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R. A. Cervantes-Castaneda, P. V. Bhat, N. Huynh, T. Yilmaz, C. S. Foster; The Role of Azathioprine in the Treatment of Ocular Inflammatory Disease: A Six Month Follow-Up Analysis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5822.
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The purpose of this study is to evaluate the use of azathioprine in the current management of various ocular inflammatory conditions
The charts of patients diagnosed with ocular inflammatory disease and treated with azathioprine were identified and reviewed after obtaining Institutional Review Board approval. Thirty patients who had at least 6 months follow-up data were included in this study. Data collected included age, gender, ocular diagnosis, best-corrected visual acuities, and grade of inflammation. Anterior chamber cells and flare and vitritis were graded between 0 and 4 in 0.5 gradations, with 0.5 or less considered inactive. Inflammation of the retina and choroid was documented by the presence of retinal vasculitis, cystoid macula edema, chorioretinitis, or papillitis. A flare-up was defined as an increase in cellular activity by 1+ cell or more. Inflammation score was calculated according to the cell score (1+ to 4+) in the anterior chamber and vitreous. Corticosteroid sparing effect was defined as control of inflammation off topical /systemic corticosteroids and on immunomodulatory therapy
The mean age of our group of patients was 47±19 years (range 13-70). Eighteen patients were female and 26 were Caucasian. Ocular diagnoses included: scleritis, intermediate uveitis, juvenile idiopathic uveitis, ocular cicatricial pemphigoid, anterior uveitis, panuveitis, and others. Nineteen patients received azathioprine as mono therapy while twelve patients received it as combination therapy with another immunomodulatory medication. Baseline inflammation score was 0.81 and at 6 moths follow up was 0.16, this difference was statistically significant (p=0.0003). Corticosteroid sparing effect was obtained in 29 patients. Visual acuity improved in both eyes at 6 months follow-up but this change was not statistically significant (p=0.23 for OD and p=0.06 OS). Adverse effects included anemia, diarrhea, fatigue, transient leucopenia, transient liver enzyme elevation and nausea. Twelve patients reported no adverse effect.
Azathioprine is a useful drug for the control of ocular inflammatory disease, is well tolerated and has a corticosteroid-sparing effect in a six month follow up period.
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