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Hrarat Linda, Christine Fardeau, ; Immunosuppressive treatment in Sympathetic ophthalmia: long-term visual outcome.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6299.
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The sympathetic ophthalmia (OS ) is a chronic bilateral recurrent granulomatous pan uveitis following a traumatic or surgical transfixing wound.The aim of the study is to retrospectively evaluate the long-term visual outcome on various immunosuppressants (IS) used in the OS management.
Analytical monocentric retrospective epidemiological study from February 1999 to July 2013 performed in Pitié Salpêtrière Hospital.The OS was diagnosed on bilateral granulomatous uveitis occurring after a context of penetrating trauma with wide autoimmune and infectious record negative.At admission all patients are treated with methylprednisolone bolus followed by an initial bone per relay to 1mg/kg, then tapering to a prednisone dose of 20mg by day before IS therapy starting. Four phases have been identified for the collection of various parameters :admission time, one month later, under 20mg/d of prednisone, at 1 and 3 years under various IS treatments.The primary endpoint is a criterion combining cellular vitreous decrease of 2 mark with steroid dose sparing effect.
10 eyes with OS were included,6 men and 4 women, 8 secondary to iterative surgical treatments and 2 secondary to accidental trauma.The time to onset of the OS was an average of 19 months (2-60 ).After admission time the IS were : Interferon alpha2a (1 year n = 6 ,3 years n = 1), Azathioprine (1 year n = 6 and 3 years n = 3), Mycophenolate mophetyl (1year n = 2), Methotrexate (1 year n = 1),3 eyes were enucleated late. Evaluation of the primary endpoint:at 1 month after the steroid bolus, success in 5 eyes of 9 (55%), under 20 mg/d of prednisone success in 4 eyes on 9 (44%), at 1 year under IS success of 11 eyes : 4 with Azathioprine (66%), 6 with Interferon (100 %), 1 with Mycophenolate mophetyl (50%), and no success with Methotrexate.The mean steroid sparing was 12mg under Interferon, 18mg under Azathioprine, 20mg under Mycophenolate mophetyl .At 3 years under IS success on 4 eyes (N = 1 in Interferon and N = 3 in Azathioprine ) and the mean steroid sparing was 7mg under Azathioprine and 5 mg under Interferon.At the end of the study 5 eyes are under IS for less than 3 years and 1 eye is phtysic following tuberculous infection.
During the study immunosuppressive combination therapy became necessary in the long term . Interferon alpha2a and Azathioprine appeared most effective in controlling the disease and steroid sparing effect.
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