Success with single-agent immunosuppression for multifocal choroidopathies

Area of Science:

• Ophthalmology
• Immunology
• Retinal Diseases

Background:

• Posterior uveitides are inflammatory eye conditions impacting vision.
• Birdshot chorioretinitis, multifocal choroiditis with panuveitis, and punctate inner choroiditis are specific posterior uveitis subtypes.
• Effective immunosuppression is crucial for managing these sight-threatening conditions.

Purpose of the Study:

• To assess the efficacy of single-agent immunosuppression in treating posterior uveitides.
• To evaluate treatment success rates for specific conditions like birdshot chorioretinitis.
• To determine the need for escalating therapy or adding second agents.

Main Methods:

• Retrospective case series analysis of patients treated at tertiary care uveitis practices.
• Standardized treatment protocol: prednisone (1 mg/kg) and mycophenolate (2 g daily), with dose adjustments.
• Treatment success defined as no disease activity with low-dose prednisone (≤10 mg daily) at 6, 12, and 24 months.

Main Results:

• High treatment success rate (95% at 2 years) was achieved with immunosuppression.
• Prednisone successfully tapered in 95% of patients, with mean daily doses below 6 mg at 2 years.
• Visual acuity remained stable, and visual field scores improved in birdshot chorioretinitis patients.

Conclusions:

• Single-agent immunosuppression is a viable primary treatment for most posterior uveitides.
• Escalation to higher mycophenolate doses or addition of a second agent is necessary in approximately one-fifth of cases.
• This approach allows for disease suppression with acceptably low prednisone doses.