April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Immunosuppressive treatment in Sympathetic ophthalmia: long-term visual outcome.
Author Affiliations & Notes
  • Hrarat Linda
    hopital pitie salpetriere, Stains, France
  • Christine Fardeau
    hopital pitie salpetriere, Stains, France
  • Footnotes
    Commercial Relationships Hrarat Linda, None; Christine Fardeau, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 6299. doi:
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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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Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: 746 uveitis-clinical/animal model • 462 clinical (human) or epidemiologic studies: outcomes/complications  
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