Artikel
Interferon alfa-2a: a new option for the treatment of chronic cystoid macular edema in uveitis?
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Autoren
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C.M.E. Deuter
- University Eye Hospital, Dept. I, Tübingen
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I. Kötter
- University Medical Clinic, Dept. II, Tübingen
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I. Günaydin
- University Medical Clinic, Dept. II, Tübingen
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M. Zierhut
- University Eye Hospital, Dept. I, Tübingen
| Veröffentlicht: | 22. September 2004 |
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Gliederung
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Objective
Cystoid macular edema (CME) is the main cause for an irreversible loss of visual acuity in uveitis patients. Medical treatment of CME usually consists of systemic steroids, acetazolamide and immunosuppressive drugs as well. Unfortunately not in all patients CME responses to this therapeutic options or remains dry after withdrawal of this therapy. Interferon alfa-2a (IFN alfa-2a) has shown very effective in the treatment of CME due to ocular Behçet´s disease. Thus we wanted to investigate if IFN alfa-2a is also effective in the therapy of CME in endogenous uveitis.
Methods
Seven patients (two male, five female; 13 eyes) with CME due to non-infectious intermediate or posterior uveitis received IFN alfa-2a at an initial dosage of 3 million IU or 6 million IU per day (depending on body weight). Characteristically the uveitis was completely quiet in all patients but CME was highly active and did respond whether to the combination of systemic steroids and acetazolamide (all patients) and to at least one additional immunosuppressive drug (five patients). Control of treatment efficacy was performed mainly by optical coherence tomography (OCT).
Results
Only one patient, who developed antibodies against IFN alfa, did not respond. In all other six patients a response to IFN alfa-2a was seen within three days and CME completely resolved between two to four weeks in all 11 eyes of these patients. The mean retinal thickness of the fovea (normal value 150-180μm) was 551μm (SD 101μm) before, 293μm (SD 98μm) three days, 165 μm (SD 40μm) two weeks and 156µm (SD 31μm) four weeks after initiation of IFN alfa-2a treatment.
Conclusions
To our knowledge this is the first description of treating refractory CME in endogenous uveitis with IFN alfa. This substance seems to have an extremely strong anti-exsudative effect which was not known before and which seems to be superior to conventional anti-inflammatory drugs as steroids or immunosuppressants. Thus IFN alfa may become a new option for the therapy of chronic CME in uveitis patients.
