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Cyclosporine therapy for severe sight-threatening uveitis in children and adolescents
R C Walton1, R B Nussenblatt, S M Whitcup
1Clinical Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.
Insights
Cyclosporine effectively treated severe pediatric uveitis, improving or stabilizing vision in most eyes long-term. While initial side effects like increased creatinine occurred, they resolved, indicating cyclosporine
Area of Science:
- Ophthalmology
- Immunosuppressive Therapy
- Pediatric Uveitis
Background:
- Severe bilateral sight-threatening intermediate uveitis and panuveitis in children pose significant challenges to vision preservation.
- Conventional treatments may have limitations, necessitating exploration of alternative immunosuppressive agents.
Purpose of the Study:
- To evaluate the safety and efficacy of cyclosporine in pediatric patients with severe, sight-threatening uveitis.
- To assess long-term outcomes of cyclosporine treatment in this population.
Main Methods:
- Retrospective chart review of pediatric patients (<18 years) with chronic bilateral sight-threatening uveitis treated with cyclosporine.
- Assessment of visual acuity, intraocular inflammation, and laboratory parameters (creatinine, hemoglobin) at 6 months, 2 years, and 4 years.
Main Results:
- Visual acuity improved or stabilized in 82.1% of eyes at 6 months, and 64%-75% at 2-4 years.
- Vitreous inflammation significantly decreased and remained stable.
- Transient increases in serum creatinine and decreased hemoglobin were noted early, with most lab values normalizing by 4 years. Common side effects included transient creatinine elevation, gingival hyperplasia, and hirsutism.
Conclusions:
- Cyclosporine demonstrates safety and efficacy as a therapeutic option for children with severe bilateral sight-threatening intermediate uveitis or panuveitis.
- Long-term treatment can lead to sustained visual improvement and inflammation control with manageable side effects.
Objective:
To review the safety and efficacy of cyclosporine in the treatment of children with severe bilateral sight-threatening intermediate uveitis or panuveitis.
Design/Participants:
A retrospective chart review was performed on all children younger than 18 years of age with chronic bilateral sight-threatening uveitis who were treated with cyclosporine.
Main Outcome Measures:
Assessment of the therapeutic efficacy and development of adverse effects of cyclosporine after 6 months, 2 years, and 4 years of therapy was performed.
Results:
Between 1983 and 1992, 15 children and adolescents were treated with cyclosporine. After 6 months, visual acuity improved or stabilized in 82.1% of eyes, while median vitreous inflammation decreased from 2.0 to 0.5. After 2 and 4 years, visual acuity improved or stabilized in 64% and 75% of eyes, respectively. Median vitreous inflammation remained 0.5 after 2 and 4 years of therapy. Mean creatinine clearance and hemoglobin values decreased and serum creatinine increased after 6 months. After 2 years, only mean hemoglobin values remained decreased. After 4 years, no significant differences were noted in any of the laboratory studies. The most frequently noted side effects included transient increases in serum creatinine in 53%, gingival hyperplasia in 40%, and hirsutism in 20% of patients.
Conclusions:
The authors' results suggest that cyclosporine is a safe and effective therapy for the treatment of children with severe bilateral sight-threatening intermediate uveitis or panuveitis.