Ophthalmology Department, Reference Center for Rare Diseases, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, Sorbonne University, 75013, Paris, France.
Ophthalmology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Eye (Lond). 2022 Nov;36(11):2144-2150. doi: 10.1038/s41433-021-01829-y. Epub 2021 Oct 30.
A non-interventional, longitudinal, retrospective follow-up study to assess CsA-induced nephrotoxicity (IN) and its reversibility after withdrawal in patients exhibiting a bilateral chronic posterior uveitis (CPU) associated with cystoid macular oedema (CMO) in at least one eye. Data from medical records between 1986 and 2013.
Primary outcome was the renal tolerance during and after CsA treatment assessed by plasma creatinine concentration and glomerular filtration rate (GFR) estimated by Chronic Kidney Disease Epidemiology (CKD-Epi) formula. Secondary outcomes were CsA through concentration, occurrence of cancers and ophthalmologic efficacy assessed by three parameters including CMO, vitreous inflammation, and best-corrected visual acuity BVCA changes.
One hundred forty-three patients were followed for renal tolerance. Underlying diseases were Birdshot retinochoroiditis (n = 67), Behçet disease (n = 9), probable sarcoidosis (n = 23), sympathetic ophthalmia (n = 3), idiopathic (n = 41). After CsA discontinuation in 115 patients (mean treatment duration of 5.9 ± 3.8 years) mean plasma creatinine concentration was 82.2 ± 14.2 µmol/L versus 82.1 ± 14.1 µmol/L at baseline, mean GFR was 79.4 ± 13.9 mL/min versus 82.5 ± 14.3 mL/min at baseline, with no significant difference (respectively p = 0.91 and p = 0.09). Blood pressure did not significantly change during follow-up. CMO was completely resorbed in at least one eye, in 70.8% patients (n = 72) at 6 months, in 71.4% patients (n = 49) at 10 years and in 54.2% patients (n = 24) at 20 years. BCVA did not statistically change over time.
Early and long-term monitoring of renal tolerance and dual adjustment of CsA doses in inflammatory stages of CPU were associated with reversible CsA IN. CsA could be effective in the treatment of CMO in CPU patients.
一项非介入性、纵向、回顾性随访研究，旨在评估 CsA 诱导的肾毒性（IN）及其在至少一只眼存在双侧慢性后部葡萄膜炎（CPU）伴囊样黄斑水肿（CMO）的患者中停用后逆转的情况。数据来自 1986 年至 2013 年的病历。
主要结局是通过血浆肌酐浓度和慢性肾脏病流行病学（CKD-Epi）公式估计的肾小球滤过率（GFR）评估 CsA 治疗期间和治疗后的肾脏耐受性。次要结局是通过 CMO、玻璃体炎症和最佳矫正视力 BVCA 变化的三个参数评估 CsA 浓度、癌症发生和眼科疗效。
143 例患者接受了肾脏耐受性随访。基础疾病为鸟枪样视网膜脉络膜炎（n=67）、贝切特病（n=9）、疑似结节病（n=23）、交感性眼炎（n=3）、特发性（n=41）。在 115 例患者（平均治疗时间为 5.9±3.8 年）停用 CsA 后，平均血浆肌酐浓度为 82.2±14.2µmol/L，与基线时的 82.1±14.1µmol/L 相比，平均 GFR 为 79.4±13.9mL/min，与基线时的 82.5±14.3mL/min 相比，无显著差异（分别为 p=0.91 和 p=0.09）。随访期间血压无明显变化。CMO 在至少一只眼中完全吸收，6 个月时为 70.8%（n=72），10 年时为 71.4%（n=49），20 年时为 54.2%（n=24）。BCVA 随时间无统计学变化。
早期和长期监测 CPU 炎症期的肾脏耐受性和 CsA 剂量的双重调整与可逆性 CsA IN 相关。CsA 可能对 CPU 患者的 CMO 治疗有效。
