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| ORIGINAL ARTICLE |
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| Year : 1980 | Volume
: 28
| Issue : 4 | Page : 215-217 |
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Immunosuppressive drugs in uveitis
OP Ahuja, Manoj Shukla
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
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 7287114 
How to cite this article:
Ahuja O P, Shukla M. Immunosuppressive drugs in uveitis. Indian J Ophthalmol 1980;28:215-7 |
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 | |  |
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 | | |
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 | | |
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 | | |
| 1. | Wirostko, E., and Halbert, S.P., 1962, J. Exp. Med., 116 :653.  |
| 2. | Hersh, E. M., Levin, R.H., Wong, V.G., and Freireich, E.J, 1963, clinic Res.. 11:399 |
| 3. | Wong V.G., 1968, Proc. 117th Annual Convention of A.M.A. San Francisco |
| 4. | Lazar, M., Weiner, M.J., and Leopold, I.H., 1969, Amer. J. Ophthalmol., 67 : 383 |
| 5. | Bignell, J.L., and Mackay: 1., 1966, XX Concilium Ophthalmologicum Germania, 1966 internat. |
| 6. | Newell, F.W., and Krill, A.E.,11967, Trans. Ophthalmol, Soc. U.K., 87: 499. |
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| 10. | Wong, V.G., Hersh E.M., 1965, Trans. Amer. Acad. Ophthalmol. Otolaryng. 69 ; 279. |
| 11. | Francois, J., and Vanoye, R., 1973, Ann. Ocul., 206 : 851. |
| 12. | Rosslet, E., Saudan, Y., and Zenklusen, G.. 1968. Ophthalmologica (Base)), 156 : 218 |
| 13. | Aoki, K., Fujioka, K., and Saito, K., 1971, Jap. J, clinic. Ophthalmol., 25 : 1397 |
| 14. | Buckley, C.E., and Gills. J.P., 1969, Arch, intern. med. 124 : 29. |
| 15. | Berlin, N.L, 1963, Ann. intern. Med., 59:931. |
| 16. | Abdalla, M.I., and Bahgat, N. 1973, Brit. J. Ophthalmol., 57 ; 706. |
| 17. | Mamo, I.G., and Azzam, S.A., 1970, Arch. Ophthalmol,, 84: 446. |
| 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 |
| 19. | Dinning. W.J., and Perkins, E.S., 1975, Brit.J. Ophthalmol, 59 : 397. |
[Table - 1]
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