Cyclosporine therapy for uveitis: long-term followup

Long term followup in 52 uveitis patients treated with Cyclosporine (CsA) is presented here. The patients included in this study all had intermediate or posterior uveitis of noninfectious etiology; and all were considered therapeutic failures to systemic corticosteroids and/or cytotoxic agents. Patients were considered a therapeutic success if the visual acuity in either eye improved two lines or more and/or the vitreal haze improved more than two grading levels. While five patients stopped therapy before the three month interval, 41 of 52 patients or 79% were therapeutic successes at three months after the initiation of CsA as the sole systemic immunosuppressive agent for their disease. Twenty-five of a potential 35 patients (71%) remained on CsA after one year's time, with 63% (22/35) of these individuals receiving the medication considered a therapeutic success. The patients who appeared to respond particularly well to CsA therapy were those with pars planitis, intermediate uveitis of the non-pars planitis type, VKH, and Behcet's disease. In vitro S-antigen (S-Ag) testing did not appear to have a predictive value in determining which patients would be therapeutic successes (improvement in visual acuity), however the S-Ag responder group did appear to have a statistically greater improvement in vitreal haze. Renal toxicity was by far the most common adverse effect, which we have found to be reversible with our approach to therapy. However, adverse reactions required a reduction in CsA dosage in some patients, making it not feasible to maintain therapeutically effective CsA levels. In those patients, low dose prednisone was added to these patients' CsA regimens with generally good results. We did not observe opportunistic infections nor CsA associated neoplasms in our patients. This long term study demonstrates the potential efficacy of CsA in the treatment of severe intra-ocular inflammatory disorders. However, we firmly believe that only in the context of a randomized clinical trial that a definitive evaluation as to the true effectiveness of CsA will be reached.