title: Successful treatment of serpiginous choroiditis with alkylating agents.
abstract: OBJECTIVE
  To describe the management and long-term outcomes of patients with serpiginous choroiditis treated with alkylating agents.
  
  
  METHODS
  Retrospective, noncomparative case series.
  
  
  METHODS
  Nine patients with active, vision-threatening serpiginous choroiditis who had progressive inflammation while on steroids and/or immunosuppressive agents other than alkylating agents treated at three tertiary care uveitis referral centers.
  
  
  METHODS
  Patients received systemic immunosuppression with an alkylating agent, either chlorambucil or cyclophosphamide. Prednisone also was given initially and was tapered and discontinued.
  
  
  METHODS
  Visual acuity, clinical disease activity, duration of treatment, duration of drug-free disease remission, and side effects of alkylating agent therapy.
  
  
  RESULTS
  No patients had recurrences while on therapy. No further visual loss was encountered after starting the therapy. Six of the patients regained vision. All but two patients achieved prolonged drug-free remissions, ranging in duration between 15 and 96 months (median, 78 months). Side effects included transient bone marrow suppression, nausea, and fatigue. Secondary malignancy was encountered in one patient, whose carcinoma of the urinary bladder was treated successfully.
  
  
  CONCLUSIONS
  Adequate immunosuppression with alkylating agents may favorably alter the long-term prognosis of patients with serpiginous choroiditis.
authors.affiliation: The Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
authors.forename: Esen Karamursel
authors.initials: EK
authors.lastname: Akpek
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.forename: Howard H
authors.initials: HH
authors.lastname: Tessler
authors.forename: Brian C
authors.initials: BC
authors.lastname: Joondeph
authors.forename: C Stephen
authors.initials: CS
authors.lastname: Foster
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D002699:Chlorambucil / Q000627:therapeutic use*; D002833:Choroiditis / Q000175:diagnosis / Q000188:drug therapy*; D003520:Cyclophosphamide; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D018906:Antineoplastic Agents, Alkylating; D007166:Immunosuppressive Agents; D002699:Chlorambucil; D003520:Cyclophosphamide