Immunosuppressive therapy of ocular disease

Care and caution are required in using immunosuppressive agents to combat sight-threatening ocular disease. Informed consent of the patient and the active participation of a knowledgeable internist are mandatory in view of the known potential consequences of therapy. These consequences or side effects include specific and general problems, and before initiating therapy the cost/benefit ratio must be considered. Although the most commonly used agents are nonspecific, some drugs appear more beneficial in certain conditions than others, as is the case of chlorambucil in Behcet disease. It is a policy at the Uveitis Clinic of the University of California, Irvine, to institute immunosuppressive therapy early enough for conservation of useful vision, yet late enough so that it is clear that moderate to heavy steroid therapy cannot prevent blindness. In the event of failure of the "conventional" immunosuppressive therapy, plasmapheresis may prove a helpful adjunct.