Purpose

To evaluate the efficacy of combination therapy with mycophenolate mofetil (MMF) and rituximab (RTX) in patients affected by refractory chronic recurrent uveitis associated with Vogt-Koyanagi-Harada (VKH) disease.

Methods

Retrospective case series of patients with refractory chronic recurrent VKH disease associated uveitis treated with combination therapy of MMF and RTX. Patients were treated with oral MMF (2 g daily) and intravenous RTX at a dose of 1000 mg per infusion on days 1 and 15 and then at 6 months. RTX infusion was repeated after at least 6 months in cases of uveitis relapse. All patients underwent complete ophthalmic examination, best-corrected visual acuity (BCVA), laser flare photometry (LFP), fundus photography, subfoveal choroidal thickness (SFCT) measurement on enhanced depth imaging optical-coherence tomography (EDI-OCT), fluorescein and indocyanine green angiography on day 0 and at months 6, 12 and 18.

Results

Four patients, 3 females and 1 male (8 eyes), with a median age of 32.5 ± 8.8 years (range 18-38), were treated with oral MMF (2 g daily) and received a mean of 3.5 RTX intravenous infusions. Mean BCVA improved from 20/25 Snellen equivalent at baseline before treatment to 20/22 Snellen equivalent (p=0.103) at last follow-up. Mean LFP decreased from 22.6 ph/ms (SD=8.9) to 10.1 ph/ms (SD=2.6) (p=0.003), while mean SFCT on EDI-OCT decreased from 469.8 µm (SD=105.1) to 330.6 µm (SD=90.2) (p=0.001). All patients achieved uveitis remission and were able to discontinue corticosteroid treatment. No systemic treatment complications were reported during follow-up.

Conclusions

Combination therapy with MMF and RTX was effective in chronic recurrent uveitis associated with VHK disease, providing corticosteroid-sparing effect along with control of ocular inflammation.