Pulse Cyclophosphamide (PCP) in ophthalmologic manifestations of Behcet's disease (BD).


Abstract: PCP as lg/m2/body surface was given once per month, with 0.5 mg prednisolone/kg/day, to 155 patients with sever posterior uveitis (PU) and/ or retinal vasculitis (RV). A Disease Activity Index (DAI), based upon the inflammatory state of the eye, was calculated for each section of each eye before the first PCP and then after each PCP. When a remission was obtained the gap between PCP was increased gradually to 2, and then to 3 months, and prednisolone was tapered. If the result remained stable, PCP was given only in case of a new att ck. A comparison between the DAI before PCP, and after the last one, was made by the Student t test. Our patients received a total number of 979 PCPs, with a mean number of 6.3 PCPs per patient. The mean follow up time was 11.4 months. 73% of the eyes with PU improved, 11% were stabilized, while 17% were aggravated. The mean DAI improved from 2.6 to 1.3 with t=10.173 and p<0.001.65% of the eyes with RV improved, 14% were stabilized, while 21% were aggravated. The meal DAI improved from 1.9 to 0.9 with t=6.078 and p<0.001. The Visual Acuity (VA), as an overall index, improved in ­55% of eyes. VA was stabilized in 23% and decreased i­n 22% of eyes. The mean VA improved from 3.2 to 4.2/10 with t=5.678 and p<0.001. Non of the major side effects of oral cyclophosphamide was observed with PCP. A comparison of results between patients who had received 1 to 4, 5 to 8, 9 to 12, and more than 12 PCPs, did not showed any significant difference between these subgroups. From these results we conclude that: 1- PCP is a very useful method for sever ophthalmological manifestations of BD. 2- The percentage of good results does not decrease with time. 3- Side effects are minor.