Efficacy and Safety of Mycophenolate Mofetil in the Treatment of Recalcitrant Intermediate Uveitis

Purpose: To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in the treatment of recalcitrant intermediate uveitis in a tertiary referral eye-care center over a 1-year period.

Methods: Patients with at least three recurrences of intermediate uveitis per year, defined as relapse of disease after quiescent phase for >3 months after discontinuing all treatments and those with a minimum follow-up of 1 year, were analyzed retrospectively. MMF was initiated with oral steroids and the Standardization of Uveitis Nomenclature guidelines were used to evaluate patients at every visit. Response to treatment, worsening of uveitis, visual benefit, steroid withdrawal rates, and side-effect due to MMF were monitored.

Results: Data from 30 eyes of 19 patients were analyzed, of which 10 were men and 11 has bilateral disease. The mean age of presentation was 32.6 ± 15.4 years and the commonest presenting complaints were floaters (26 eyes). The mean vitreous haze was 3+ at presentation and reduced to 0 at last follow-up (24 eyes). Out of the 30 eyes, 80% had complete resolution of vitreous haze at the end of one year. Worsening intermediate uveitis was seen in six eyes (15.78%). Steroid withdrawal was successful in 85% of eyes. Vision improved in 56% of eyes. None of the patient developed serious systemic complications warranting withdrawal of MMF.

Conclusion: MMF in our series was a safe and effective drug in controlling disease and preventing worsening in majority eyes with the most severe forms of intermediate uveitis. Larger studies are required before MMF is widely adopted for the management of recalcitrant intermediate uveitis.