RESUMO
PURPOSE: To prospectively compare 2 immunosupressive regimens in patients with active Vogt-Koyanagi-Harada disease in spite of systemic glucocorticoid treatment. METHODS: Forty-four patients were diagnosed between 1998 and 2005. Twenty-one developed chronic intraocular inflammation in spite of glucocorticoid treatment and were randomized to receive either prednisone and azathioprine (AZA) (n = 12) or prednisone and cyclosporine (CyA) (n = 9). RESULTS: In the AZA group Tyndall score decreased from 1.21 +/- 1.10 to 0.29 +/- 0.62 (p < .01), and visual acuity (LogMAR) improved from 0.32 +/- 0.35 to 0.09 +/- 0.16 (p < .001). In the CyA group Tyndall score decreased from 1.67 +/- 1.08 to 0.16 +/- 0.51 (p < .001), and visual acuity improved from 0.41 +/- 0.40 to 0.25 +/- 0.42 (p < .001). Patients in the AZA group needed a significantly higher average prednisone dose and total cumulative dose than those in the CyA group, p < .01 for each comparison. CONCLUSIONS: Both regimens showed a good clinical efficacy, but CyA seems to be a better glucocorticoid-sparing agent than AZA.
Assuntos
Azatioprina/administração & dosagem , Ciclosporina/administração & dosagem , Glucocorticoides/administração & dosagem , Terapia de Imunossupressão/métodos , Imunossupressores/administração & dosagem , Prednisona/administração & dosagem , Síndrome Uveomeningoencefálica/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Acuidade Visual , Adulto JovemRESUMO
BACKGROUND: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. AIM: To evaluate the role of Azathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. PATIENTS AND METHODS: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. RESULTS: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87%). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 %, visual acuity improved. The ocular inflammatory score decreased in 86.5%. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. CONCLUSIONS: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.
Assuntos
Azatioprina/uso terapêutico , Imunossupressores/uso terapêutico , Uveíte/tratamento farmacológico , Adolescente , Adulto , Idoso , Azatioprina/efeitos adversos , Doenças da Coroide/tratamento farmacológico , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Doenças Retinianas/tratamento farmacológico , Estudos Retrospectivos , Esclerite/tratamento farmacológico , Esteroides/uso terapêutico , Síndrome Uveomeningoencefálica/tratamento farmacológicoRESUMO
Background: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. Aim: To evaluate the role ofAzathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. Patients and methods: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. Results: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87 percent). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 percent, visual acuity improved. The ocular inflammatory score decreased in 86.5 percent. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. Conclusions: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Azatioprina/uso terapêutico , Imunossupressores/uso terapêutico , Uveíte/tratamento farmacológico , Azatioprina/efeitos adversos , Doenças da Coroide/tratamento farmacológico , Resistência a Medicamentos , Quimioterapia Combinada , Seguimentos , Imunossupressores/efeitos adversos , Doenças Retinianas/tratamento farmacológico , Estudos Retrospectivos , Esclerite/tratamento farmacológico , Esteroides/uso terapêutico , Síndrome Uveomeningoencefálica/tratamento farmacológicoRESUMO
BACKGROUND: Thrombophilia is an alteration of hemostasis that increases the risk to venous or arterial thrombosis. This condition may be the underlying cause of retinal vein thrombosis. AIM: To study the presence of thrombophilia in patients with retinal vein thrombosis. PATIENTS AND METHODS: Prospective study of 55 patients aged 22 to 86 years, with retinal vein thrombosis (central or branch). Antithrombin III, coagulant protein C, functional protein S, resistance to activated C protein, homocysteine, prothrombin G20210A gene, lupus anticoagulant and anticardiolipin antibodies were measured in all. RESULTS: Seventeen patients had thrombophilic markers (antiphospholipid syndrome in seven, hyperhomocysteinemia in six and resistance to protein C in three). Of these 17 patients, 53% had high blood pressure, 35% an abnormal serum lipid profile and 23% a personal history of thrombosis. The thrombosis was central in 12 (ischemic in four) and of a branch in five (ischemic in two). CONCLUSIONS: Thrombophilic markers must be assessed in patients with retinal vein thrombosis.
Assuntos
Oclusão da Veia Retiniana/etiologia , Trombofilia/complicações , Resistência à Proteína C Ativada/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Testes de Coagulação Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Deficiência de Proteína S/sangue , Oclusão da Veia Retiniana/sangue , Fatores de Risco , Distribuição por Sexo , Trombofilia/sangueAssuntos
Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , alfa 1-Antitripsina/análise , Antígenos HLA/análise , Uveíte Anterior/classificação , SeguimentosRESUMO
Se describen las características clínicas y los resultados quirúrgicos en un grupo de 41 pacientes con un desprendimiento retinal inducido por un pelotazo en el juego del fútbol (39 pacientes), baloncesto (1 paciente) y voleibol (1 paciente). El período de latencia entre el trauma y el desprendimiento retinal fue inferior a 1 semana en 18 casos, sugiriendo que los desgarros se generan en el momento del impacto La mayor parte de los pacientes presentaban diálisis y desgarros superotemporales. Desgarro en herradura sólo se observó en un ojo miope. El impacto provocó un desgarro retinal gigante en un ojo alto miope. Se obtuvo la reaplicación retinal quirúrgica en 38 de 41 casos (92.7%). 60% de los casos mostraron maculopatía de grado variable. La visión final fue inferior a 0.1 en 6 casos con retina aplicada. Estos casos presentaban un desprendimiento retinal muy antiguo o una severa maculopatía