytomegalovirus Infections; Drug Therapy, Combination; Ganciclovir; Humans; Immunosuppressive Agents; Leukopenia; Male; Mycophenolic Acid; Prednisone; Treatment Outcome; Valganciclovir; Viremia

To describe restoration of retinal architecture following systemic immunosuppressive treatment in a patient with birdshot chorioretinopathy (BSCR).. Case report.. A patient with BSCR and vitritis, reduced electroretinographic responses, and a constricted visual field was treated with prednisone and mycophenolate mofetil.. Spectral domain optical coherence tomography (SD-OCT) at baseline demonstrated a disruption of retinal architecture. After 4 months of treatment retinal architecture, as visualized on SD-OCT, was restored to normal.. Treatment of BSCR with systemic immunosuppression can result in restoration of disrupted retinal architecture. This structural improvement can be visualized and assessed using SD-OCT.

Topics: Birdshot Chorioretinopathy; Chorioretinitis; Electroretinography; Female; Fundus Oculi; Humans; Immunosuppression Therapy; Middle Aged; Mycophenolic Acid; Retina; Tomography, Optical Coherence; Treatment Outcome

This is a case report of Birdshot chorioretinopathy to highlight investigations required to establish the diagnosis and to assess outcome under specific treatment.

Topics: Chorioretinitis; Drug Therapy, Combination; Female; Fluorescein Angiography; Glucocorticoids; Humans; Immunosuppressive Agents; Microscopy, Acoustic; Middle Aged; Mycophenolic Acid; Prednisolone; Tomography, Optical Coherence; Treatment Outcome

Topics: Anti-Inflammatory Agents, Non-Steroidal; Brain Diseases; Chorioretinitis; Humans; Magnetic Resonance Imaging; Male; Mycophenolic Acid; Retinal Pigment Epithelium; Young Adult