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Purpose To evaluate the success of single-agent immunosuppression for patients with the posterior uveitides, birdshot chorioretinitis, multifocal choroiditis with panuveitis, and punctate inner choroiditis. Design Retrospective case series. Methods Setting: Tertiary care uveitis practices. Population: Patients initiated on immunomodulatory therapy. Intervention: Patients were treated with prednisone 1 mg/kg and mycophenolate 2 gm daily. Prednisone was tapered after one month. Immunosuppression was escalated to mycophenolate 3 gm daily, with addition of a second agent, as needed, to achieve treatment success. Outcome Measure: Treatment success, defined as no disease activity with prednisone dose ≥10 mg daily, at 6, 12, and 24 months. Results Twenty-seven patients were followed. Mean presentation and 2-year follow-up acuities were 20/41 and 20/42, respectively. For birdshot chorioretinitis, mean (± standard deviation) quantitative Goldmann visual field scores improved from 761±69° (IV/4 isopter) and 496 ±115° (I/4 isopter) at prese ntation, to 784 ±57° and 564 ±125°, respectively. Prednisone was successfully tapered in 95% of patients; mean prednisone doses at 1 and 2 years were 5.3 ±4.1 and 5.7 ±4.8 mg/day, respectively. At 2 years, prednisone was discontinued in 11% of patients. Treatment success was achieved in 74% of patients on one immunomosuppressant, and an additional 21% of patients on two agents, for an overall 95% success rate at 2 years. Conclusions Posterior uveitides can be treated with one agent in most patients, but the data suggest a need to escalate therapy to higher mycophenolate doses, and in one-fifth of cases add a second agent to maintain disease suppression with acceptably low prednisone doses.

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