Cyclosporin A therapy for severe anterior scleritis. Five case reports of patients without associated systemic disease

Background. Patients with severe scleritis who do not respond to high-dose corticosteroid therapy, or who require a daily corticosteroid maintenance d ose higher than 30 mg prednisone should be treated by other immunosuppressa nts. Patients and methods. In five patients with various types of severe anterio r scleritis a long-term high-dose steroid treatment failed to control scler al inflammation. They therefore received cyclosporin (CsA). Follow up was 1 6-26 months. Results. Sceral inflammation and ocular complications were controlled in al l patients by a regimen of systemic CsA combined with a low maintenance ste roid dose below the Gushing threshold. We observed no side effects under Cs A serum levels of 120-150 ng/ml. In only one patient was scleral inflammati on totally and lastingly eliminated. Conclusions. Systemic CsA therapy is of definite therapeutic value in the s ymptomatic management of steroid refractory severe anterior scleritis witho ut associated systemic disease. Complete healing, however, is achieved only in a minority of cases.