title: Treatment of Serpiginous Choroiditis with Chlorambucil: A Report of 17 Patients.
abstract: OBJECTIVE
  To evaluate the efficacy of chlorambucil in the treatment of serpiginous choroiditis.
  
  
  METHODS
  Patient records from the Massachusetts Eye Research and Surgery Institution (MERSI) were reviewed from over the past 10 years. In total, 17 patients with the diagnosis of serpiginous choroiditis treated with chlorambucil were identified. QuantiFERON gold was negative in all of them. Chlorambucil was started at 0.15 mg/kg and dosage was titrated up using weekly white blood cell (WBC) count to achieve a target cell number of 3.0-4.5 × 109cells/L. The goal of therapy was to maintain this value for at least 6-9 months. Adverse effects, recurrence, rate of new choroidal neovascularization (CNVM), and visual acuity before and after treatment were recorded.
  
  
  RESULTS
  The mean age of the 17 patients with the diagnosis of serpiginous choroiditis treated with chlorambucil was 46 years, and six patients (35%) were male. The mean duration of treatment for chlorambucil was 8.4 months. None of them developed cancer or persistent side-effects, with a mean follow-up of 53 months. Of the patients, 12 (71%) achieved an average of 45 (5-120) months drug-free remission in their last follow-up. Visual acuity of 33 treated eyes remained within two lines of Snellen acuity in 27 eyes (82%), improved in one eye (3%), and deteriorated in five eyes (15%). Leukopenia was the most common side-effect, which was reversible in all cases.
  
  
  CONCLUSIONS
  Chlorambucil in a relatively short duration of time, with an escalating dose guided by weekly WBC was well tolerated, as well as effective in preventing recurrence and maintaining vision in patients with serpiginous choroiditis.
authors.affiliation: a Massachusetts Eye Research and Surgery Institute , Waltham , Massachusetts , USA.|b Ocular Immunology and Uveitis Foundation , Weston , Massachusetts , USA.
authors.forename: Nazanin
authors.initials: N
authors.lastname: Ebrahimiadib
authors.affiliation: c Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA.
authors.forename: Bobeck S
authors.initials: BS
authors.lastname: Modjtahedi
authors.affiliation: c Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Davoudi
authors.affiliation: a Massachusetts Eye Research and Surgery Institute , Waltham , Massachusetts , USA.|b Ocular Immunology and Uveitis Foundation , Weston , Massachusetts , USA.|d Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA.
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* / Q000503:physiopathology; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D002699:Chlorambucil
keywords: Alkylating agents; chlorambucil; choroidal neovascularization; serpiginous choroiditis; uveitis