Immunomodulatory Treatment Versus Systemic Steroids in Inflammatory Choroidal Neovascularization Secondary to Idiopathic Multifocal Choroiditis - 16/05/24
Highlights |
• | Many clinicians still favor systemic steroids as needed over immunomodulatory therapy (IMT) for multifocal choroiditis (MFC) with inflammatory choroidal neovascularization (iCNV). |
• | We identified a historic cohort of MFC patients with iCNV treated with IMT and matched it to a comparable cohort treated with steroids. |
• | IMT resulted in fewer iCNV reactivations, fewer anti-VEGF injections, and better visual acuity gains compared to steroids as needed. |
• | Prompt IMT for MFC is more effective than systemic steroids alone in preventing structural and functional damage caused by iCNV. |
Résumé |
PURPOSE |
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.
DESIGN |
Multicenter retrospective matched cohort study.
METHODS |
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.
RESULTS |
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).
CONCLUSIONS |
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.
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Vol 262
P. 62-72 - juin 2024 Retour au numéro
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