Department of Ophthalmology, Reference Center for Rare Diseases, Pitié-Salpêtrière Hospital, Paris-Sorbonne University, Paris, France.
Department of Medicine, Division of Immunology and Allergy, Geneva University Hospitals, Geneva, Switzerland.
Retina. 2024 Oct 1;44(10):1814-1822. doi: 10.1097/IAE.0000000000004177.
To assess the long-term efficacy and safety of treatments for cystoid macular edema in birdshot retinochoroïditis.
Observational retrospective study of 142 HLA-A29-positive patients with cystoid macular edema; the main outcome was the optical coherence tomography intraretinal cysts resolution.
During the mean follow-up of 75 months (12-178), 61.3% of patients were successfully treated using 1 to 3 treatment steps, while the others needed more steps. At 6 months, there were no significant effects on ME for anti-TNF (tumor necrosis factor) and IVIg (immunoglobulin) in contrast to antimetabolites (OR 1.98), systemic GCS (glucocorticosteroids), CsA (cyclosporine A) and tocilizumab (odds ratio closed to 2.7), intraocular injected GCS (odds ratio of 4.2), and interferon (odds ratio of 4.4). The percentages of therapeutic success trend to decrease from the initial three treatment steps to the subsequent treatment steps, for systemic GCS (84% to 70%), for anti-TNF (42% to 33%), and for CsA (71% to 33%); the success percentages did not decrease for injected GCS (83% to 89%). Macular edema recurrence occurred with the highest percentage for injected GCS (86.8%, P = 0.01) and the lowest for tocilizumab (10.5%, P = 0.001). Interferons-α and tocilizumab were associated with the lowest prednisone daily doses.
The classical uveitic cystoid macular edema therapeutic algorithm could be adapted to birdshot retinochoroïditis.
评估治疗鸟枪弹样脉络膜视网膜炎性黄斑水肿的长期疗效和安全性。
对 142 例 HLA-A29 阳性的黄斑囊样水肿患者进行回顾性观察性研究；主要结局是视网膜内 OCT 囊肿的消退。
在平均 75 个月（12-178）的随访期间，61.3%的患者通过 1 至 3 个治疗步骤成功治疗，而其余患者需要更多步骤。在 6 个月时，与抗代谢物（OR1.98）、全身 GCS（糖皮质激素）、CsA（环孢素 A）和托珠单抗（OR 接近 2.7）相比，抗 TNF（肿瘤坏死因子）和 IVIg（免疫球蛋白）对 ME 无显著影响，眼内注射 GCS（OR4.2）和干扰素（OR4.4）。从初始的三个治疗步骤到后续的治疗步骤，治疗成功率呈下降趋势，全身 GCS（84%降至 70%）、抗 TNF（42%降至 33%）和 CsA（71%降至 33%）；而注射 GCS（83%至 89%）的成功率并未下降。黄斑水肿复发率以注射 GCS 最高（86.8%，P=0.01），托珠单抗最低（10.5%，P=0.001）。干扰素-α和托珠单抗与泼尼松每日剂量最低有关。
经典的葡萄膜炎性黄斑水肿治疗方案可以适用于鸟枪弹样脉络膜视网膜炎。
