Br J Ophthalmol 1998;82:737-742 ( July )
Cyclosporin A therapy in refractory non-infectious childhood
uveitis
D J Kilmartin,
J V Forrester,
A D Dick
Department of
Ophthalmology, University of Aberdeen Medical School, Aberdeen
Correspondence to: Mr D J Kilmartin, Department of Ophthalmology, University of Aberdeen
Medical School, Foresterhill, Aberdeen AB25 2ZD.
; Accepted for publication 29 January 1998
AIMS To assess the
immunosuppressive efficacy, steroid sparing effect and adverse effects
of cyclosporin A (CsA) therapy in refractory non-infectious childhood uveitis.
METHODSA
retrospective case series review of the medical records of children on
CsA therapy attending a tertiary referral centre for refractory
endogenous uveitis was performed. Low dose ( 5.0 mg/kg/day) CsA
therapy was started either as monotherapy or in combination with other
agents. The CsA immunosuppressive efficacy was assessed by visual
acuity and binocular indirect ophthalmoscopy (BIO) score outcomes and
steroid sparing effect by 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.
RESULTS14 patients
(25 eyes, 10 males, four females) were recruited with steroid failure
as the most common CsA indication. 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 maintenance CsA dose of 4.0 (1.0)
mg/kg/day. From baseline, visual acuity improved or was maintained in
23 (92%) eyes and BIO score improved in 19 (76%) eyes. Height
centiles were preserved and the maintenance prednisolone dose was 6.3 (3.3) mg/day, where required, in 10 (71%) patients. Nephrotoxicity was
not observed, with transient systemic hypertension developing in one
patient. Minor adverse effects were more common but were well tolerated.
CONCLUSIONSCyclosporin
A therapy is effective and safe in the medium term, if closely
monitored, in refractory non-infectious childhood uveitis.
Keywords:
cyclosporin A;
childhood
uveitis
© 1998 by British Journal of Ophthalmology
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