Chlorambucil combination therapy in refractory serpiginous c
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• Serpiginous choroiditis may be recurrent or refractory to chlorambucil in conjunction with systemic corticosteroids.

• The stability of WBC counts within lower limits of normal is an essential factor for the success of chlorambucil therapy.

• This can be achieved with dexamethasone intravitreal implant or systemic immunomodulatory without systemic corticosteroid therapy.

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.

The stability of WBC counts within toxic levels close to normal or lower limits of normal (3000–4500 cells/?l) 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.

Read more : https://www.sciencedirect.com/science/article/pii/S2451993621000050?dgcid=rss_sd_all
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