Immunosuppressives in uveitis. A preliminary report of experience with chlorambucil.

Since the mid-I96os there has been a small but steady trickle of reports of patients with severe uveitis who have been treated with non-steroid immunosuppressive drugs.This has paralleled the use of these drugs in other non-malignant conditions.In the past 2 years 14 patients at the Institute of Ophthalmology have been treated with chloram- bucil.This report is concerned with the preliminary findings in this group of patients.Chlorambucil was chosen for its relatively low toxic/therapeutic ratio, and its selective depression of lymphocytes (de Gruchy, 1970).The choice was encouraged by the experience of others who had used chlorambucil (Mamo and Azzam, 1970; Abdalla and Bahgat, I973).Rationale: evidence of an immunological dis- order in uveitis In attempting to explain the association of uveal disease with disorders of other tissues Perkins (I96I, I963) suggested an immunological disturbance based on common tissue antigens.He and others have demonstrated common tissue components, but without adducing firm evidence of their role in disease.Support for the antigenic role of uveal pigment in sympathetic ophthalmitis and Vogt-Koyanagi-Harada disease was advanced by Hammer (1971) in his work on lymphocyte transformation in patients with these conditions.Feinberg, Shore, Leopold, and Henley (1972) demonstrated leucocyte migration inhibition by an aqueous extract of uveal tissue in II of I2 patients with uveitis, although Strandgaard and Braendstrup (I 97 I) had previously failed to show this in 22 patients.Bonnet, Mouriquand, Jolbert, and Laurent (I 97 I) demonstrated the failure of aqueous in patients with relapsing uveitis to activate their own lymphocytes, and inferred from this the existence of cellular autoantibodies.