Cyclosporine, an endecapeptide fungal product with specific anti-T-cell characteristics, is being administered to patients with sight-threatening ocular inflammatory disease of noninfectious origin, who have failed on either corticosteroid or cytotoxic agent therapy, to test its efficacy in the treatment of uveitis. Within the context of these ongoing studies, the combined use of cyclosporine A and ketaconazole has been tested in a randomized masked study of a small group of patients whose uveitis was well controlled with cyclosporine. The combination allowed a significant reduction in the dose of cyclosporine needed to control the disease. In some instances, the dose could be reduced by as much as 90 percent. No significant increase in side effects was noted. A phase I/II randomized trial using cyclosporine A and cyclosporine G has ended. There is a definite trend showing that combined use of a cyclosporine and low to moderate steroid doses is efficacious in preventing the progression of uveitis. An effective dose of cyclosporine appears to be around 5 mg/kg. At this dosage, toxicity has been reduced for up to 12 months of followup. Cyclosporine G was more effective than cyclosporine A in treating cystoid macular edema. Patients who remain on cyclosporine long term continue to be followed to gain further information about renal (or other) toxicity. We foresee that these studies will end in the coming year.
