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   Table of Contents      
ORIGINAL ARTICLE
Year : 1980  |  Volume : 28  |  Issue : 4  |  Page : 215-217

Immunosuppressive drugs in uveitis


A.M.U. Institute of Ophthalmology, J. N. Medical College, Aligarh, India

Correspondence Address:
Manoj Shukla
A.M.U. Institute of Ophthalmology J.N. Medical College, Aligarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 7287114

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How to cite this article:
Ahuja O P, Shukla M. Immunosuppressive drugs in uveitis. Indian J Ophthalmol 1980;28:215-7

How to cite this URL:
Ahuja O P, Shukla M. Immunosuppressive drugs in uveitis. Indian J Ophthalmol [serial online] 1980 [cited 2020 Feb 19];28:215-7. Available from: http://www.ijo.in/text.asp?1980/28/4/215/28260

Table 1

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Table 1

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Immunosuppression is defined as inhibition of immunological processes by preventing the lymphoid cells of the reticulo endothelial system from responding to the injection of antigen. The agents which inhibit these immunological processes are likewise called immunosuppressive agents.

A new era in the history of treatment of uveitis was opened by Wirostko and Halbert[1] who studied the efficacy of 6-Mercaptopurine in experimental uveitis in rabbits. Later treat­ment of uveitis by different immunosuppressive agents in human beings was reported by many workers- Methotrexate[2],[3],[4], Imuran[5],[6], 6-Mercaptopurine[7], cyclophosphamide[8], azathioprine[9]'[14] and chlorambuci1[14],[19]. The best results of immunosuppressive agents have been described in cystitis[3],[8],[9],[10] sympathe­tic ophthalmitis[4],[7],[9] Behcet's disease[11],[12],[13] and pars planitis[14]

Though potent anti-inflammatory in nature, all these drugs are potentially dangerous drugs because of certain side effects which include alopecia, stomatitis, secondary infections, leucopenia,, thrrombocytopenia and liver damage.


  Methods and materials Top


This deals mainly with our experience of methotrexate therapy in three corticosteroid resistant cases of Vogt Koyanagi Harada's syndrome. The fourth patient had bilateral recurrent iridocyclitis and had already four attacks in a span of two years. All these patients had previously received prolonged treatment with systemic and local steroids and other forms of conventional treatment without any appreciable success. Each patient was given detailed uveitis work up and was kept on small doses of systemic steroids. Methotrexate (MTX) therapy was started in these cases with a dose of 35 mg (7 vial of 5 mg each) slow intravenous injection over a period of 20 minutes. The same dose was repeated every fourth day till a total of five injections were given. Complete blood picture, bleeding and clotting time, platelet count, liver function tests were done prior to and after each methotrexate injection.

Following methotrexate (MTX) therapy all the four patients showed appreciable improve­ment in uveitis activity after the first dose. The signs of anterior chamber activity decreased following the first injection and the condition improved progressively on subsequent doses [Table - 1]. By the end of third week the affected eyes were practically quiet without any cellular reaction in the anterior chamber and anterior part of the vitreous. At the end of three weeks treatment with Methotrexate (MTX) therapy, visual acuity improved in two cases while in the remaining two visual recovery could not be recorded because of complicated cataract. During the two year follow up of these case (except the one with bilateral recurrent anterior uveitis) there has been no recurrence of inflammation in any eye and the visual acuity has been by and large maintained.


  Discussion Top


Immunosuppressive drugs have been sparin­gly used in the treatment of uveitis obviously because of their serious side effects. Conseque­ntly no report on a large series of cases is available. By and large stubborn steroid resistant varities of uveitis such as Behcet's disease, sympathetic ophthalmitis, pars planitis etc. have been treated with these agents by various workers. The use of metho­trexate (MTX) in the present study of four stubborn corticosteroid resistant cases of uveitis was considered because of its well understood pharmacological action, low toxicity and suppression of mononuclear inflammatory response. Three unfortunate cases of Vogt Koyanagi Harada's syndrome and another with bilateral recurrent iridocyc­litis were referred to our clinic following failure with conventional treatment. The results of methotrexate therapy in all these patients were very gratifying. The drug should be given intermittently as it has been observed that continuous administration of the drug increases the chances of drug toxicity by thirty times[19]. Although no side effects were obser­ved following methotrexate therapy in the present study, the use of such agents must be weighed against potential toxic side effects associated with the use of such drugs. In view of excellent clinical response obtained following methotrexate therapy in the present study, we would recommend to include cases of Vogt Koyanagi Harada's syndrome in clinical enti­ties of uveitis for treatment with such drugs.

Follow up of eyes treated big immunosuppression agents is essential to evaluate the long term therapeutic efficiency of these drugs.


  Summary Top


The experience of Methotrexate (MTX) therapy in three progressive corticosteroid resistant cases of Vogt Koyanagi Harada's syndrome and another case of recurrent bilate­ral anterior uveitis is reported. Cases of Vogt Koyanagi Harada's syndrome merit consideration for treatment with such drugs.

 
  References Top

1.
Wirostko, E., and Halbert, S.P., 1962, J. Exp. Med., 116 :653.  Back to cited text no. 1
    
2.
Hersh, E. M., Levin, R.H., Wong, V.G., and Freireich, E.J, 1963, clinic Res.. 11:399  Back to cited text no. 2
    
3.
Wong V.G., 1968, Proc. 117th Annual Conven­tion of A.M.A. San Francisco  Back to cited text no. 3
    
4.
Lazar, M., Weiner, M.J., and Leopold, I.H., 1969, Amer. J. Ophthalmol., 67 : 383  Back to cited text no. 4
    
5.
Bignell, J.L., and Mackay: 1., 1966, XX Con­cilium Ophthalmologicum Germania, 1966 internat.  Back to cited text no. 5
    
6.
Newell, F.W., and Krill, A.E.,11967, Trans. Ophthalmol, Soc. U.K., 87: 499.  Back to cited text no. 6
    
7.
Newell, F.W., Krill, A.E. and Thompson, A., 1966, Amer. J. Ophthalmol. 61 : 1250.   Back to cited text no. 7
    
8.
Gills, J.P., 1968, Arch. Ophthalmol., 79: 723  Back to cited text no. 8
    
9.
Wong, V.G.. Hersh, E.M., anddMcMaster, P.R.B., 1966, Arch. Ophthalmol. 76 ; 66.  Back to cited text no. 9
    
10.
Wong, V.G., Hersh E.M., 1965, Trans. Amer. Acad. Ophthalmol. Otolaryng. 69 ; 279.  Back to cited text no. 10
    
11.
Francois, J., and Vanoye, R., 1973, Ann. Ocul., 206 : 851.  Back to cited text no. 11
    
12.
Rosslet, E., Saudan, Y., and Zenklusen, G.. 1968. Ophthalmologica (Base)), 156 : 218  Back to cited text no. 12
    
13.
Aoki, K., Fujioka, K., and Saito, K., 1971, Jap. J, clinic. Ophthalmol., 25 : 1397  Back to cited text no. 13
    
14.
Buckley, C.E., and Gills. J.P., 1969, Arch, intern. med. 124 : 29.  Back to cited text no. 14
    
15.
Berlin, N.L, 1963, Ann. intern. Med., 59:931.  Back to cited text no. 15
    
16.
Abdalla, M.I., and Bahgat, N. 1973, Brit. J. Ophthalmol., 57 ; 706.  Back to cited text no. 16
    
17.
Mamo, I.G., and Azzam, S.A., 1970, Arch. Ophthalmol,, 84: 446.  Back to cited text no. 17
    
18.
Godfrey, W.A. Epstein, W.V., 0' Conner, G.R., Kimura, S.J., Hogan, M.J. and Nozik, R.A., 1974, Amer. J. Ophthalmol., 78 : 415  Back to cited text no. 18
    
19.
Dinning. W.J., and Perkins, E.S., 1975, Brit.J. Ophthalmol, 59 : 397.  Back to cited text no. 19
    



 
 
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