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Evidenzbasierte medikamentöse Therapie

 in der evidenzbasierten Medizin (EbM)

© Uveitis-Zentrum Münster

 

Inhalt:

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EbM Beurteilung:       Therapie von entzündlichen Augenerkrankungen

EbM Analyse:

                        ·            Uveitis im Kindesalter

                        ·                Uveitis im Erwachsenenalter

                        ·                Skleritis

                        ·                Chronische vernarbende Konjunktivitis beim Schleimhautpemphigoid

                        ·                Keratoplastik-Nachsorge


 

 

EbM Beurteilung: Therapie von entzündlichen Augenerkrankungen

 

Graduierung der Evidenz

I                                      >1 randomisierte kontrollierte Studie

II                                     >1 kontrollierte, aber nicht randomisierte Studie, Kohorten- oder Fall-Kontroll-Studien, bevorzugt von

                                           mehr als einer Forschungsgruppe oder von mehr als einem Zentrum, Beobachtung  von sehr

                                           deutlichen Effekten innerhalb unkontrollierter Studien

III                                     Expertenmeinung, klinische Erfahrung oder deskriptive Studien

 

Graduierung der Empfehlungen

Grad A                            Gute Evidenz für die Durchführung der Maßnahme/Therapie

Grad B                            Mäßige Evidenz für die Durchführung der Maßnahme/Therapie

Grad C                            Wenig Evidenz für die Durchführung der Maßnahme/Therapie

Grad D                            Mäßige Evidenz gegen die Durchführung der Maßnahme/Therapie

Grad E                            Gute Evidenz gegen die Durchführung der Maßnahme/Therapie

 

 

 

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EbM Analyse: Uveitis im Kindesalter

Stand Juli 2008 (jeweils beste Evidenzlage)

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Methotrexat                          IIIA

Weiss AH, Wallace CA, Sherry DD. Methotrexate for resistant chronic uveitis in children with juvenile rheumatoid arthritis. J Pediatr 1998; 133:266-268.    PubMed

Shetty AK, Zganjar BE, Ellis GS Jr, Ludwig IH, Gedalia A. Low-dose methotrexate in the treatment of severe juvenile rheumatoid arthritis and sarcoid iritis. J Pediatr Ophthalmol Strabismus 1999; 36:125-129.   PubMed

Samson CM, Waheed N, Baltatzis S, Foster CS. Methotrexate therapy for chronic noninfectious uveitis: analysis of a case series of 160 patients. Ophthalmology 2001; 108:1134-1139.   PubMed

Foeldvari I, Wierk A. Methotrexate is an effective treatment for chronic uveitis associated with juvenile idiopathic arthritis. J Rheumatol 2005; 32:362-365.   PubMed

Heiligenhaus A, Mingels A, Heinz C, Ganser G. Methotrexate for uveitis associated with juvenile idiopathic arthritis: value and requirement for additional anti-inflammatory medication. Eur J Ophthalmol 2007; 17: 743-748  PubMed

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Sulfasalazin                           IIIC

Benitez-Del-Castillo JM, Garcia-Sanchez J, Iradier T. Sulfasalazine in the prevention of anterior uveitis associated with ankylosing spondylitis. Eye 2000; 14: 340-343.   PubMed

Munoz-Fernandez S, Hidalgo V, Fernandez Melon J, Sulfasalazine reduces the number of flares of acute anterior uveitis over a one-year period. J Rheumatol 2003; 30. 1277-1279.   PubMed

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Cyclosporin A                       IIIC

Tappeiner C, Roesel M, Heinz C, Michels H, Ganser G, Heiligenhaus A. Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis. Eye 2008, Jun 13. [Epub ahead of print] 

Kilmartin DJ, Forrester JV, Dick  AD. Cyclosporin A therapy in refractory non-infectious childhood uveitis. Br J Ophthalmol 1998; 82: 737-42.   PubMed

Kotaniemi K. Late onset uveitis in juvenile-type chronic polyarthritis controlled with prednisolone, cyclosporin A and methotrexate. Clin Exp Rheumatol 1998; 16: 469-71.  PubMed

Gerloni V, Cimaz R, Gattinara M, Arnoldi C, Pontikaki I, Fantini F. Efficacy and safety profile of cyclosporin A in the treatment of juvenile chronic (idiopathic) arthritis. Results of a 10-year prospective study. Rheumatology (Oxford)  2001; 40: 907-13.   PubMed

Walton RC, Nussenblatt RB, Whitcup SM. Cyclosporine therapy for severe sight threatening uveitis in children and adolescents. Ophthalmology 1998; 105: 2028-2034.   PubMed

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Azathioprin                           IIIB

Hemady RK, Baer JC, Foster CS. Immunosuppressive drugs in the management of progressive, corticosteroid-resistant uveitis associated with juvenile rheumatoid arthritis. Int Ophthalmol Clin 1992: 32: 2241-252.   PubMed

Savoloinen HA, Kautianen H, Aho K. Azathioprin in patients with juvenile chronic arthritis: a long-term follow up study. J Rheumatol 1997; 24: 2444-2450   PubMed

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Mycophenolat Mofetil          IIIB

Doycheva DG, Deuter CM, Stuebiger N. Mycophenolate mofetil in the treatment of uveitis in children. Br J Ophthalmol 2007; 91: 180-184   PubMed

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Cyclophosphamid und Chlorambuzil                IIID

Palmer RG, Kanski JJ, Ansell BM. Chlormabucil in the treatment of intractable uveitis associated with juvenile chronic arthritis. J Rheumatol 1985; 12: 967-970.   PubMed

Miserocchi E, Balcatzis S, Ekong A. Efficacy and safety of chlorambucil in intractable noninfectious uveitis. Ophthalmology 2002; 109: 137-142.   PubMed

Pras E, Neumann R, Zandman-Goddard G, Levy Y, Assai EL, Shoenfeld Y, Langevitz P. Intraocular inflammation in autoimmune diseases. Semin Arthritis Rheum 2004; 34: 602-609.  PubMed
Wittmer R. Juvenile uveitis. Klin Monatsbl Augenheilk 1987; 191: 332-333.
PubMed
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Etanercept                            IC

Reiff A, Takei S, Sadeghi S et al. Etanercept therapy in children with treatment-resistant uveitis. Arthritis Rheum 2001; 44: 1411-1415   PubMed

Smith JA, Thompson DJ, Whitcup SM et al. A randomized, placebo-controlled, double-masked clinical trial of etanercept for the treatment of uveitis associated with juvenile idiopathic arthritis. Arthritis Rheum 2005; 53: 18-23   PubMed

Braun J, Baraliakos X, Listing J et al. Decreased incidence of anterior uveitis in patients with ankylosing spondylitis treated with the anti-tumor necrosis factor agents infliximab and etanercept. Arthritis Rheum 2005; 52: 2447-2451   PubMed

Reddy AR, Backhouse OC. Does etanercept induce uveitis? Br J Ophthalmol 2003; 89: 925   PubMed

Kaipiainen-Seppänen O, Leino M. Recurrent uveitis in a patient with juvenile spondylarthropathy associated with tumour necrosis factor inhibitors. Ann Rheum Dis 2003; 62: 88-89   PubMed

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Infliximab                             IIA

Tynjälä P, Lindahl P, Honkanen V, Lahdenne P, Kotaniemi K. Infliximab and etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis. Ann Rheum Dis. 2007 Apr;66(4):548-50   PubMed

Mangge H, Heinzl B, Grubbauer HM et al. Therapeutic experience with infliximab in a patient with polyarthritis juvenile idiopathic arthritis and uveitis. Rheumatol Int 2003; 23: 258-261   PubMed

Rajaraman RT, Kimura Y, Li S et al. Retrospective case review of pediatric patients with uveitis treated with infliximab. Ophthalmology 2006; 113: 308-314   PubMed

Kahn P, Weiss M, Imundo LF et al. Favorable response to high-dose infliximab for refractory childhood uveitis. Ophthalmology 2006; 113: 860-864   PubMed

Saurenmann RK, Levin AV, Rose JB et al. Tumour necrosis factor inhibitors in the treatment of childhood uveitis. Rheumatology 2006; 45: 982-989.   PubMed

Foeldvari I, Nielsen S, Kuemmerle Deschner J, Espada G, Horneff G, Bica B, Olivieri AN, Wierk A, Saurenmann RK. Tumour necrosis factor alpha blocker in treatment of juvenile idiopathic arthritis associated uveitis refractory to second line agents: results of a multinational survey. J Rheumatol 2007: 34: 1146-1150.   PubMed

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Adalimumab                         IIIA

Tynjälä P, Kotaniemi K, Lindahl P, Lavta K, Aalto K, Honkanen V, Lahdenne P. Adalimumab in juvenile idiopahic arthritis associated chronic anteriore uveitis. Rheumatology 2008; 47: 339-344.   PubMed

Biester S, Deuter C, Michels H, Haefner R, Kuemmerle-Deschner J, Doycheva D, Zierhut M. Adalimumab in the therapy of uveitis in childhood. Br J Ophthalmol 2007; 91: 319-324.   PubMed

Vazquez-Cobian LB, Flynn T, Lehmann TJ. Adalimumab therapy for childhood uveitis. J Pediatr 2006: 149: 572-575.  PubMed

 

 

 

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EbM Analyse: Uveitis im Erwachsenenalter

Stand Juli 2008 (jeweils beste Evidenzlage)

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Cyclosporin A                       IA

de Vries J, Baarsma GS, Zaal MJW, et al. Cyclosporin in the treatment of severe chronic idiopathic uveitis. Br J Ophthalmol 1990, 74:344-349.  PubMed

Nussenblatt RB, Palestine AG, Chan CC, et al. Randomized, double-masked study of cyclosporine compared to prednisolone in the treatment of endogenous uveitis. Am J Ophthalmol 1991; 112:138-146.   PubMed

BenEzra D, Cohen E, Chajek T, et al. Evaluation of conventional therapy versus cyclosporine A in Behçet’s syndrome. Transplant Proc 1988; 20:136-143.   PubMed

Masuda K, Nakajima A, Urayama A, et al. Double-masked trial of cyclosporin versus colchicines and long-term open study of cyclosporin in Behçet’s disease. Lancet 1989; 1:1093-1096.   PubMed

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Tacrolimus                            IIC

Mochizuki M, Masuda K, Sakane T, et al. A clinical trial of FK506 in refractory uveitis. Am J Ophthalmol 1993; 115:763-769.   PubMed

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Azathioprin                           IIB, (randomisiert kontrolliert (IB) nur für M Behcet)

Yazici H, Pazarli H, Barnes CG, et al. A controlled trial of azathioprine in Behcet´s syndrome. N Engl J Med 1990; 322: 281-285   PubMed

Andrasch RH, Pirofsky B, Burns RP. Immunosuppressive therapy for severe chronic uveitis. Arch Ophthalmol 1978; 96:247-251.    PubMed

Jabs DA, Rosenbaum JT, Foster CS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol 2000; 130:492-513.   PubMed

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Methotrexat                          IIB

Samson CM, Waheed N, Baltatzis S, Foster CS. Methotrexate therapy for chronic noninfectious uveitis: analysis of a case series of 160 patients. Ophthalmology 2001; 108:1134-1139.   PubMed

Kaplan-Messas A, Barkana Y, Avni I, Neumann R. Methotrexate as a first line corticosteroid sparing therapy in a cohort of uveitis and scleritis. Ocular Immunol Inflamm 2003; 11:131-139.    PubMed

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Mycophenolat Mofetil          IIB

Baltatzis S, Tufail F, Yu EN, et al. Mycophenolate mofetil as an immunomodulatory agent in the treatment of chronic ocular inflammatory disease. Ophthalmology 2003; 110:1061-1065. PubMed

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Cyclophosphamid                IIC

Özyazgan Y, Yurdakul S, Yazici H, et al. Low dose cyclosporin A versus pulsed cyclophosphamide in Behçet’s syndrome: a single masked trial. Br J Ophthalmol 1992; 76:241-243.    PubMed

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Chlorambucil                                   IIC

Miserocchi E, Baltatzis S, Ekong A, et al. Efficacy and safety of chlorambucil in intractable noninfectious uveitis: the Massachusetts Eye and Ear Infirmary experience. Ophthalmology 2002; 109:137-142.   PubMed

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Interferon alpha                   IIB (bei M Behçet IIA)

Kötter I, Eckstein AK, Stübiger N, Zierhut M. Treatment of ocular symptoms of Behçet’s disease with interferon alpha 2a: a pilot study. Br J Ophthalmol 1998; 82:488-494.    PubMed

 

 

 

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EbM Analyse: Skleritis

Stand Juli 2008 (jeweils beste Evidenzlage)

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Kortison systemisch                         IIIB

McCluskey P, Wakefield D. Intravenous pulse methylpredisolone in scleritis. Arch Ophthalmol 1987; 105: 793-795.   PubMed

Sainz de la Maza M, Jabbur NS, Foster CS. An analysis of therapeutic decision for sclertiis. Ophthalmology 1993; 100: 1372-1376.   PubMed

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Nichtsteroidale Antirheumatika     IIB  (nichtnekrotisierend)

Sainz de la Maza M, Jabbur NS, Foster CS. An analysis of therapeutic decision for sclertiis. Ophthalmology 1993; 100: 1372-1376.   PubMed

Jabs DA, Mudun A, Dunn JP et al. . Episcleritis and scleritis: clinical features and treatment. Am J Ophthalmol 2000; 130: 469-476.   PubMed

Heiligenhaus A, Dück N, Michel D, Hudde T, Koch J, Steuhl KP. Indication and effect of immunosuppression in patients with scleritis. Klin Monatsbl Augenheilk 2003; 220: 471-480.  PubMed

Sainz de la Maza M, Jabbur NS, Foster CS. An analysis of therapeutic decision for sclertiis. Ophthalmology 1993; 100: 1372-1376.    PubMed

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Coxibe (Cox II Hemmer)                 IIB (nichtnekrotisierend)

Bauer AM, Fiehn C, Becker MD. Celecoxib, a selective inhibitor of cyclooxygenase 2 for therapy of diffuse anterior scleritis. Am J Ophthalmol 2005; 139: 1086-1089.    PubMed

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Cyclophosphamid                            IIB für nichtnekrotisirend, IIA für nekrotisierend

Jampol LM, West C, Goldberg MF. Therapy of scleritis with cytotoxic agents. Am J Ophthalmol 1978; 86: 266-271.   PubMed

Foster CS, Forstot SL, Wilson LA. Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or peripheral ulcerative keratitis: effects of systemic immunosuppression. Ophthalmology 1984; 91: 1253-1263.   PubMed

Jabs DA, Mudun A, Dunn JP et al. . Episcleritis and scleritis: clinical features and treatment. Am J Ophthalmol 2000; 130: 469-476.   PubMed

Meyer PA, Watson PG, Franks W, et al. Pulsed immunosuppressive therapy in the treatment of immunologically induced corneal and scleral disease. Eye 1987; 1: 487-495.   PubMed

Fauci AS, Hayes BF, Katz P, et al. Wegener´s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern med 1983; 98: 76-85.  PubMed

Sainz de la Maza M, Jabbur NS, Foster CS. An analysis of therapeutic decision for sclertiis. Ophthalmology 1993; 100: 1372-1376.   PubMed

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Methotrexat                                      IIIB

Shah SS, Lowder CY, Schmitt MA et al.. Low dose methotrexate therapy for cular inflammatory disease. Ophthalmology 1992; 99: 1419-1423.   PubMed

Jampol LM, West C, Goldberg MF. Therapy of scleritis with cytotoxic agents. Am J Ophthalmol 1978; 86: 266-271.    PubMed

Sainz de la Maza M, Jabbur NS, Foster CS. An analysis of therapeutic decision for sclertiis. Ophthalmology 1993; 100: 1372-1376.   PubMed

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Azathioprin                                      IIIB

Jampol LM, West C, Goldberg MF. Therapy of scleritis with cytotoxic agents. Am J Ophthalmol 1978; 86: 266-271.   PubMed

Sainz de la Maza M, Jabbur NS, Foster CS. An analysis of therapeutic decision for sclertiis. Ophthalmology 1993; 100: 1372-1376.   PubMed

Soukiasian SH, Foster CS, Raizman MB. Treatment strategies for scleritis and uveitis associated with inflammatory bowel disease. Am J Ophthalmol 1994; 118: 601-611.   PubMed

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Cyclosporin A                                  IIIB

Wakefield D, McCluskey P. Cyclosporin therapy for severe scleritis. Br J Ophthalmol 1989; 73: 743-746.   PubMed

McCarthy JM, Dubord PJ, Chalmers A, et al. Cyclosporine A for the treatment of of necrotizing scleritis and corneal melting in patients with rheumatoid arthritis. J Rheumatol 1992; 19: 1358-1361.   PubMed

Jampol LM, West C, Goldberg MF. Therapy of scleritis with cytotoxic agents. Am J Ophthalmol 1978; 86: 266-271.   PubMed

Sainz de la Maza M, Jabbur NS, Foster CS. An analysis of therapeutic decision for sclertiis. Ophthalmology 1993; 100: 1372-1376.   PubMed

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Mycophenolat Mofetil                     IIIB

Larkin G, Lightman S. Mycofenolate mofetil: a useful immunosuppressive in inflammatory eye disease. Ophthalmology 1999; 106: 307-314.   PubMed

Sen HN, Suhler EB, Al-Khatib SQ, et al. Mycophenolate mofetil for the treatment of scleritis. Ophthalmology 2003; 110: 1750-1755.   PubMed

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Tumor Nekrose Faktor alpha Inhibitoren

Infliximab                                         IIIB

Murphy CC; Ayliffe WH, Booth A, Makanjuola D, Andrews PA, Jayne D. Tumor necrosis factor alpha blockade with infliximab for refractory uveitis and scleritis. Ophthalmology 2004; 111: 352-356.     PubMed

El-Shabrawi Y, Hermann J. Anti-TNF alpha therapy in chronic necrotizing scleritis resistant to standard immunomodulatory therapy in a patient with Wegener´s granulomatosis. Eye 2005; 19: 1017-1018.   PubMed

Weiss K, Rieger R, Keitzer R, Pleyer U. Successful infliximab treatment of psterior scleritis in a 13 year old child refractory to other immunosuppressive therapy. Graefes Arch Clin Exp Ophthalmol 2007; 2245: 1735-1737.   PubMed

Adalimumab                                     IIIB

Huynh N, Cervantes-Castaneda RA, Bhat P, Gallagher J, Foster CS. Biologic response modifier therapy for psoriatic ocular inflammatory disease. Ocul Immunol Inflamm 2008; 16: 89-93.   PubMed

 

 

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EbM Analyse: Chronische vernarbende Konjunktivitis beim Schleimhautpemphigoid

Stand Juli 2008 (jeweils beste Evidenzlage)

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Lokales Kortison                  IIB

Foster CS, Wilson LA, Ekins MB. Immunosuppressive therapy for progressive ocular cicatricial pemphigoid. Ophthalmology 1982; 89: 340-353.   PubMed

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Lokales Cyclosporin A        IIIC

Holland EJ, Olsen TW, Ketcham JM, Florine C, Krachmer JH, Purcell JJ, Lam S, Tessler HH, Sugra J. Topical cyclosporin A in the treatment of anterior segment inflammatory disease. Cornea 1993; 12: 413-419.   PubMed

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FK 506                                   IVC

Hall VC, Liesegang TJ, Kostick DA, Lookingbill DP. Ocular mucous membrane pemphigoid and ocular pemphigus vulgaris treated topically with tacrolimus ointment. Arch Dermatol 2003; 139: 1083-1084.   PubMed

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Systemisches Kortison          IB

Mondino BJ, Brown SI. Immunosuppressive therapy in ocular cicatricial pemphigoid. Am J Ophthalmol 1983; 96: 453-459.   PubMed

Foster CS. Cicactricial pemphigoid. Trans Am Ophthalmol Soc 1986; 84: 527-663.  PubMed

Elder MJ, Lightman S, Dart JKG. Role of cyclophosphamide and high dose steroid in ocular cicatricial pemphigoid. Br J Ophthalmol 1995; 79: 264-266.   PubMed

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Cyclophosphamid                IB

Foster CS, Wilson LA, Ekins MB. Immunosuppressive therapy for progressive ocular cicatricial pemphigoid. Ophthalmology 1982; 89: 340-353.   PubMed

Foster CS. Cicactricial pemphigoid. Trans Am Ophthalmol Soc 1986; 84: 527-663.    PubMed

Mondino BJ, Brown SI. Immunosuppressive therapy in ocular cicatricial pemphigoid. Am J Ophthalmol 1983; 96: 453-459.   PubMed

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Azathioprin                           IIB

Mondino BJ, Brown SI. Immunosuppressive therapy in ocular cicatricial pemphigoid. Am J Ophthalmol 1983; 96: 453-459.   PubMed

Mondino BJ. Cicatricial pemphigoid and erythema multiforme. Ophthalmology 1990; 97: 939-952.   PubMed

Tauber J, Sainz de la Maza M, Foster CS. Systemic chemotherapy for ocular cicatricial pemphigoid. Cornea 1991; 10: 185-195.    PubMed

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Methotrexat                          IIIB

McCluskey P, Chang JH, Singh R, Wakefield D. Methotrexate therapy for ocular cicatricial pemphigoid. Ophthalmology 2004; 111: 796-801.   PubMed

Miserocchi E, Baltatzis S, Roque MR, Ahmed AR, Foster CS. The effect of treatment and its related side effect in patients with severe ocular cicatricial pemphigoid. Ophthalmology 2002; 109: 111-118.    PubMed

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Mycophenolat Mofetil          IIIB

Reis A, Reinhard T, Sundmacher R, Althaus C, Voiculescu A, Kutkuhn B. Mycophenolate mofetil in ocular immunological disorders. A survey of the literature and 3 case reports. Klin Monatsbl Augenheilk. 1998; 213: 257-261.   PubMed

Zurdel J, Aboalchamat B, Zierhut M, Stübinger N, Bialasiewicz A, Engelmann K. Erste klinische Erfahrungen mit Mycophenolatmofetil bei der immunsuppressiven Therapie des okulären Pemphigoides. Klin Monatsbl Augenheilk 2001; 218: 222-228.   PubMed

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Cyclosporin A                       IIIC

Foster CS. Cicactricial pemphigoid. Trans Am Ophthalmol Soc 1986; 84: 527-663.   PubMed

Neumann R, Tauber J, Foster CS. Remission and recurrence after withdrawal of therapy for ocular cicatricial pemphigoid. Ophthalmology 1991; 98: 858-862.   PubMed

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Tacrolimus                            IIIC

Letko E, Ahmed AR, Foster CS. Treatment of ocular cicatricial pemphigoid with tacrolimus (FK 506). Graefes Arch Clin Exp Ophthalmol 2001; 239: 441-444.   PubMed

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Dapson                                  IB

Foster CS. Cicactricial pemphigoid. Trans Am Ophthalmol Soc 1986; 84: 527-663.   PubMed

Fern AI, Jay JL, Young H, McKie R. Dapsone therapy for acute inflammatory phase of ocular pemphigoid. Br J Ophthalmol 1992; 76: 332-335.   PubMed

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Sulfasalazin                           IVC

Doan S, Lerouic JF, Robin H, Prost C, Savoldelli M, Hoang-Xuan T. Treatment of ocular cicatricial pemphigoid with sulfasalazine. Ophthalmology 2001; 108: 1565-1568.   PubMed

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Immunglobuline                   IIB

Letko E, Miserocchi E, Daoud YJ, Christen W, Foster CS, Ahemd AR. A nonrandomized comparison of the clinical outcome of ocular involvement in patients with mucous membrane (cicatricial) pemphigoid between conventional immunosuppressive and intravenous immunoglobulin therapies. Clin Immunol 2004; 111: 303-310.   PubMed

Sami N, Letko E, Androudi S, Daous Y, Foster CS. Intravenous immunoglobulin therapy in patients with ocular cicatricial pemphigoid. A long-term follow-up. Ophthalmology 2004; 111: 1380-1382.   PubMed

 

 

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EbM Analyse: Keratoplastik-Nachsorge

Stand Juli 2008 (jeweils beste Evidenzlage)

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Systemische Kortikosteroide bei akuter endothelialer Abstossung                    IIB

Hudde T, Minassian DC, Larkin DF. Randomised controlled trial of corticosteroid regimens in endothelial corneal allograft rejection. Br J Ophthalmol. 1999; 83: 1348-1352.   PubMed

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systemisches Cyclosporin A                                                IIA

Reinhard T, Sundmacher R, Heering P. Systemic ciclosporin A in high-risk keratoplasties. Graefes Arch Clin Exp Ophthalmol. 1996; 234 Suppl 1: S115-121.   PubMed

Hill T. The use of cyclosporine in high-risk keratoplasty. Am J Ophthalmol. 1989; 107: 506-510.    PubMed

Poon AC, Forbes AC, Dart JK; et al. Systemic cyclosporin A in high risk penetrating keratoplasties: a case-control study. Br J Ophthalmol. 2001; 85:1464-1469.   PubMed

Hill JC. Systemic cyclosporine in high-risk keratoplasty: long-term results. Eye. 1995; 9: 422-428.   PubMed

Young AL, Rao SK, Cheng LL, et al.. Combined intravenous pulse methylprednisolone and oral cyclosporine A in the treatment of corneal graft rejection: 5-year experience. Eye. 2002; 16: 304-308.   PubMed

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Mycofephenolat Mofetil                                          IA

Reinhard T, Mayweg S, Sokolovska Y, et al. Systemic mycophenolate mofetil avoids immune reactions in penetrating high-risk keratoplasty: preliminary results of an ongoing prospectively randomized multicentre study. Transpl Int. 2005; 18: 703-708.   PubMed

Reinhard T, Reis A, Böhringer D, et al. Systemic mycophenolate mofetil in comparison with systemic cyclosporin A in high-risk keratoplasty patients: 3 years' results of a randomized prospective clinical trial. Graefes Arch Clin Exp Ophthalmol. 2001; 239: 367-372.   PubMed

Reis A, Reinhard T, Voiculescu A, et al. Mycophenolate mofetil versus cyclosporin A in high risk keratoplasty patients: a prospectively randomised clinical trial. Br J Ophthalmol. 1999; 83:1268-1271.  PubMed

 

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