The clinical use of immunosuppressants in the treatment of putative autoimmune intra-ocular diseases

Abstract

Uveitis refers to a large number of intra-ocular inflammatory disorders with both endogenous and exogenous causes, the latter including such disorders as toxoplasmosis and cytomegalovirus retinitis. A large number of blinding disorders are of putative autoimmune origin, requiring effective immunosuppression. High dose steroids have been used to treat several endogenous conditions. Alkylating agents appear anecdotally to be more effective than anti-metabolites. However, the concern of long-term and short-term side effects, as well as the question as to whether vision is being preserved in these patients has made this approach somewhat less attractive. Cyclosporine has been utilized in the treatment of several sight-threatening disorders. Approaches have concentrated on therapeutic regimens that will give the least in secondary effects, while other studies are presently evaluating the usefulness of cyclosporine G. Several conditions, such as Behçet's disease and the intermediate and posterior uveitic entities that lead to macular edema appear to respond well. It is imperative to evaluate the patient for other causes of poor vision that may not respond to this type of therapy.