Cyclosporine: a therapy in inflammatory eye disease

Severe uveitis is a relatively common and difficult clinical management problem in ophthalmology. Recently, cyclosporine-A (Cs-A) has been shown to be of therapeutic benefit in the management of sight threatening inflammatory eye disease. In order to examine the efficacy and long term safety of Cs-A, we conducted an open uncontrolled study in 22 patients with sight threatening uveitis whose disease had previously been refractory to treatment with systemic corticosteroids (22 patients), azathioprine (5 patients) and cyclophosphamide (2 patients). Uveitis was idiopathic in 16 cases, one patient had Reiter's syndrome, two had Vogt Koyanagi Harada disease and one patient had sarcoidosis. There were twelve males and ten females with a mean age of 40.5 years (range 22-67 yrs). Nineteen patients (86%) showed significant clinical improvement after treatment with Cs-A (10 mgm/kg/day) with decreased inflammatory activity and improved visual acuity. Three patients failed to respond to Cs-A therapy, while 4 subjects whose disease had initially responded to Cs-A relapsed on attempted withdrawal of this medication. Side effects were common in patients receiving Cs-A [5 mgm/kg/day (or greater)], with hypertension, tremor, hirsutism and raised serum creatinine being most frequent. We conclude that CS-A is an effective immunosuppressive agent in the treatment of patients with uveitis; however, its usefulness is limited by frequent side effects and disease relapse on attempted drug withdrawal.