[Alternatives to steroid therapy in chronic uveitis]. / Alternativen zur Steroidtherapie bei der chronischen Uveitis.

In a search for alternative therapeutic methods other than corticosteroids and cytostatics, the effect of a dialyzable leukocyte extract (DLE), the antimetabolite 5-fluorouracil and the immunosuppressive agent cyclosporin A in corticosteroid-resistant idiopathic uveitis was studied. When DLE was administered to 26 patients who had uveitis forms with exogenous triggering (e.g., infection), as well as forms with an autoimmune background, there was a reduction in the number and duration of recurrences and a statistically proven prolongation of the inflammation-free intervals. This was particularly true in anterior and posterior uveitis and to a lesser extent in the intermediate form. No side effects were observed. 5-Fluorouracil, injected subconjunctivally, is indicated in intermediate uveitis with marked vitreous infiltration and beginning proliferation. Corneal erosion occurs relatively often. During treatment with cyclosporin A (low dose, 5 mg/kg of body weight per day), 14 of 17 patients (9 with intermediate uveitis, 6 with retinal vasculitis, 1 with sympathetic ophthalmia, 1 with panuveitis) showed improved results; in 2 cases the findings remained stationary and only 1 case had low-grade deterioration. If one takes into consideration the fact that in this patient any therapy would have failed, the results are convincing. This is particularly true of retinal vasculitis. There is no effect in cases of central hemorrhagic chorioretinopathy. So far, there have been no serious side effects.

[High-dosage combination antibiotic treatment in severe therapy-resistant uveitis and necrotizing (chorio)retinitis]. / Hochdosierte antibiotische Kombinationsbehandlung bei schweren therapierefraktären Uveitiden und nekrotisierenden (Chorio-) Retinitiden.

Twelve patients with extremely severe uveitis and two patients with necrotizing (chorio-)retinitis were treated with a combination of antibiotics consisting of penicillin G, gentamicin and metronidazole. The antibiotics were administered in 5 cases (all uveitis patients) after unsuccessful long-term treatment with other drugs, in nine cases after short-term treatment with other drugs or immediately. The treatment was effective in 10 of the uveitis patients, including all 5 cases in which the previous treatment had been unsuccessful. In 2 cases it was ineffective. It was effective, however, in both of the cases of necrotizing (chorio-)retinitis. The duration of the required treatment with antibiotics was not significantly prolonged in cases which had previously undergone long-term treatment with other drugs. However, the clinically detectable onset of improvement of vision and of the findings was significantly delayed. Despite some cogent connections between the antibiotics therapy and the improvement in the clinical picture, no well-founded conclusions as to etiology can be derived for the uveitis or necrotizing (chorio-)retinitis patients in question. The successful treatment of problematic cases identifies therapy with antibiotics as a therapeutic alternative.