P 706
Allopurinol as an anti-inflammatory treatment in ocular toxoplasmosisH. I. Adam, C. M. C. Klais, F. Koch, F. Grus*, H. O. C. Gümbel
Introduction: A combination of systemic antibiotics and steroids has proved efficient in the treatment of ocular toxoplasmosis. Frequent side-effects often require dose reduction. Previous studies have shown allopurinol´s anti-inflammatory effect in experimental uveitis. This anti-inflammatory action of allopurinol is believed to be a result of free radical scavenging activity and immunomodulating activity.
Methods: In 8 patients with ocular toxoplasmosis daily doses of 600 to 800 mg of allopurinol and 6 million units of spiramycine were given orally over a period of 8 to 12 weeks. The control group, consisting of 6 patients, daily received 80 mg methylprednisolone p.o. instead of allopurinol. The anti-inflammatory effect was measured by tyndallometry, biomicroscopy, ophthlmoscopy and fluorescein angiography.
Results: In both groups a rapid equivalent decrease in the anterior chamber inflammation, a complete restoration of visual acuity, and a considerable improvement of vitreal inflammatory response was observed. No side-effects were noted in the allopurinol group in comparison to the steroid group such as depression, weight gain or dermatological problems.
Conclusion: In the view of the favourable clinical outcomes absent significant side-effects in the allopurinol patients, we would recommend the administration of allopurinol and spiramycine in ocular toxoplasmosis. Randomized clinical trials will be required to definitely prove the effectiveness in comparison to steroid therapy.
Augenklinik, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, D - 60590 Frankfurt am Main,
*Augenklinik der Universität Mainz, Langenbeckstr.1, 55101 Mainz