From the Eye Clinic (M.A., D.M., G.T., F.Z., M.O., G.S., A.I.), Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy; Department of Molecular and Translational Medicine (M.A.), University of Brescia, Brescia, Italy.
From the Eye Clinic (M.A., D.M., G.T., F.Z., M.O., G.S., A.I.), Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy.
Am J Ophthalmol. 2024 Jun;262:62-72. doi: 10.1016/j.ajo.2024.01.006. Epub 2024 Jan 14.
To evaluate the influence of immunomodulatory therapy (IMT) on visual and treatment outcomes of inflammatory choroidal neovascularization (iCNV) in patients affected by multifocal choroiditis (MFC), and to compare them to patients treated with steroids as needed.
Multicenter retrospective matched cohort study.
Patients affected by MFC with iCNV were divided into a IMT group and a "steroids as needed" group and matched according to the time between diagnosis and beginning of systemic treatment. Visual acuity (VA), number of anti-vascular endothelial growth factor (VEGF) intravitreal injections, and number of iCNV reactivations during 2 years of follow-up after treatment initiation were compared between the 2 groups.
A total of 66 eyes of 58 patients were included, equally divided into the 2 groups. Patients in the IMT group had a lower relative risk (RR) of iCNV reactivation (0.64, P = .04) and of anti-VEGF intravitreal injection retreatment (0.59, P = .02). Relapses of MFC-related inflammation were independently associated with a higher RRs of iCNV reactivation (1.22, P = .003). Final VA was higher in the IMT compared to the steroids as needed group (mean [SD], 69.1 [15.1] vs 77.1 [8.9] letters, P = .01), and IMT was associated with greater VA gains over time (+2.5 letters per year, P = .04).
IMT was associated with better visual and treatment outcomes in MFC complicated by iCNV compared to steroids as needed. The better outcomes of the IMT group and the association between MFC-related inflammation and iCNV reactivations highlight the need for tighter control of inflammation to prevent iCNV relapses and visual loss.
评估免疫调节治疗（IMT）对多灶性脉络膜炎（MFC）患者炎症性脉络膜新生血管（iCNV）的视觉和治疗结果的影响，并与按需使用类固醇治疗的患者进行比较。
多中心回顾性匹配队列研究。
将患有 MFC 合并 iCNV 的患者分为 IMT 组和“按需使用类固醇”组，并根据诊断和开始全身治疗之间的时间进行匹配。比较两组患者在治疗开始后 2 年的视力（VA）、抗血管内皮生长因子（VEGF）玻璃体腔内注射次数和 iCNV 再激活次数。
共纳入 58 例 66 只眼，平均分为两组。IMT 组患者 iCNV 再激活的相对风险（RR）较低（0.64，P =.04），抗 VEGF 玻璃体腔内注射再治疗的 RR 也较低（0.59，P =.02）。MFC 相关炎症的复发与 iCNV 再激活的 RR 较高独立相关（1.22，P =.003）。与“按需使用类固醇”组相比，IMT 组的最终 VA 更高（平均[标准差]，69.1[15.1]比 77.1[8.9]个字母，P =.01），并且 IMT 与随时间 VA 增加相关（每年增加 2.5 个字母，P =.04）。
与按需使用类固醇相比，IMT 可改善 MFC 合并 iCNV 患者的视觉和治疗结果。IMT 组的更好结果和 MFC 相关炎症与 iCNV 再激活之间的关联强调了需要更严格地控制炎症，以防止 iCNV 复发和视力丧失。
