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Sarju Patel, Laura V. Echandi, Emilio M. Dodds, Debra A. Goldstein; Induction of Prolonged Drug-free disease remission of Sympathetic Ophthalmia with chlorambucil therapy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5502.
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Sympathetic ophthalmia typically requires long term immunosuppressive therapy. Drug-free remission has been reported with high-dose short-term chlorambucil therapy; however, follow-up was brief and sustained remission remained questionable. This study was conducted to evaluate the effectiveness and long-term safety of chlorambucil in treatment of sympathetic ophthalmia, and its ability to achieve sustained, drug-free remission.
Retrospective review of patients diagnosed with sympathetic ophthalmia and treated with a high-dose short-term chlorambucil protocol from January 1970 to December 2010 at the University of Illinois-Chicago Department of Ophthalmology and Consultores Oftalmologicos, Buenos Aires, Argentina. Descriptive data were collected and presented as proportions and percentages. Bivariate analyses are presented as associations with p-values calculated by Fishers Exact testing.
11 cases of sympathetic ophthalmia treated with short-term, high dose chlorambucil were identified. Cases were treated for an average of 14 weeks (range 13.0-18.4). Mean follow-up was 93.3 (range 58-137) months from initiation of chlorambucil therapy. Control of inflammation was achieved in 100% of patients. 2 patients (22.2%) relapsed after 49 and 122 months, respectively. Both relapses were controlled with topical therapy, additional immunomodulatory therapy was not required. No patients developed systemic malignancies, although 1 patient developed a conjunctival Karposi’s Sarcoma thought to be unrelated to therapy.
High-dose short-duration chlorambucil therapy provides sustained periods of drug-free remission with low rates of recurrence and minimal long-term serious health consequences or adverse events.
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