Chlorambucil combination therapy in refractory serpiginous choroiditis: A cure?

Abstract

Purpose To find a remedy for serpiginous choroiditis refractory to oral prednisone and chlorambucil treatment. Observations Eight eyes of four patients (all female) with advanced macular involvement secondary to serpiginous choroiditis were included in the study. The average age of the patients was 45.2 years. One eye of each patient was legally blind and the lesion was close to the fovea in the other eye. All four patients failed oral prednisone and chlorambucil therapy. However, case 1 responded to chlorambucil treatment after intravitreal dexamethasone implant implantation and discontinuation of oral prednisone. Case 2 responded to chlorambucil therapy when oral prednisone was stopped in combination with infliximab therapy. Due to long follow-up period of more than four years, these two cases are considered to be cured. Case 3 and case 4 were not able to achieve remission with chlorambucil and immunomodulatory therapy. They refused intravitreal steroid implant due to side effects profile. Conclusions and importance The stability of WBC counts within toxic levels close to normal or lower limits of normal (3000–4500 cells/μl) during treatment with chlorambucil is an essential factor for the success of this therapy. A combination of dexamethasone intravitreal implant with chlorambucil therapy can be an effective and promising regimen in inducing and maintaining remission in refractory serpiginous choroiditis patients who fail a combination of systemic corticosteroid and chlorambucil therapy.

Tuberculosis-related serpiginous choroiditis: aggressive therapy with dual concomitant combination of multiple anti-tubercular and multiple immunosuppressive agents is needed to halt the progression of the disease

“…Majunder et al, in their extensive review on SC, gave a detailed account on treatments used in SC [1]. In the literature, a trend was found towards treatments which may have severe life-threatening side-effects such as chlorambucil [20][21][22] and cyclophosphamide [23,24], an indication on how difficult and how unsatisfactory the treatment of this condition appears to be. This was a stimulus for us to opt for an immunosuppressive therapy with multiple agents.…”

Adalimumab Monotherapy in the Treatment of Idiopathic Multifocal Choroiditis: A Case Report

“…The theory of epitope spreading postulates that the longer inflammation persists, the more resistant and stubborn it will become as cell destruction by the activated immune system exposes more cryptogenic self-antigens to the immune system, further stimulating autoimmune inflammation [7,8]. This is believed to happen in patients with more resistant cases of uveitis, including MFC or PICCP [9,10]. In addition, even a few milligrams of daily prednisone can lead to long-term side effects such as weight gain, bone density loss (especially in post-menopausal women), and sleep/mood disturbances.…”