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O. Rozenbaum, B. Bodaghi, N. Cassoux, I. Tostivint, O. Kirsch, C. Fardeau, G. Deray, P. Lehoang; Long–Term Efficacy and Safety of Cyclosporine in Patients With Sight–Threatening Birdshot Retinochoroidopathy : A Single–Centre Follow–Up Study . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1521.
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© ARVO (1962-2015); The Authors (2016-present)
To study the visual outcome of patients with birdshot retinochoroidopathy treated with long–term cyclosporine A (CsA).
Retrospective, noncomparative, interventional case series. Forty–nine patients (98 eyes) with severe birdshot retinochoroidopathy, treated with CsA between 1986 and 2004, with a minimal follow–up of 5 years were included. Medical records were retrospectively reviewed. Data collected included characteristics of the disease before CsA threapy, Snellen visual acuity, fluorescein and ICG angiography findings, Humphrey visual field analyses, dose, treatment duration and side effects of CsA, need for additional medications. Efficacy was evaluated by the improvement of macular edema, retinal vasculitis, papillitis and visual acuity. Tolerance was analyzed by regular measurement of blood pressure, plasma creatinine and creatinine clearance.
All patients had bilateral eye involvement. Mean initial and final CsA dosages were 3.9 mg/kg/day (range 2.2 –5.0) and 1.6 mg/kg/day (range 0.9–2.1) respectively. Macular edema was present before treatment in 89 eyes and at the end of follow–up in 31 eyes (p<0.001). Stabilization or improvement of VA occurred in 81.6% of eyes. CsA was discontinued in 10 patients due to prolonged disease inactivity. For these patients, mean duration of treatment was 8.5 years and fluorescein angiography showed prolonged remission in 8 patients. Follow–up period ranged from 5 to 19 years and twenty patients (40.8%) had more than 10 years of follow–up. Hypertension occurred in 78% of patients after two years but was medically controlled and renal function was significantly altered initially before dose reduction.
Long–term CsA is an alternative to corticosteroid treatment for patients with birdshot retinochoroidopathy. Control of ocular inflammation is achieved in most cases, but nephrologic monitoring is mandatory to avoid severe and irreversible renal impairment.
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