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S. Shulman, V. Menezo, M. Comer, S. Lightman; Outcomes of Chronic Immunosuppression for Chronic Uveitis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2416.
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Purpose: Retrospective evaluation of outcome following immunosuppressive treatment in patients with chronic non-infectious intermediate and posterior uveitis who did not respond to or did not tolerate treatment with corticosteroids alone. Methods: 118 eyes of 63 patients treated with steroids and a second line immunosuppressive agent were reviewed. Results: The mean age of patients was 43.6 years (range 15-76 years). Median visual acuity at the time of commencing second line therapy was 6/18 (range 6/5-LP). The commonest indication for second line immunosuppression was active inflammation (58% of the patients) followed by refractory CME (17%). The most common second line agent used was Cyclosporin in 66.7% of patients, followed by azathioprine (15.9%) .The mean period of time the drug was used was 998.63 days at the time of data collection (range 139-3767 days) . The mean maintenance dose of steroids required to control inflammation prior to starting second line therapy was 16 mg and 9mg once the second line agent was added. 10 patients (15.9%) were able to discontinue the steroid treatment and in 17 patients ( 27% )the steroid dose was reduced to 5mg or less. The mean relapse rate was 1.68 per year for the year before the immunosuppresant drug was introduced (range 0-11) comparing to a mean of 0.75 relapses in the first year after second line introduction and 0.48 relapses during the second year. 16% of eyes demonstrated a improvement of two or more lines of Snellen visual acuity following the introduction of second line therapy, 60% percent of eyes did not demonstrate any change despite the reduction in steroid dose. 24% of the eyes demonstrated visual loss of between 1 and 4 Snellen lines. 27 patients (42.9%) had clinical improvement allowing the dose of the second line agent to be reduced and in 14 patients (22.2%) the immunosuppresant drug could be discontinued. 36 patients (57.1%) had side effects, 19 of those had to reduce the dose due to these side effects and 14 had to discontinue the drug. The most common side effects were abnormal renal/hepatic function in 8 patients, high blood pressure in 8 patients and gastro-intestinal upset in 7 patients. 26 patients ( 41%) required a third agent , the most common indication was persistent inflammation in 14 patients. Conclusion: The addition of immunosuppressive agents improves the outlook for patients with chronic intermediate and posterior uveitis by reducing the amount of corticosteroids required, reducing the relapse rate and the visual acuity may also improve.
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