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Clinical outcome of chronic immunosuppression in patients with non‐infectious uveitis
Author(s) -
Menezo Victor,
Lau Chun,
Comer Marie,
Lightman Susan
Publication year - 2005
Publication title -
clinical and experimental ophthalmology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.3
H-Index - 74
eISSN - 1442-9071
pISSN - 1442-6404
DOI - 10.1111/j.1442-9071.2005.00904.x
Subject(s) - medicine , prednisolone , immunosuppression , uveitis , corticosteroid , visual acuity , eye disease , posterior segment of eyeball , retrospective cohort study , surgery , ophthalmology
Aim: To determine the visual outcome and corticosteroid dose requirement in patients with non‐infectious uveitis affecting the posterior segment treated with corticosteroids and additional second‐line immunosuppression. Method: A retrospective, non‐comparative case series was carried out. Seventy‐two patients (141 eyes) with uncontrolled non‐infectious uveitis on systemic prednisolone were treated with at least one second‐line immunosuppressive agent in addition to systemic prednisolone and followed for at least 3 months. Visual acuity (VA), clinical disease activity, corticosteroid‐sparing effect, disease relapses requiring corticosteroid dose increase, and side‐effects from second‐line agents were evaluated. Results: At the end of the follow‐up period (mean: 55.5 months), 70 eyes (49.6%) had VA of 6/9 or better. There was a reduction in the mean maintenance dose of prednisolone required before the introduction of the second‐line agent (19 mg/day ± 2 SE) when compared to the mean maintenance dose of prednisolone at the end of the data collection (9 mg/day ± 1 SE; P < 0.001). There was also a significant reduction in the number of disease relapses requiring an increase in prednisolone dose after starting the second‐line agents as compared to the year before ( P < 0.02). Conclusion: In patients with uveitis affecting the posterior segment, the addition of all second‐line immunosuppressive therapy was effective in allowing reduction of the dose of systemic prednisolone to 10 mg/day or less, in controlling intraocular inflammation, reducing the number of relapses and in maintaining vision. Because of their side‐effects, immunosuppressive treatment should be individualized and monitored closely but its addition is beneficial in the short and longer term.