mycophenolic-acid and Choroid-Diseases

To compare the frequencies of attacks before and after immunomodulatory therapy (IMT) with mycophenolate mofetil (MMF) in recurrent punctate inner choroidopathy (PIC) and to report fundus autofluorescence (FAF) findings.. Eight patients who had at least two recurrent episodes of increased activity before MMF and 12 months of documented clinical course before and after MMF were included. The frequencies of attacks before and after MMF were compared. FAF images evaluated.. Before MMF, the 8 patients experienced 19 attacks of recurrent disease activity; during MMF therapy, 3 (38%) patients experienced 6 recurrent episodes. The attack frequencies were 1.09 ± 0.75 before and 0.23 ± 0.32 during treatment (p = .036). Among the 6 patients who had FAF, surrounding hyperautofluorescent halo was detected in 4 and recurrence occurred in 2 who did not show any changes on the intensity during treatment.. In the index study, the employment of MMF has decreased frequency of attacks in recurrent PIC. FAF may be employed to monitor and predict the response to treatment.

Topics: Adult; Choroid Diseases; Female; Fluorescence; Fundus Oculi; Humans; Immunologic Factors; Male; Middle Aged; Mycophenolic Acid; Recurrence; Retrospective Studies; Young Adult

A 55-year-old man who had multiple subretinal and choroidal yellowish lesions and episcleral nodules for 1.5 years was diagnosed as having nodular sclerochoroidopathy after developing classic features of posterior scleritis with choroidal and serous retinal detachment. Long-term therapy with steroids in combination with mycophenolate mofetil resulted in regressed posterior scleritis and nodular lesions, as well as improved visual acuity. Nodular sclerochoroidopathy should be suspected in patients with subretinal and choroidal lesions and should be distinguished from choroidal neoplasm.

Topics: Choroid Diseases; Choroid Neoplasms; Diagnosis, Differential; Drug Administration Schedule; Fluorescein Angiography; Fundus Oculi; Humans; Male; Middle Aged; Mycophenolic Acid; Scleral Diseases; Steroids; Tomography, Optical Coherence; Ultrasonography; Visual Acuity

Topics: Adult; Choroid Diseases; Drug Therapy, Combination; Fluorescein Angiography; Functional Laterality; Graft Survival; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Mycophenolic Acid; Polycystic Kidney Diseases; Prednisone; Retinal Diseases; Tomography, Optical Coherence

Topics: Adult; Choroid Diseases; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Mycophenolic Acid; Retinal Diseases; Tacrolimus

To evaluate the outcomes of patients with birdshot retinochoroidopathy (BSRC) treated with corticosteroid-sparing systemic immunomodulatory therapy (IMT).. Retrospective, noncomparative, interventional case series.. Thirty-five patients with BSRC evaluated at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary from 1980 through 2003.. Data on age, gender, follow-up time, delay to diagnosis or referral, treatment before and during follow-up, complications of BSRC or treatment, Snellen visual acuities (VAs), and electroretinograms (ERGs) were recorded from patient charts.. Disease progression as determined by Snellen VAs and serial ERGs, ocular complications of BSRC or corticosteroids, and complications of systemic IMT.. Twenty-eight patients with a mean follow-up of 81.2 months were included. None of the patients had sufficient control of their inflammation before referral. All patients were treated with corticosteroid-sparing systemic IMT at some point during their follow-up: 92.9% were treated with cyclosporine, 67.9% with mycophenolate mofetil, 17.9% with azathioprine, 10.7% with oral methotrexate, and 7.1% with daclizumab. Ocular complications of BSRC and/or corticosteroids were cataract (53.6%), cystoid macular edema (35.7%), glaucoma (21.4%), epiretinal membrane (10.7%), and retinal detachment (3.6%). Average Snellen VAs at the time of initial visit were 0.64 (right eye) and 0.59 (left eye). Average final Snellen VAs were 0.74 (right eye) and 0.71 (left eye). (Logarithm of the minimum angle of resolution equivalents were -0.23, right eye initial; -0.19, right eye final; -0.38, left eye initial; and -0.31, left eye final.) In the right eye, 78.6% of patients and, in the left eye, 89.3% of patients had either the same or improved VA at the end of the follow-up. The 30-hertz flicker implicit time was prolonged in 58.3% of initial ERGs and in 62.5% of final ERGs. The bright scotopic amplitude was abnormal in 45.5% of initial and final ERGs.. Long-term preservation of visual function is attainable with systemic corticosteroid-sparing IMT for patients with BSRC. Prompt treatment with systemic IMT may offer the best hope of maintaining retinal function in what is often thought of as a chronically progressive disease resistant to treatment.

Topics: Adult; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Azathioprine; Choroid Diseases; Cyclosporine; Daclizumab; Disease Progression; Drug Therapy, Combination; Electroretinography; Female; Follow-Up Studies; HLA-A Antigens; Humans; Immunoglobulin G; Immunosuppressive Agents; Male; Methotrexate; Middle Aged; Mycophenolic Acid; Retinal Diseases; Retrospective Studies; Treatment Outcome; Visual Acuity