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Green MB, Butler NJ. Topical and Subcutaneous Interferon-Alpha for the Treatment of Refractory Inflammatory Macular Edema. Ocul Immunol Inflamm 2024:1-7. [PMID: 39012757 DOI: 10.1080/09273948.2024.2374439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 06/25/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE To evaluate the efficacy of topical interferon alpha-2b (tIFN a2b) and subcutaneous pegylated interferon alpha-2a (peg-IFN a2a) in the treatment of refractory pseudophakic (PME) and uveitic (UME) macular edema. METHODS Retrospective case series of patients with PME or UME that was non-responsive to conventional therapies. Topical IFN a2b drops (1 MIU/ml) were commenced four times a day. Non-responders were offered treatment with subcutaneous peg-IFN a2a starting at 180 mcg weekly. RESULTS Seven eyes of seven patients (three UME and four PME) were treated with tIFN a2b. Three eyes had complete ME resolution with tIFN treatment after a mean of 2.66 weeks (range 1-4 weeks) and no recurrence after a mean total course of 11.33 weeks (range 5-20 weeks). Two cases (both PME) had partial responses to tIFN treatment and two cases (both UME) failed to respond. Of the four eyes that incompletely responded to tIFN (treatment range 6 weeks to 4 months), three were treated with peg-IFN a2a, which invariably led to complete and sustained ME resolution. Adverse effects from topical treatment were mild and consisted mainly of superficial irritation. Adverse effects of subcutaneous treatment included nausea, vomiting, anorexia, and leukopenia, though none limited treatment. CONCLUSIONS Topical IFNa-2b appears safe and effective in isolation or in conjunction with topical steroids for the treatment of inflammatory macular edema (IME) in about half of patients in our small series. All partial and non-responders had complete disease resolution with systemic IFN. Topical IFN a2b should be considered in patients with refractory IME.
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Affiliation(s)
- Michael B Green
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts, USA
- Department of Ophthalmology, VA Boston Health Care System Jamaica Plain Campus, Boston, Massachusetts, USA
| | - Nicholas J Butler
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts, USA
- Department of Ophthalmology, VA Boston Health Care System Jamaica Plain Campus, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Afarid M, Azimi A, Meshksar A, Sanie-Jahromi F. Interferons in vitreoretinal diseases; a review on their clinical application, and mechanism of action. Int Ophthalmol 2024; 44:223. [PMID: 38727788 DOI: 10.1007/s10792-024-03144-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/11/2024] [Indexed: 07/12/2024]
Abstract
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.
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Affiliation(s)
- Mehrdad Afarid
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran
| | - Ali Azimi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran
| | - Aidin Meshksar
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran
| | - Fatemeh Sanie-Jahromi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran.
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Huang L, Flaxel C, Suhler E, Lin P. Two Cases of Chronic Central Serous Chorioretinopathy Successfully Treated with Systemic Interferon Alpha. Ocul Immunol Inflamm 2023:1-10. [PMID: 37450492 PMCID: PMC10787811 DOI: 10.1080/09273948.2023.2226206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
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.
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Affiliation(s)
- Lingling Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Christina Flaxel
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric Suhler
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Ophthalmology, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Kawali A, Patil A, Mishra SB, Mahendradas P, Shetty R. Choroidal Involvement and Chronic Macular Edema in Acute Retinal Necrosis: A Novel Finding and a Novel Treatment. Ocul Immunol Inflamm 2023:1-5. [PMID: 37339500 DOI: 10.1080/09273948.2023.2220785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/05/2023] [Accepted: 05/29/2023] [Indexed: 06/22/2023]
Abstract
Acute retinal necrosis (ARN) as the term suggests is recognized as necrotic inflammation of retina, in contrast to toxoplasma retinochoroiditis where involvement of choroid can be appreciated as choroidal thickening on optical coherence tomography scan during active stage. Secondly, sequelae of ARN, such as chronic anterior uveitis and cystoid macular edema, could be challenging to manage as steroid use in various forms poses a risk of virus reactivation. We present a case of ARN caused by varicella zoster virus with an initial confusing clinical picture with toxoplasma retinochoroiditis, documented with choroidal involvement. The patient also developed a chronic anterior uveitis with macular edema after resolution of ARN which was treated with topical interferon (IFN) alfa 2b therapy with successful outcome. This report supports the recently described choroidal involvement in ARN and suggests topical IFN as a novel treatment in management of chronic macular edema post ARN.
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Affiliation(s)
- Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Aditya Patil
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Sai Bhakti Mishra
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | | | - Rohit Shetty
- Department of Refractive Surgery, Narayana Nethralaya, Bangalore, India
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Faghihi H, Inanloo B, Mirzaee A, Fadakar K, Mirshahi A, Ebrahimiadib N, Ghassemi F, Bazvand F, Amini A, Mirghorbani M, Faghihi S, Khalili Pour E, Riazi-Esfahani H. Evaluation of the additive effect of interferon α 2b with monthly intravitreal injection of bevacizumab in refractory diabetic macular edema. Int J Retina Vitreous 2022; 8:74. [PMID: 36224669 PMCID: PMC9558405 DOI: 10.1186/s40942-022-00424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background To evaluate the additive effect of topical or sub-tenon injection of interferon (IFN)-α 2b in the treatment of refractory diabetic macular edema. Methods In this prospective study patients with center-involved DME who were unresponsive to 3 monthly consecutive IVB injections were recruited. Patients were divided into three groups: group1, received IFN- α 2b topical drop at a dose of 1mIU/ml four times a day for 3 months. Group 2, received a single sub-tenon injection of 1mIU/ml IFN- α 2b at the enrollment. Group 3 received artificial tears four times a day for 3 months (control group). All groups received three consecutive monthly IVB injections and were evaluated monthly up to 1 month following the last IVB injection. Results In this study, 59 eyes of 35 patients with refractory DME were assessed. The final follow-up showed that although CMT decreased in all groups, only patients in Group 2 had statistically significant lower CMT compared to their baseline values (change in CMT: − 117 ± 213 µm; p-value = 0.025). Comparison of CMT changes between three groups showed no statistically significant difference, although it was higher in group 2 (change in CMT: − 117 ± 213 µm (Group2) vs. − 49 ± 173 (Group 1) vs. − 36 ± 86 (Group 3); p-value = 0.085). Considering eyes with baseline CMT > 400 µm, sub-tenon injection of IFN α2b led to a significant reduction of CMT at the first month and final follow-up visit (CMT change: − 166 ± 210, − 145 ± 231 µm; p-value = 0.018 and 0.035, respectively). In this subgroup, eyes in Group 2 had lower CMT at the first month following treatment in comparison with the control group (CMT: 444 ± 123 µm vs. 544 ± 96 µm, p-value = 0.042). Alterations of CDVA were not statistically significant among groups, although patients in Group 1 had a significant improvement in vision at second and last follow up (CDVA change: − 0.23 ± 0.39, − 0.20 ± 0.43 logMAR; p-value = 0.030 and 0.010, respectively). Conclusions In short term, Sub-tenon injection of IFN might have an additive anatomical effect in eyes with refractory DME. Validation of this observation requires further prospective controlled studies.
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Affiliation(s)
- Hooshang Faghihi
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Bahman Inanloo
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Arash Mirzaee
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Kaveh Fadakar
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Ahmad Mirshahi
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Nazanin Ebrahimiadib
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Fariba Ghassemi
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Fatemeh Bazvand
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Abdulrahman Amini
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Masoud Mirghorbani
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Shahin Faghihi
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Elias Khalili Pour
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran
| | - Hamid Riazi-Esfahani
- Retina Service, Farabi Eye Hospital, Tehran University Of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, 1336616351, Iran.
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