Cystoid Macular Edema in birdshot retinochoroïditis: long-term treatment study in 142 patients

To assess the long-term efficacy and safety of treatments for cystoid macular edema (CME) in birdshot retinochoroïditis (BRC) Observational retrospective study of 142 HLA-A29 positive patients with CME; the main outcome was the optical coherence tomography intra-retinal cysts change. During the mean follow up of 75 months [12-178], 61.3% patients were successfully treated using 1 to 3 treatment steps, the others needed more steps. At 6 months there were no significant effects on ME for anti-TNF (tumor necrosis factor) and IVIg (immunoglogulin) in contrast to antimetabolites (OR 1.98), systemic GCS (glucocorticosteroids), CsA (ciclosporineA) and TCZ (tocilizumab) (OR closed to 2.7), intraocular injected GCS (OR of 4.2) and IFN interferon (OR of 4.4). Compared to the 3 first steps of treatment, percentages of success trend to decline in the following steps, for systemic GCS (84% to 70%), anti-TNF (42% to 33%), and CsA (71% to 33%) while did not decrease for injected GCS (83% to 89%). ME recurrence occurred with the highest percentage for injected GCS (86.8%, p=0.01) and the lowest for TCZ (10.5%, p=0.001). IFN-α and TCZ were associated with the lowest prednisone daily dose. The classical uveitic CME therapeutic algorithm could be adapted to BRC.