難治性葡萄膜炎に対するCyclosporin Aの効果

Systemic cyclosporin A in the treatment of severe uveitis

　従来の治療法によって効果が得られなかった難治性葡萄膜炎患者4例にCyclo-sporin Aを試みた．初期投与量は全例10mg／kg／dayとして，症状を見て漸減した．ベーチェット病2例はいずれも葡萄膜炎の再発発作が減少し，眼外主症状も改善したが，1例は心筋梗塞を，他の1例は神経ベーチェット病を発症した．桐沢型葡萄膜炎患者ではほとんど効果が見られなかった．糖尿病を伴った原因不明の葡萄膜炎の患者では，減量中に大きな発作を起こしステロイドを使用せざるをえなかった．副作用については長期投与例3例の内2例に多毛が見られたが，腎機能については，投与量を少なめに抑えたため血清クレアチニンの軽度上昇が見られただけで，他の機能に重大な異常は出なかった．

We treated four cases with severe uveitis with a new anti-immunological agent, Cyclosporin A. Cy-closporin A was administered daily, starting with the daily dosis of 10mg/kg.

In 2 cases with Behçet's disease, a dramatic de-crease in the frequency of recurrent attacks of uveitis was induced after initiation of the therapy. Myocardial infarction developed in one case duringthe course of treatment. Neuro-Behçet's disease occurred in the other.

A third case with Kirisawa-type uveitis was treat-ed with Cyclosporin A without apparent effect. Fur-ther appraisal for this clinical entity seems necessary because the present case was already at the end stage of the disease when the treatment was insti-tuted.

A fourth case suffered from severe, bilateral uveit-is with mild diabetes mellitus. Systemic steroid was effective but the state of diabetes became aggravat-ed. Substitution of systemic steroid by CyclosporinA did not improve the clinical course of the eyes.

Throughout the present series, laboratory data were within normal limits except for slight eleva-tion of serum creatinine. The absence of notable side effects seemed to have kept the dosis of Cyclo-sporin A at a relatively low level of 6mg/kg during maintenance period.