RESUMEN
PURPOSE: To evaluate the effectiveness of tacrolimus in patients with noninfectious intermediate, posterior, or panuveitis needing a two-immunosuppressive-agent regimen. METHODS: Design: Retrospective cohort study. Setting: Two tertiary-care uveitis practices at academic medical centers. Patient population: Thirty-two patients with noninfectious intermediate, posterior, or panuveitides in whom single-agent immunosuppression was inadequate to effect successful corticosteroid sparing. Intervention: tacrolimus, added as the second immunosuppressive agent. Main outcome measure: successful corticosteroid sparing, defined as inactive uveitis at a dose of prednisone ≤7.5 mg/day. RESULTS: Active uveitis was present in 65.6% of patients at initiation of tacrolimus, and the median time to inactive uveitis was 1.5 months (95% confidence interval 1.2, 4.08). The median time to successful corticosteroid sparing was 3.9 months (95% confidence interval 1.41, 6.67), and by 6 months of follow-up successful corticosteroid sparing was achieved in 75% of patients. Tacrolimus was discontinued for side effects in five patients, three for tremor, and two for hyperglycemia. All side effects were reversible with tacrolimus discontinuation. CONCLUSION: Tacrolimus seems to have efficacy as a second immunosuppressive agent in two-immunosuppressive drug regimens, when a single agent does not permit successful corticosteroid sparing. Side effects were reversible with tacrolimus discontinuation.
Asunto(s)
Panuveítis , Uveítis , Humanos , Tacrolimus/uso terapéutico , Estudios Retrospectivos , Panuveítis/tratamiento farmacológico , Uveítis/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Terapia de Inmunosupresión , Resultado del TratamientoRESUMEN
AIMS: To compare anti-vascular endothelial growth factor (VEGF) treatment outcomes for macular oedema (ME) secondary to retinal vein occlusion (RVO) based on vitreoretinal interface (VRI) status. METHODS: This retrospective case series includes treatment-naive eyes diagnosed with RVO and treated with anti-VEGF injections. Eyes were stratified based on international VRI classification schema at baseline into three groups-vitreomacular traction (group A), no posterior vitreous detachment (PVD) (group B) and PVD without vitreomacular attachment (group C). Fifty-two eyes were identified based on inclusion/exclusion criteria. The primary endpoint was change in central subfield thickness (CST) on optical coherence tomography at 6â months. RESULTS: There were no statistically significant differences in baseline characteristics of patients with RVO when stratified by VRI subgroups. After 6â months of treatment, there was no statistically significant difference in the change in CST from baseline between VRI cohorts (p=0.11). There was a trend demonstrating the greatest improvement in CST in eyes in group A compared with eyes in groups B and C (-224.13â µm, -160.88â µm and -50.92â µm, respectively, p=0.11 between cohorts). Mean change in logarithm of the minimum angle of resolution visual acuity from baseline to month 6 in group A compared with groups B and C was -0.25, -0.14 and -0.13, respectively (p=0.64 between cohorts). CONCLUSIONS: We did not identify an association between VRI status and treatment outcomes with anti-VEGF agents for ME secondary to RVO.