Four patients with granulomatous disease of the anterior visual pathway presented with optic neuropathy between July 1986 and February 1987, secondary to an orbital pseudotumor (n = 1) and sarcoidosis (n = 3). All but one became resistant to corticosteroid therapy, and all were subsequently treated for 1 to 2 years with low-dose cyclosporine alone or in combination with tapering doses of prednisone. Two patients experienced pronounced recovery of visual function, and visual function was stabilized in the other two; in one of these, magnetic resonance imaging showed substantial regression of intracranial lesions. Steroid-induced complications of uncontrolled hyperglycemia (n = 2) and obesity (n = 4) were controlled with cyclosporine. The authors conclude that low-dose cyclosporine is a safe and effective therapeutic alternative in ocular granulomatous diseases.
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