Long-Term, Drug-Free Remission of Sympathetic Ophthalmia with High-Dose, Short-Term Chlorambucil Therapy

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• 作者：Sarju S. Patel ; Emilio M. Dodds ; Laura V. Ech ; i ; Cristobal A. Couto ; Ariel Schlaen ; Howard H. Tessler ; Debra A. Goldstein
• 刊名：Ophthalmology
• 出版年：February, 2014
• 年：2014
• 卷：121
• 期：2
• 页码：596-602
• 全文大小：155 K

文摘

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Objective

To evaluate the safety and effectiveness of short-term, high-dose chlorambucil therapy in achieving long-term, drug-free remission in the treatment of sympathetic ophthalmia (SO).

Design

Retrospective case series.

Participants

Sixteen patients with SO treated with high-dose, short-term chlorambucil therapy between 1970 and聽2010.

Methods

Descriptive and bivariate analyses were used to characterize disease and outcomes.

Main Outcome Measures

Months of disease-free remission, prevalence rate of relapse, and prevalence of serious treatment-related adverse events.

Results

Sixteen patients with SO treated with short-term, high-dose chlorambucil were identified. Patients were treated with chlorambucil for a median of 14.0 weeks (mean, 14.5 weeks; range, 12.0-19.0 weeks). Median follow-up was 98.5 months (mean, 139.1 months; range, 48-441 months) from initiation of chlorambucil therapy. Control of inflammation was achieved in 100% of patients. Thirteen patients (81.3%) maintained vision of 20/40 or better in the sympathizing eye. Four patients (25%) relapsed after a median of 83 months (mean, 131 months) after cessation of systemic therapy. Seventy-five percent of relapses were controlled with topical therapy only. Conjunctival Kaposi's sarcoma developed in 1 patient. No patient demonstrated systemic malignancy.

Conclusions

Short-term, high-dose chlorambucil therapy provides sustained periods of drug-free remission. With median follow-up of more than 8 years (mean, 11.6 years; range, 4-37 years), there was a low rate of recurrence and minimal long-term serious health consequences or adverse events. Because SO may be a lifelong condition and because chlorambucil therapy may offer long-term, drug-free remission, this treatment may be聽worth considering early in the decision-making process for severe sight-threatening disease.