Long-term follow-up of patients with birdshot retinochoroidopathy treated with corticosteroid-sparing systemic immunomodulatory therapy
Long-term follow-up of patients with birdshot retinochoroidopathy treated with corticosteroid-sparing systemic immunomodulatory therapy
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DOI：
10.1016/j.ophtha.2004.12.036
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发表时间：
2005-06-01
期刊：
影响因子：
13.7
通讯作者：
Foster, CS
中科院分区：
文献类型：
--
作者：
Kiss, S;Ahmed, M;Foster, CS
目的：目的：评价鸟弹状视网膜脉络膜病变（BSRC）患者应用皮质类固醇保留系统免疫调节治疗（IMT）的疗效。设计：回顾性、非比较性、干预性病例系列。参与者：35例BSRC患者，均在1980年至2003年期间在马萨诸塞州眼耳医院眼免疫学和葡萄膜炎服务中心接受评价。从患者病历中记录年龄、性别、随访时间、诊断或转诊延迟、随访前和随访期间的治疗、BSRC或治疗的并发症、Snellen视力（VA）和视网膜电图（ERG）等数据。Snellen VA和系列ERG，BSRC或糖皮质激素的眼部并发症，全身IMT的并发症确定的疾病进展。结果：28例患者，平均随访81.2个月。在转诊前，没有一名患者的炎症得到充分控制。所有患者均在随访期间的某个时间点接受保留皮质类固醇的全身IMT治疗：92.9%接受环孢素治疗，67.9%接受吗替麦考酚酯治疗，17.9%接受硫唑嘌呤治疗，10.7%接受口服甲氨蝶呤治疗，7.1%接受达利珠单抗治疗。BSRC和/或皮质类固醇的眼部并发症为白内障（53.6%）、黄斑囊样水肿（35.7%）、青光眼（21.4%）、视网膜前膜（10.7%）和视网膜脱离（3.6%）。初次访视时的平均Snellen VA为0.64（右眼）和0.59（左眼）。平均最终Snellen VA为0.74（右眼）和0.71（左眼）。（最小分辨率等效角度的对数为-0.23，右眼初始;-0.19，右眼最终;-0.38，左眼初始;和-0.31，左眼最终。）在随访结束时，78.6%的右眼患者和89.3%的左眼患者的VA相同或改善。58.3%的初始ERG和62.5%的最终ERG的30赫兹闪烁隐式时间延长。明亮的暗视振幅异常的初始和最终ERGs.Conclusions的45.5%：长期保存的视觉功能是可以实现的全身皮质类固醇保留IMT与BSRC患者。系统性IMT的及时治疗可能提供维持视网膜功能的最佳希望，这种疾病通常被认为是一种对治疗有抗性的慢性进展性疾病。
Purpose: To evaluate the outcomes of patients with birdshot retinochoroidopathy (BSRC) treated with corticosteroid-sparing systemic immunomodulatory therapy (IMT).Design: Retrospective, noncomparative, interventional case series.Participants: Thirty-five patients with BSRC evaluated at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary from 1980 through 2003.Methods: Data on age, gender, follow-up time, delay to diagnosis or referral, treatment before and during follow-up, complications of BSRC or treatment, Snellen visual acuities (VAs), and electroretinograms (ERGs) were recorded from patient charts.Main Outcome Measures: Disease progression as determined by Snellen VAs and serial ERGs, ocular complications of BSRC or corticosteroids, and complications of systemic IMT.Results: Twenty-eight patients with a mean follow-up of 81.2 months were included. None of the patients had sufficient control of their inflammation before referral. All patients were treated with corticosteroid-sparing systemic IMT at some point during their follow-up: 92.9% were treated with cyclosporine, 67.9% with mycophenolate mofetil, 17.9% with azathioprine, 10.7% with oral methotrexate, and 7.1% with daclizumab. Ocular complications of BSRC and/or corticosteroids were cataract (53.6%), cystoid macular edema (35.7%), glaucoma (21.4%), epiretinal membrane (10.7%), and retinal detachment (3.6%). Average Snellen VAs at the time of initial visit were 0.64 (right eye) and 0.59 (left eye). Average final Snellen VAs were 0.74 (right eye) and 0.71 (left eye). (Logarithm of the minimum angle of resolution equivalents were -0.23, right eye initial; -0.19, right eye final; -0.38, left eye initial; and -0.31, left eye final.) In the right eye, 78.6% of patients and, in the left eye, 89.3% of patients had either the same or improved VA at the end of the follow-up. The 30-hertz flicker implicit time was prolonged in 58.3% of initial ERGs and in 62.5% of final ERGs. The bright scotopic amplitude was abnormal in 45.5% of initial and final ERGs.Conclusions: Long-term preservation of visual function is attainable with systemic corticosteroid-sparing IMT for patients with BSRC. Prompt treatment with systemic IMT may offer the best hope of maintaining retinal function in what is often thought of as a chronically progressive disease resistant to treatment.