Zierhut M, Pleyer U, Waetjen R, Thiel H J, Weidle E G
Abteilung I, Universitäts-Augenklinik Tübingen.
Klin Monbl Augenheilkd. 1989 Oct;195(4):221-5. doi: 10.1055/s-2008-1046443.
Chronic recurrent uveitis still responds unsatisfactorily to therapy. Prolactin, a pituitary hormone that attains high blood levels physiologically in stress situations, has an immune modulating effect. The prolactin antagonist bromocriptine (2 x 2.5 mg/day) was administered prophylactically to prevent recurrence in seven patients with chronic iritis/iridocyclitis or panuveitis (Group A). On this therapy two patients suffered a mild recurrence (in one case in the first month). Another patient developed rebound uveitis after discontinuing bromocriptine medication. Tolerance appears to vary considerably, and in three patients the therapy had to be discontinued because of arterial hypotension and congestive rhinopathy, respectively. The three patients in Group B (with iritis, sympathetic ophthalmia, and intermediate uveitis) received bromocriptine in addition to cyclosporin A after plasmapheresis. This combination resulted in an elevated cyclosporin A plasma level, and the dosage was reduced by 30-50% (plasma level 70-120 ng/ml). With this lower dosage of cyclosporin A, the creatinine level of one of the patients returned to normal. Viewed on the basis of these initial results bromocriptine would appear to reduce the number of recurrences of chronic uveitis. Moreover, the synergism with cyclosporin A, described both theoretically and in an animal model in the literature, appears attainable in therapy.
慢性复发性葡萄膜炎的治疗效果仍不尽人意。催乳素是一种垂体激素，在应激状态下生理水平会升高，具有免疫调节作用。对7例慢性虹膜炎/虹膜睫状体炎或全葡萄膜炎患者（A组）预防性给予催乳素拮抗剂溴隐亭（2×2.5mg/天）以预防复发。接受该治疗的2例患者出现轻度复发（1例在第一个月复发）。另1例患者在停用溴隐亭后发生反弹性葡萄膜炎。耐受性似乎差异很大，3例患者分别因动脉低血压和鼻充血而不得不停药。B组的3例患者（患有虹膜炎、交感性眼炎和中间葡萄膜炎）在血浆置换后除接受环孢素A外还接受溴隐亭治疗。这种联合治疗使环孢素A的血浆水平升高，剂量减少了30 - 50%（血浆水平为70 - 120ng/ml）。使用较低剂量的环孢素A后，其中1例患者的肌酐水平恢复正常。基于这些初步结果来看，溴隐亭似乎可以减少慢性葡萄膜炎的复发次数。此外，理论上以及文献中的动物模型均描述过的溴隐亭与环孢素A的协同作用，在治疗中似乎是可以实现的。
