LOW-DOSE CYCLOSPORINE THERAPY IN THE TREATMENT OF BIRDSHOT - RETINOCHOROIDOPATHY

Introduction: Birdshot retinochoroidopathy is an uncommon uveitic synd rome of presumed autoimmune etiology. Therapy with systemic and perioc ular steroids is of inconsistent efficacy, attendant with numerous pot ential long-term side effects. Steroid-sparing strategies with more sp ecific agents such as cyclosporine (Cyclosporin A, CSA) have been sugg ested as the first line treatment for this disease. Patients and Metho ds: The records of 19 patients (35 eyes) with the clinical diagnosis o f birdshot retinochoroidopathy were examined. Age at onset ranged from 33 to 69 years (mean, 46.1 years) in nine men and ten women. The medi an follow-up from disease onset was 36 months. Eight patients were tre ated with low-dose (2.5-5 mg/kg daily) CSA alone, six required the add ition of azathioprine (1.5-2 mg/kg daily), and six received no systemi c immunosuppressive therapy. Results: HLA-A29 was positive in 94% (16 of 17) of patients tested. Vitreous inflammation was controlled in 23 (88.5%) treated eyes, with fewer bouts of recurrent inflammation, and a corresponding improvement or stabilization of visual acuity in 20 (8 3.3%) eyes. In contrast, intraocular inflammation never was controlled fully in untreated eyes, and visual acuity decreased in six (54.5%) e yes by an average of 2.5 Snellen lines. Nephrotoxic side effects of lo w-dose CSA therapy were not observed, but hypertension developed in tw o patients. Conclusion: Although the definitive strategy for the manag ement of birdshot retinochoroidopathy is unknown, control of intraocul ar inflammation with a favorable visual outcome, together with a lack of demonstrable CSA-associated nephrotoxicity and secondary side effec ts in these patients with birdshot retinochoroidopathy indicate that v ision preservation is possible with low-dose CSA alone or in combinati on with other steroid-sparing immunosuppressive agents as an alternati ve to the long-term use of corticosteroids.