Immunosuppressive treatment in sympathetic ophthalmia long-term visual outcome

Purpose Sympathetic ophthalmia(OS) is a chronic bilateral recurrent granulomatous pan uveitis following a traumatic or surgical transfixing wound.The aim of the study is to evaluate retrospectively the long-term visual outcome on various immunosuppressants(IS) used in the OS management Methods Serial patients with fitting clinical and ancillary data were included in the study.On admission, all patients were treated with a methylprednisolone bolus followed by oral prednisone to 1mg/kg/day,tapered before beginning IS therapy.Three phases have been identified for the collection of various parameters:Admission time,after one and three year under various IS treatments.The primary endpoint is a criterion combining cellular vitreous decrease of 2 marks with steroid dose sparing. Results 10 eyes of 10 patients with OS were included.After admission time the administrated IS were: Azathioprine(1year N=6 and 3years N=3),Mycophenolate mophetyl(1year N=2),Methotrexate(1year N=1) Interferon alpha2a(1year N=6,3 years N=1).Evaluation of the primary endpoint is success at 1 year under IS:4 with Azathioprine(66%),with Mycophenolate mophetyl(50%),No success with Methotrexate and 6 with Interferon(100%). The mean steroid sparing was 12mg under Interferon,18mg under Azathioprine,20mg under Mycophenolate mophetyl,20mg under Methotrexate.Evaluation of the primary endpoint is Success At 3 years under IS: 3 with Azathioprine(100%)and 1 with Interferon(100%). The mean steroid sparing was 7mg under Azathioprine and 5 mg under Interferon. Conclusion Interferon alpha2a and Azathioprine appeared the most effective in controlling the disease and in terms of steroid sparing effect.