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[Failures of cytostatic treatment in ophthalmology (author's transl)]
Abstract:
At the Department of Ophthalmology of the Univeristy of Zurich, cytostatic drugs have been used since 1962 for the treatment of various eye conditions: 16 keratoplasties, 11 cases of degenerative or proliferative eye disease, six cases of retinal vasculitis and 147 of uveitis (sympathetic ophthalmia, Behcet, chronic cyclitis, rheumatoid infantile uveitis etc. After a few rather unsatisfactory trials with methotrexate and azathioprine, a routine therapy combining cyclophosphamide and procarbazine was established. Of the 29 failures (16.1%) six were in the group of keratoplasties (37.5%!), three in cases of degenerative disease, three in the six vasculitis cases, and only 17 in the 147 cases of uveitis. The main cause of failure in corneal grafts was pre-existent vascularization, and in uveitis belated commencement of therapy. In cases where blindness threatens immunodepressors should be administered as early as possible. In the 180 cases reported here, these drugs did not produce any serious complications.
Insights
Cytostatic drugs, including cyclophosphamide and procarbazine, show promise for treating various eye conditions like uveitis and keratoplasties. Early intervention is crucial for better outcomes in these ophthalmic treatments.
Area of Science:
- Ophthalmology
- Immunosuppressive therapy
Context:
- Cytostatic drugs have been utilized since 1962 at the University of Zurich's Ophthalmology Department.
- Treatment encompasses keratoplasties, degenerative/proliferative eye diseases, retinal vasculitis, and uveitis (e.g., sympathetic ophthalmia, Behcet's disease).
Purpose:
- To evaluate the efficacy and safety of cytostatic drug combinations in managing diverse ocular conditions.
- To identify factors contributing to treatment failure and establish optimal therapeutic strategies.
Summary:
- A routine therapy combining cyclophosphamide and procarbazine was established after initial trials with methotrexate and azathioprine proved unsatisfactory.
- Out of 180 cases, 29 (16.1%) experienced treatment failure, with higher rates in keratoplasties (37.5%) due to pre-existent vascularization and in uveitis due to delayed therapy.
- The study reported no serious complications associated with the administered immunodepressors.
Impact:
- Highlights the importance of early immunodepressor administration in sight-threatening conditions.
- Provides insights into the effectiveness of specific cytostatic drug combinations for ophthalmic diseases.
- Suggests that pre-existent vascularization and delayed treatment initiation are key factors influencing outcomes in corneal grafts and uveitis, respectively.