Treatment of non infectious ocular inflammatory disease with low doses of cyclosporin A

Background: Cyclosporin A has an adequate immunosuppressive capacity and ca n be useful in the treatment of non infectious ocular inflammatory diseases . Aim: To describe the clinical effect of cyclosporin A treatment in low do ses, along wit corticosteroids, in the treatment of refractor ocular inflam matory diseases. Patients and methods: Twenty patients (13 female), aged 17 to 74 years old with severe and refractory ocular inflammatory diseases we re studied. All except one, received variable doses of prednisone (10 to 60 mg/kg/day) and all received cyclosporin in doses that started in 2.5 mg/da y and were increased to 5 mg/kg/day, according to clinical response. Patien ts were followed from 8 to 24 months, with monthly assessments of ocular in flammation (using a four point score), visual acuity and adverse effects of treatment. Results: A two points or more reduction in th ocular inflammati on score was observed in 52% of patients. Visual acuity improved in 10 subj ects, stabilized in 8 and worsened in 2. Prednisone doses were reduced in m ost patients. Observed adverse effects were hypertension in 2 patients, cre atinine elevation in 2, gastrointestinal disturbances in 3 and hypertrichos is in 12. A reduction of cyclosporin dose was required in these cases, but it was discontinued only in one patient with a vascular purpura. Conclusion s: Low cyclosporin doses, associated to prednisone, are useful to reduce in flammation and improve visual acuity in patients with non infectious ocular inflammatory disease, refractory to other treatment methods.