Interferon Alpha for the Treatment of Cystoid Macular Edema Associated with Presumed Ocular Tuberculosis

Effectiveness of Pegylated Interferon Alpha-2a in Post-Uveitic Macular Edema Previously Responding to Non-Pegylated Interferon

PURPOSE

To evaluate the efficacy of pegylated interferon (PEG-IFN) alpha-2a to treat post-uveitic relapsing macular edema (ME) after withdrawal of non-PEG IFN alpha-2a or 2b to maintain treatment efficacy.

METHODS

This retrospective study investigated subjects with post-uveitic ME who received weekly subcutaneous PEG-IFN alpha-2a injections. Comparisons between baseline central macular thickness (CMT) and best-corrected visual acuity (BCVA) and those at all follow-up visits were made.

RESULTS

Six patients (nine eyes) were treated and followed up for six months. CMT (mean [standard deviation]) decreased from 375[117] to 283[39] μm after one month (p < 0.001), remaining significantly lower up to the final follow-up visit at six months (275[38] μm, p = 0.008), and BCVA (0.21[0.16] logMAR at baseline) showed an improvement of 0.12[0.11] logMAR (p = 0.026) at six months. Neither recurrences nor any serious adverse events were recorded.

CONCLUSIONS

Post-uveitic ME patients were effectively and safely treated with PEG-IFN alpha-2a.

Interferons in vitreoretinal diseases; a review on their clinical application, and mechanism of action

PURPOSE

This review investigates the therapeutic benefits of interferons (IFNs) in vitreoretinal diseases, focusing on their regulatory roles in innate immunological reactions and angiogenesis. The study aims to categorize the clinical outcomes of IFN applications and proposes a molecular mechanism underlying their action.

METHODS

A systematic review was conducted using MEDLINE/PubMed, Web of Science, EMBASE, and Google Scholar databases to identify randomized clinical trials, case series, and case-control studies related to IFNs' impact on vitreoretinal diseases (1990-2022). The data synthesis involved an in-depth analysis of the anti-inflammatory and anti-angiogenesis effects of IFNs across various studies.

RESULTS

Our findings indicate that IFNs exhibit efficacy in treating inflammation-associated vitreoretinal disorders. However, a lack of sufficient evidence exists regarding the suitability of IFNs in angiogenesis-associated vitreoretinal diseases like choroidal neovascularization and diabetic retinopathies. The synthesis of data suggests that IFNs may not be optimal for managing advanced stages of angiogenesis-associated disorders.

CONCLUSION

While IFNs emerge as promising therapeutic candidates for inflammation-related vitreoretinal diseases, caution is warranted in their application for angiogenesis-associated disorders, especially in advanced stages. Further research is needed to elucidate the nuanced molecular pathways of IFN action, guiding their targeted use in specific vitreoretinal conditions.

The Role of Corticosteroids and Immunomodulatory Therapy in the Management of Infectious Uveitis

PURPOSE

The index review aims to provide an update on the role of corticosteroids and steroid-sparing immunomodulatory therapy (IMT) in managing patients with infectious uveitis.

METHOD

Narrative literature review.

RESULTS

Corticosteroids and immunomodulatory therapy (IMT) focus on the host defense system instead of the pathogen, adjusting exaggerated inflammatory reactions to reduce potential harm to ocular tissues. Systemic or local corticosteroids are primarily selected as adjunctive medication for infectious uveitis. Concomitant corticosteroids have also been used in cases of paradoxical worsening in ocular tuberculosis and immune recovery uveitis in cytomegalovirus (CMV) retinitis. While there is no well-established evidence to support the use of IMT in infectious uveitis, it is occasionally used in clinical settings to treat persistent inflammation following resolution of infection such as cases of ocular tuberculosis and ocular syphilis where an insufficient response is observed with corticosteroids.

CONCLUSION

There is no consensus on the position of immunomodulatory therapy in the management of infectious uveitis with different etiologies. The index review provides an overview of available adjunctive corticosteroids and IMT options to assist clinicians in managing such disease entities more efficiently.

Two Cases of Chronic Central Serous Chorioretinopathy Successfully Treated with Systemic Interferon Alpha

Chronic central serous chorioretinopathy (CSCR) is a sight threatening disease that can lead to legal blindness. Verteporfin photodynamic therapy is the main treatment for chronic CSCR, however, there has been a critical worldwide shortage of verteporfin. Other medical treatments have been attempted with variable efficacy. Interferons have shown efficacy in treating uveitis and associated macular edema. We report 2 cases of treatment refractory chronic CSCR successfully treated with subcutaneous injection of interferon alpha with significant anatomical and functional improvement. To our knowledge, this is the first report observing the therapeutic potential of systemic interferon alpha in the treatment of chronic CSCR. A large randomized controlled clinical trial would help to better evaluate the safety and efficacy of systemic PEG-IFNα2a in treating chronic CSCR, and further define the optimal dose, treatment interval and duration.

Interferon Alpha-2a for the Treatment of Cystoid Macular Edema Secondary to Acute Retinal Necrosis

PURPOSE

To report the results of interferon (IFN) α-2a treatment in patients with cystoid macular edema (CME) secondary to acute retinal necrosis (ARN).

METHODS

We reviewed the records of seven patients (eight eyes) who received IFNα-2a for post-ARN CME. The initial dose of IFNα-2a was 3 MIU/day and it could be tapered down to 3 MIU twice a week. Efficacy was assessed by central macular thickness (CMT) on spectral-domain optical coherence tomography and visual acuity.

RESULTS

Age range of seven patients (four men, three women) was 36-74 years. Mean CMT decreased from 477.9 ± 167.5 μm to 367.3 ± 120.5 μm at first week, and vision improved up to five lines in five eyes. CME relapsed after cessation of IFNα-2a in all and improved following reinstitution of treatment. Treatment was discontinued in one patient because of depression. Three patients electively discontinued treatment due to poor tolerability or lack of functional improvement.

CONCLUSION

IFNα-2a is an effective therapeutic option for post-ARN CME, though side effects such as fatigue, elevated liver enzymes, neutropenia, and depression may limit tolerability. Lower initial doses may be a better tolerated.

BTS clinical statement for the diagnosis and management of ocular tuberculosis

The BTS clinical statement for the diagnosis and management of ocular tuberculosis (TB) draws on the expertise of both TB and and ophthalmic specialists to outline the current understanding of disease pathogenesis, diagnosis and management in adults. Published literature lacks high-quality evidence to inform clinical practice and there is also a paucity of data from animal models to elucidate mechanisms of disease. However, in order to improve and standardise patient care, this statement provides consensus points with the currently available data and agreed best practice.

Medical Therapy of Uveitic Macular Edema: Biologic Agents

Introduction: Uveitic macular edema (UME) is a significant cause of visual impairment in all uveitis types. Methods: Reports that were cited in the MEDLINE database, that analyzed the effectiveness of biologics for UME in at least five patients, with a minimum follow-up of 3 months, published prior to April 1, 2019 were included. Reports that did not compare UME findings before and after the therapy, using either OCT or fluorescein angiography, were excluded. Results: Case series that analyzed the efficacy of intravitreal anti-VEGF agents showed modest, short-term benefit. Studies that investigated systemic anti-TNF agents in patients with noninfectious uveitis reported a therapeutic effect on UME. Anti-IL-6 antibodies have shown promising results for most severe cases of noninfectious UME. Interferon represents an option for patients with persistent UME in infectious and noninfectious uveitis. Conclusion: Multicenter, randomized controlled trials are needed to assess the effectiveness of each group of biologic agents in sufficient number of patients.

Efficacy and Safety of Interferon Alpha 2A and Pegylated Interferon Alpha 2A in Inflammatory Macular Edema

Purpose: The aim of this study was to further explore the efficacy and safety of interferon-α in refractory non-infectious inflammatory macular edema and to compare interferon-α2a and pegylated interferon-α2b.Methods: 34 patients with refractory non-infectious uveitic macular edemaunder interferon-α were retrospectively reviewed.Results: Mean baseline best-corrected visual acuityimproved from 0.55 logMar to 0.37 logMAR (P < 0.001) at month (M) 1 and 0.40 logMAR (P < 0.001) at M6. The mean baseline CMT decreased from 554 µm to 367 µm (P < 0.001) at M1 and 394 µm (P < 0.001) at M6. Clinical adverse effects (AEs) were observed in a third of patients, leading to treatment discontinuation because of frequent mild AEs and few severe AE. No statistically significant difference was found between both molecules.Conclusions: Anatomically and functionally, interferon-α was rapidly effective despite a low dosage regimen and no difference in efficacy and tolerance was observed between interferon-α2a and pegylated interferon-α2b.

The Results of Interferon-Alpha Treatment in Behçet Uveitis

Purpose: To assess the efficacy and tolerability of interferon alpha (IFN-α) treatment in patients with refractory Behçet uveitis (BU).Methods: The patients with BU who were treated with subcutaneous IFN-α were divided into groups according to treatment response. Demographic features, best corrected visual acuity (BCVA), central macular thickness (CMT) value, and fluorescein angiography (FA) scores were compared between the groups.Results: Twenty-one (84%) of the 25 patients responded to IFN-α treatment. Active inflammation resolved at the first month's visit in all patients. The improvement in mean BCVA and CMT achieved at the first month's visit in all groups; however, the improvement in mean CMT in the non-responder group could not be maintained at the last visit. Main FA score significantly decreased in both the complete and partial remission group; however, it decreased minimally in the non-responder group.Conclusion: IFN-α seems an effective and safe treatment option in the management of refractory BU.

Interferon Alpha 2a and 2b in Ophthalmology: A Review

Interferon alpha (IFN-α) is a glycoprotein with antitumor, antiviral, and immunomodulatory activity, used widely in the treatment of viral infections (hepatitis B and C, condylomata acuminata, herpes zoster, etc.), hematological disorders (leukemia, multiple myeloma, T cell lymphoma, and essential thrombocythemia), and solid tumors (clear cell carcinoma in the metastatic stage, melanoma, hepatocellular carcinoma, and cervical neoplasia). Studies have proven the effectiveness of IFN-α in the treatment of ophthalmic disorders involving the anterior segment of the eye (conjunctival papilloma, squamous neoplasia, conjunctival mucosa-associated lymphoid tissue, Mooren's ulcer, and vernal keratoconjunctivitis) and the posterior segment of the eye (serpiginous choroidopathy, posterior uveitis, pseudophakic and diabetic cystoid macular edema, and proliferative diabetic retinopathy). The therapy with IFN-α remains a promising alternative in cases of a failing response to conventional therapy, helping to maintain or improve visual acuity, prevent vision loss, and ameliorate the prognosis of the patient. However, clinicians who decide to use IFN-α in their patients must be aware of general and ophthalmological side effects and inform their patients to undergo a systemic evaluation such as a physical examination, blood and serological tests, and a chest X-ray before the beginning of treatment. This review presents the current knowledge of the use of IFN-α, its efficacy, and properties in ophthalmological diseases, and thus may encourage clinicians to administer this drug as a treatment modality in ophthalmological diseases in the future.

Infectious uveitis: an Asian perspective

Several intraocular infections can present with protean manifestations posing major diagnostic and management challenges. Infections such as tuberculosis, dengue and chikungunya fever have continued to remain major endemic diseases that are associated with uveitis in the Asia Pacific region. These entities often require a high index of clinical suspicion and laboratory analysis including assays of ocular fluids and/or tissues for confirmation of the diagnosis. Infectious uveitis caused by tuberculosis, dengue and chikungunya can present with characteristic clinical features and imaging findings on ancillary investigations; that may provide clue to the early diagnosis. Use of modern imaging modalities such as enhanced-depth imaging optical coherence tomography, optical coherence tomography angiography and ultra-wide field fundus photography greatly aid in the evaluation of these conditions. In the current review, we have discussed the epidemiology, clinical phenotypes, imaging characteristics, diagnosis and management of uveitis caused by tuberculosis, dengue and chikungunya.