Multifocal Choroiditis (MFC) patients with inflammatory choroidal neovascularization (iCNV) face challenges in visual and treatment outcomes. A recently published study delves into the effectiveness of Immunomodulatory Therapy (IMT) compared to an approach using steroids as needed, shedding light on visual and treatment outcomes. This study was published in the American Journal of Ophthalmology by Matteo Airaldi and colleagues.
Dividing MFC patients into IMT and steroid groups, outcomes were compared over a 2-year follow-up. Parameters included visual acuity (VA), anti-Vascular Endothelial Growth Factor injections (IVIs), and iCNV reactivations. The influence of MFC-related inflammation on iCNV reactivation risk was also examined. Conducted as a multicenter retrospective matched cohort study, the research scrutinized patients with MFC and iCNV. The two groups, IMT and "steroids as needed," were meticulously matched based on the time from diagnosis to the initiation of systemic treatment.
The key findings of the study were:
iCNV Reactivation and IVI Retreatment:
The IMT group displayed a lower relative risk (RR) of iCNV reactivation (RR: 0.64, p = 0.04).
Similarly, the RR of IVI (intravitreal injections) retreatment was reduced in the IMT group (RR: 0.59, p = 0.02).
Relapses and iCNV Reactivation:
Relapses of MFC-related inflammation were independently associated with a higher RR of iCNV reactivation (RR: 1.22, p = 0.003).
Visual Acuity (VA):
Final VA was notably higher in the IMT group compared to "steroids as needed" (mean: 69.1 vs. 77.1 letters, p = 0.01).
IMT demonstrated superior VA gains over time (+2.5 letters/year, p = 0.04).
IMT offers superior outcomes for MFC patients with iCNV compared to "steroids as needed". Tighter control of inflammation is crucial, emphasizing the need for comprehensive management strategies. The study underscores the superiority of IMT over the "steroids as needed" approach in managing iCNV in MFC. Tighter control of inflammation, highlighted by the association between MFC-related inflammation and iCNV reactivations, emerges as a crucial strategy for preventing visual deterioration.
Reference:
Airaldi, M., Monteduro, D., Tondini, G., Pichi, F., De Simone, L., Cornish, E., Casalino, G., Zicarelli, F., Oldani, M., Staurenghi, G., McCluskey, P., Cimino, L., & Invernizzi, A. Immunomodulatory treatment vs. systemic steroids in inflammatory choroidal neovascularization secondary to idiopathic multifocal choroiditis. American Journal of Ophthalmology,2024. https://doi.org/10.1016/j.ajo.2024.01.006