Treatment of intraocular inflammatory disease with cyclosporin A

Eight patients with bilateral sight-threatening posterior uveitis of non-infectious aetiology that had not responded to corticosteroid or cytotoxic therapy were given cyclosporin A. Seven of the eight responded with improvement in visual acuity and disappearance of ocular inflammatory activity. The seven included two with Behçet's disease, who also had improvement in non-ocular symptoms. Peripheral blood lymphocytes from the seven cyclosporin A responsive patients, but not those from the non-responder, gave positive in-vitro blastogenic responses to the retinal S-antigen, a highly uveitogenic organ-specific material. In four patients OKT4/OKT8 ratios fell after the start of therapy, as the result of an increase in the OKT8 fraction. In the other four patients the fall was preceded by an increase in the OKT4/OKT8 ratio. Cyclosporin A did not influence natural killer cell activity. Side-effects ascribed to cyclosporin A were tolerated or disappeared with continued therapy, sometimes at a lower dosage. No neoplasms were observed. Cyclosporin A seems to be effective treatment for selected patients with severe bilateral uveitis of non-infectious aetiology.