Abstract
Study background: The purpose of this study is to assess the clinical response of intravenous pulses of cyclophosphamide for severe ocular inflammation. Methods: This is an observational and retrospective clinical study, with inclusion of all the patients with severe ocular inflammatory diseases treated with pulsed intravenous cyclophosphamide. The data obtained from the medical records included general information, initial and final best-corrected visual acuity, complications, previous therapy and time of follow-up. We assessed inflammation according to the ocular manifestation for outcome analysis. Clinical improvement and the corticosteroid-sparing effect were evaluated. Results: Twenty-one patients were included (32 eyes) with a median age of 57 years. The most common ocular diagnosis was necrotizing scleritis. The median number of pulses of cyclophosphamide was 3 (range 1 to 12 pulses). Eighteen patients (85.7%) attained clinical improvement, and twenty patients (95.2%) achieved reduction in the corticosteroid dose after the treatment with cyclophosphamide. Fourteen patients (66.6%) gained two or more lines of vision, with a median final best-corrected visual acuity of 20/40. Six patients (28.5%) presented adverse effects attributed to the cyclophosphamide. The median time of follow-up was 8 months (range 3 – 19 months). Conclusion: The use of intravenous pulses of cyclophosphamide in ocular inflammatory disease could be used with good results including clinical and visual improvement, and with a high rate in reduction in the corticosteroid dose.
Highlights
Severe ocular inflammatory disease may lead to blindness, the rapid control of inflammation is mandatory and requires the use of effective anti-inflammatory drugs
We assessed the clinical response of intravenous pulses of cyclophosphamide for severe ocular inflammatory disease
Cyclophosphamide was selected as the first line of treatment because the degree of inflammation could cause potential blindness or because it was the first line of therapy in systemic associated diseases like granulomatosis with polyangiitis
Summary
Severe ocular inflammatory disease may lead to blindness, the rapid control of inflammation is mandatory and requires the use of effective anti-inflammatory drugs. Cyclophosphamide, an alkylating agent that inhibits mitosis of lymphocytes, has been proven effective for the treatment of ocular manifestations of systemic autoimmune diseases such as granulomatosis with polyangiitis (Wegener’s) and rheumatoid vasculitis [1,2]. Cyclophosphamide has been effective in other ocular inflammatory conditions including idiopathic scleritis, Mooren’s ulcer and Vogt- Koyanagi-Harada Syndrome [3]. We assessed the clinical response of intravenous pulses of cyclophosphamide for severe ocular inflammatory disease. Cyclophosphamide was selected as the first line of treatment because the degree of inflammation could cause potential blindness or because it was the first line of therapy in systemic associated diseases like granulomatosis with polyangiitis
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