In the JournalsPerspective

Combination immunotherapy controls inflammation in birdshot retinochoroidopathy

Cyclosporine A and mycophenolate mofetil controlled inflammation in the treatment of birdshot retinochoroidopathy, according to a study.

The retrospective study included 98 eyes of 49 patients with birdshot retinochoroidopathy.

Initial dosages were 3 mg per kg of weight for cyclosporine A and 1 g twice daily for mycophenolate mofetil. Dosages were changed in patients who showed no improvement or experienced adverse events. The drugs were discontinued for at least 2 weeks in patients with side effects or drug toxicity until symptoms or laboratory abnormalities resolved.

There were statistically significant reductions in vitreous inflammation scores in right eyes (P < .001) and left eyes (P = .001) at 1 year. Inflammation was controlled successfully in 31 of 46 patients (67.4%) at 1 year.

Angiographic leakage of retinal vessels decreased significantly (P = .0039). There was no significant decrease in cystoid macular edema.

Changes in logMAR best corrected visual acuity were insignificant at 1 year.

Cyclosporine A and mycophenolate mofetil controlled inflammation in the treatment of birdshot retinochoroidopathy, according to a study.

The retrospective study included 98 eyes of 49 patients with birdshot retinochoroidopathy.

Initial dosages were 3 mg per kg of weight for cyclosporine A and 1 g twice daily for mycophenolate mofetil. Dosages were changed in patients who showed no improvement or experienced adverse events. The drugs were discontinued for at least 2 weeks in patients with side effects or drug toxicity until symptoms or laboratory abnormalities resolved.

There were statistically significant reductions in vitreous inflammation scores in right eyes (P < .001) and left eyes (P = .001) at 1 year. Inflammation was controlled successfully in 31 of 46 patients (67.4%) at 1 year.

Angiographic leakage of retinal vessels decreased significantly (P = .0039). There was no significant decrease in cystoid macular edema.

Changes in logMAR best corrected visual acuity were insignificant at 1 year.

    Perspective

    In this recent paper by Cervantes and colleagues, we are presented with a large retrospective analysis with a reasonable long-term follow-up to judge the efficacy of combination systemic immuno-suppression of mycophenolate mofetil twice daily with modified cyclosporine in the treatment of birdshot retinochoroidopathey (BRC). Aside from the impressive size of their cohort, they evaluated particularly rigorous objective criteria for disease progression, including vitreous haze scores (a gold standard for judging posterior uveitis activity) and electroretinogram findings (the most sensitive diagnostic test for evaluating BRC).
    This paper demonstrates clear evidence regarding the efficacy of combination therapy for the treatment of BRC, as evidenced by their survival analysis/vitreous haze score and shortening of the 30 Hz implicit time while on treatment. Their findings are unmatched in the literature in regard to size of the cohort, efficacy metrics and length of follow-up. A particularly valuable aspect of this article is an honest discussion of treatment failures and a detailed catalog of the potential side effects one may encounter when one applies this combination therapy to BRC. This article provides a striking piece of data in the treatment of BRC.

    This paper demonstrates clear evidence regarding the efficacy of combination therapy for the treatment of BRC, as evidenced by their survival analysis/vitreous haze score and shortening of the 30 Hz implicit time while on treatment. Their findings are unmatched in the literature in regard to size of the cohort, efficacy metrics and length of follow-up. A particularly valuable aspect of this article is an honest discussion of treatment failures and a detailed catalog of the potential side effects one may encounter when one applies this combination therapy to BRC. This article provides a striking piece of data in the treatment of BRC.

    • Rajiv Shah, MD
    • Vitreoretinal and Uveitis/Ocular Immunology Service, Kresge Eye Institute Wayne State University Detroit

    Disclosures: Shah has no relevant financial disclosures.