Atmaca L S, Batioğlu F
Vitreoretinal Department, Eye Clinic, Faculty of Medicine, Ankara University, Turkey.
Ophthalmic Surg. 1994 May;25(5):321-7.
We used cyclosporin A (CA) to treat 14 patients (25 eyes) with Behçet's disease characterized by severe retinal vasculitis and active intraocular inflammation. All of the patients had been treated previously with corticosteroids, colchicine, and immunosuppressives, without satisfactory results. The patients were given an initial oral dose of 5 mg/kg/day. All medication was tapered and eventually completely stopped after 12 months. The number and severity of ocular attacks (anterior and/or posterior uveitis with vitreous haze) were significantly reduced below pretreatment levels during therapy (Kolmogorov Smirnov two-pair test: P < .05). Visual acuity improved in 32% and remained unchanged in 44%. No ocular attacks recurred in 11 eyes; they recurred 1 time in 8 eyes; 2 times in 3 eyes; and 3 times in 3 eyes during CA therapy. There were no significant changes in the level of retinal vasculitis. In two cases with vaso-obstructive changes, treatment with CA was not effective and laser photocoagulation was performed. Based on our study, we recommend that an initial dose of 5 mg/kg/day CA be used in the systemic medical treatment of ocular Behçet's disease. The CA can be continued at this low dosage for an unspecified time. If intraocular inflammation does not totally resolve at this dosage or the inflammatory process recurs, combining the CA with low doses of a steroid should be considered.
我们使用环孢素A（CA）治疗14例（25只眼）以严重视网膜血管炎和活动性眼内炎症为特征的白塞病患者。所有患者此前均接受过皮质类固醇、秋水仙碱和免疫抑制剂治疗，但效果不佳。患者初始口服剂量为5mg/kg/天。所有药物逐渐减量，最终在12个月后完全停用。治疗期间，眼部发作（伴有玻璃体混浊的前葡萄膜炎和/或后葡萄膜炎）的次数和严重程度显著低于治疗前水平（柯尔莫哥洛夫-斯米尔诺夫双样本检验：P <.05）。32%的患者视力提高，44%的患者视力保持不变。CA治疗期间，11只眼未再出现眼部发作；8只眼复发1次；3只眼复发2次；3只眼复发3次。视网膜血管炎程度无显著变化。在2例出现血管阻塞性改变的患者中，CA治疗无效，遂行激光光凝治疗。基于我们的研究，我们建议在眼部白塞病的全身药物治疗中，初始剂量使用5mg/kg/天的CA。CA可在此低剂量下持续使用一段时间，具体时长未明确。如果在此剂量下眼内炎症未完全消退或炎症过程复发，应考虑将CA与低剂量类固醇联合使用。
