CYCLOSPORINE-A THERAPY IN REFRACTORY NONINFECTIOUS CHILDHOOD UVEITIS

Aims-To assess the immunosuppressive efficacy, steroid sparing effect and adverse effects of cyclosporin A (CsA) therapy in refractory non-i nfectious childhood uveitis. Methods-A retrospective case series revie w of the medical records of children on CsA therapy attending a tertia ry referral centre for refractory endogenous uveitis was performed. Lo w dose (less than or equal to 5.0 mg/kg/day) CsA therapy was started e ither as monotherapy or in combination with other agents. The CsA immu nosuppressive efficacy was assessed by visual acuity and binocular ind irect ophthalmoscopy (BIO) score outcomes and steroid sparing effect b y growth charts and ability to withdraw or maintain a low steroid dose . Possible CsA adverse effects were monitored by routine biochemistry (including serum creatinine) and haematological tests, blood pressure recordings, and symptoms. Results-14 patients (25 eyes, 10 males, four females) were recruited with steroid failure as the most common CsA i ndication. Age (mean (SD)) at start of CsA therapy was 8.7 (4.1) years with a duration of CsA therapy of 20.9 (range 3.5-88.3) months at a m aintenance CsA dose of 4.0 (1.0) mg/kg/day. From baseline, visual acui ty improved or was maintained in 23 (92%) eyes and BIO score improved in 19 (76%) eyes. Height centiles were preserved and the maintenance p rednisolone dose was 6.3 (3.3) mg/day, where required, in 10 (71%) pat ients. Nephrotoxicity was not observed, with transient systemic hypert ension developing in one patient. Minor adverse effects were more comm on but were well tolerated. Conclusions-Cyclosporin A therapy is effec tive and safe in the medium term, if closely monitored, in refractory noninfectious childhood uveitis.