mycophenolic-acid and Retinal-Diseases

The case is presented of a non-paraneoplastic autoimmune retinopathy (AIR) with positive anti-recoverin autoantibodies. A 28-year-old woman presented with a rapidly progressive bilateral visual loss of 8 months onset. Funduscopic examination revealed diffuse fine mottled atrophic changes in both eyes. Fluorescein angiographic studies showed a pattern of mottled areas of early hyperfluorescence without leakage of dye. In the ocular coherence tomography it was observed that was a loss of external layers. The electroretinogram showed absence of rod and cone responses in the right eye, and diminished cone response associated to absence of rod response in the left eye. AIR was suspected, and empirical corticosteroid treatment was started while waiting for Western-blot results, which was finally positive for recoverin, GAPDH, anti-alpha-enolase, and aldolase. The patient was able to be treated, and her visual acuity remained stable, but as soon as it was suspended, vision was completely lost in the right eye and reduced to hand movement in the left eye.

Topics: Adult; Antibodies; Autoimmune Diseases; Electroretinography; Female; Fundus Oculi; Glucocorticoids; Humans; Mycophenolic Acid; Prednisone; Recoverin; Retinal Diseases; Tomography, Optical Coherence; Visual Acuity; Visual Fields

Topics: Adult; Antibiotics, Antineoplastic; Antirheumatic Agents; Autoimmune Diseases; Cataract; Cystic Fibrosis; Electroretinography; Humans; Hydroxychloroquine; Lupus Erythematosus, Systemic; Male; Mycophenolic Acid; Physical Examination; Retina; Retinal Diseases; Vision Disorders; Vision Tests; Visual Acuity

Topics: Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Antinuclear; Autoantigens; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Lupus Nephritis; Mycophenolic Acid; Prednisone; Retinal Diseases; Retinal Vessels; Ribonucleoproteins; SS-B Antigen; Visual Acuity; Young Adult

Topics: Administration, Oral; Blindness; Cyclophosphamide; Drug Therapy, Combination; Eye Enucleation; Eye Pain; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Ophthalmia, Sympathetic; Retinal Diseases; Visual Acuity

Topics: Adult; Angiogenesis Inhibitors; Antibodies, Monoclonal, Humanized; Coloring Agents; Diagnosis, Differential; Female; Fluorescein Angiography; Humans; Immunosuppressive Agents; Indocyanine Green; Mycophenolic Acid; Ranibizumab; Recurrence; Retinal Diseases; Tomography, Optical Coherence; Vision Disorders; 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