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Suzanne K. Palafox, Rajiv E. Shah, Peter Y. Chang, C.Stephen Foster; Intravenous Cyclophosphamide for Bilateral Retinal Vasculitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2734.
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Retinal vasculitis is an ocular inflammatory condition that can progress to blindness. Several modes of immunomodulatory therapy (IMT) have been employed in treating patients with retinal vasculitis. For some, therapy has failed to save vision. We report the results of employing intravenous cyclophosphamide as treatment of such individuals suffering from refractory retinal vasculitis.
This is a review of five patients with retinal vasculitis, mostly with unknown etiology (n=3), one associated with HLA-A29, ANA and p-ANCA with anti-MPO positivity and one associated with multiple systemic past infections with IgG West Nile,IgG parvovirusB19, IgG typhi and EBV past infection. These individuals were followed for 2 to 24 months (mean: 10.8 months) from the time cyclophosphamide was commenced. Previous therapy which most of these patients failed or were intolerant to included azathioprine, cyclosporine, infliximab, methotrexate, mycophenolate mofetil and sirolimus. Outcome measures were improvement of Snellen VA by at least two lines and resolution of vasculitis by fluorescein fundus angiography (FFA).
Four of the five patients showed improvement in visual acuity. These four patients also showed resolution of vasculitis by FFA. Two of the four idiopathic retinal vasculitis patients showed improvement in terms of visual acuity: patient#1: FC at 1 foot to 20/50 in the worse eye, patient#2: 20/70 to 20/40 in the worse eye. The remaining two idiopathic retinal vasculitis patients each had worsening in the worse eye by one line. Patient #5 with retinal vasculitis presumably triggered by a microbe had dramatic improvement from FC at 1 foot bilaterally to OD 20/40 and OS 20/20. Patient#4 had worsening vasculitis after 5 months of cyclophosphamide treatment both by visual acuity and by FFA.
Intravenous cyclophosphamide is a "last ditch" treatment option in patients with retinal vasculitis which is progressively worsening despite other aggressive modes of therapy. Our protocol for such therapy will be presented.
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