Vitale A T, Rodriguez A, Foster C S
Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard University Medical School, Boston, 02114, USA.
Ophthalmology. 1996 Mar;103(3):365-73; discussion 373-4. doi: 10.1016/s0161-6420(96)30683-0.
To describe the authors' approach to the management of patients with recalcitrant, chronic, endogenous uveitis using low-dose Cyclosporin A (CSA) alone or in combination with other immunosuppressive agents with attention to the anti-inflammatory efficacy, visual outcome, and side effects of therapy.
The authors reviewed the records of 50 patients (92 eyes) with uveitis of various etiologies who had been treated with low-dose CSA (2.5-5.0 mg/kg daily) alone or in combination with prednisone and/or azathioprine (1.5-2.0 mg/kg daily). The median follow-up on low-dose CSA was 16 months (range, 6-64 months).
Inflammatory control was achieved in 68 (73.9%) eyes, while persistent inflammatory activity was observed in 14 (15.2%). Thirty-eight (41%) eyes improved two Snellen lines or more, 43 (47.0%) stabilized, and 11 (12.0%) lost two lines or more. The CSA was discontinued because of nephrotoxicity in three patients and in each of two with systemic hypertension and constitutional intolerance to the drug, respectively. Thirteen patients enjoy inflammatory remission with this regimen.
Low-dose CSA used alone or in combination with other immunosuppressive agents is effective in achieving inflammatory control with a favorable visual outcome and provides a useful steroid-sparing strategy in the management of chronic endogenous uveitis. The CSA-associated toxicity may be reduced by initiating therapy at very low initial doses, with incremental dosage escalation to the desired target range.
描述作者使用低剂量环孢素A（CSA）单独或联合其他免疫抑制剂治疗顽固性慢性内源性葡萄膜炎患者的方法，同时关注治疗的抗炎效果、视力转归及副作用。
作者回顾了50例（92只眼）各种病因葡萄膜炎患者的记录，这些患者接受了低剂量CSA（每日2.5 - 5.0 mg/kg）单独或联合泼尼松和/或硫唑嘌呤（每日1.5 - 2.0 mg/kg）治疗。低剂量CSA治疗的中位随访时间为16个月（范围6 - 64个月）。
68只眼（73.9%）炎症得到控制，14只眼（15.2%）观察到持续性炎症活动。38只眼（41%）视力提高两行或更多，43只眼（47.0%）稳定，11只眼（12.0%）视力下降两行或更多。3例患者因肾毒性停用CSA，另外2例分别因全身性高血压和对该药物体质不耐受而停药。13例患者通过该方案实现炎症缓解。
单独使用低剂量CSA或联合其他免疫抑制剂可有效控制炎症，视力转归良好，为慢性内源性葡萄膜炎的治疗提供了一种有用的激素节省策略。通过极低初始剂量开始治疗，并逐步增加剂量至所需目标范围，可降低CSA相关毒性。
