September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Treatment of serpiginous choroiditis with chlorambucil; efficacy and outcome
Author Affiliations & Notes
  • Nazanin Ebrahimiadib
    Ophthalmology, Massachusetts Eye Research and Surgery Institute, Waltham, Massachusetts, United States
  • Bobeck Modjtahedi
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
  • C. Stephen Foster
    Ophthalmology, Massachusetts Eye Research and Surgery Institute, Waltham, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Nazanin Ebrahimiadib, None; Bobeck Modjtahedi, None; C. Stephen Foster , None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 4512. doi:
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    • Get Citation

      Nazanin Ebrahimiadib, Bobeck Modjtahedi, C. Stephen Foster; Treatment of serpiginous choroiditis with chlorambucil; efficacy and outcome. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4512.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Concerns exist regarding the safety of alkylating agents in the treatment of inflammatory conditions. The safety and efficacy of chlorambucil in the treatment of serpiginous choroiditis was evaluated with a retrospective observational clinical study that examined adverse effects, recurrence, rate of new choroid neovascularization (CNVM), and visual acuity.

Methods : Institutional review board approval was attained for this study protocol. Patient records from the Massachusetts Eye Research and Surgery Institution (MERSI) were reviewed from over the past 10 years. Seventeen patients with serpiginous choroiditis treated with chlorambucil with at least 5 months of follow-up were identified. Quantiferon gold was negative in all patients. Chlorambucil was started at 0.15 mg/kg and dosage titrated up using weekly white blood cell (WBC) count to achieve a target of cell number of 3.0-4.5 x 109 cells/L . The goal of therapy was to maintain this value for 9-12 months. Chlorambucil was stopped if there were any signs of adverse events including rash, subjective side effects, white blood cell (WBC) count below 2.4 x 109 cells/L, platelet count below 125 × 109/L and or abnormalities on liver function tests.

Results : Mean age of patients was 48 years and sixteen patients (42.1%) were male. Mean duration of follow up was 40 months with a mean duration of treatment of 11 months. None of the patients developed cancer or persistent side effects. Twelve patients (70.5%) achieved drug free remission in their last follow up ranging from 7-120 months. Visual acuity remained within 2 lines of snellen acuity in 26 eyes (76.5%), deteriorated in five eyes (14.7%), and improved in three eyes (8.8%). Three patients had disease recurrence 20, 44 and 6 months after completion of therapy. Two patients had to stop treatment after four months, prior to achieving remission, due to low WBC in one patient and fever in the other. Leukopenia was the most common side effect which was reversible in all cases. No patient developed new CNVM while on treatment but one patient with pre-existing CNVM underwent multiple intravitreal anti-VEGF injections while on chlorambucil.

Conclusions : Chlorambucil with escalating dose guided by weekly WBC was well tolerated as well as effective in preventing recurrence and maintaining vision.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

upper image : Treated with methotrexate and prednisone
lower image: Four years after treatment with chlorambucil

upper image : Treated with methotrexate and prednisone
lower image: Four years after treatment with chlorambucil

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