LOW-DOSE CYCLOSPORINE-A THERAPY IN TREATING CHRONIC, NONINFECTIOUS UVEITIS

Purpose: To describe the authors' approach to the management of patien ts with recalcitrant, chronic, endogenous uveitis using low-dose Cyclo sporin A (CSA) alone or in combination with other immunosuppressive ag ents with attention to the anti-inflammatory efficacy, visual outcome, and side effects of therapy. Methods: The authors reviewed the record s of 50 patients (92 eyes) with uveitis of various etiologies who had been treated with low-dose CSA (2.5-5.0 mg/kg daily) alone or in combi nation with prednisone and/or azathioprine (1.5-2.0 mg/kg daily). The median follow-up on low-dose CSA was 16 months (range, 6-64 months). R esults: Inflammatory central was achieved in 68 (73.9%) eyes, while pe rsistent inflammatory activity was observed in 14 (15.2%). Thirty-eigh t (41%) eyes improved two Snellen lines or more, 43 (47.0%) stabilized , and 11 (12.0%) lost two lines or more. The CSA was discontinued beca use of nephrotoxicity in three patients and in each of two with system ic hypertension and constitutional intolerance to the drug, respective ly. Thirteen patients enjoy inflammatory remission with this regimen. Conclusion: Low-dose CSA used alone or in combination with other immun osuppressive agents is effective in achieving inflammatory control wit h a favorable visual outcome and provides a useful steroid-sparing str ategy in the management of chronic endogenous uveitis. The CSA-associa ted toxicity may be reduced by initiating therapy at very low initial doses, with incremental dosage escalation to the desired target range.