oa South African Medical Journal - The use of cortisone and ACTH in diseases of the eye*
*A paper read at the South African Medical Congress, Johannesburg, September 1952. 1. ACTH and cortisone are of great value in the treatment of iridocyclitis, sympathetic ophthalmia, interstitial keratitis, episcleritis, phlyctenular kerato-conjunctivitis, rosacea, keratitis, spring catarrh, acute uveitis and choroiditis. 2. In chronic granulomatous uveitis, the effect of these hormones is not so spectacular and recurrences after cessation of treatment are frequent. 3. When employed to suppress the inflammatory reaction due to infection, their use should be accompanied by specific antibiotic or chemotherapeutic procedures to eliminate the basic underlying infection. 4. They have no effect in the usual degenerative diseases of the eye. There is a possibility, however, that they may be effective in ocular disease related to fibrinoid degeneration. 5. Experimental studies, using various ocular reactions as the indices, have shown that : i. Topical or parenteral cortisone and parenteral ACTH will : (a) Suppress various recognized ocular hypersensitivity reactions; (b) Suppress ocular reactions due to irritants; (c) Suppress inflammation due to infection; (d) Inhibit neo-vascularization of the cornea; (e) Reduce fibroplastic activity in the stroma of the cornea and regeneration of the corneal endothelium. ii. Cortisone and hydrocortisone will radically alter the pathogenesis of ocular tuberculosis, changing the picture in the immune-allergic rabbit from a restrained fibrotic process into a necrotizing, caseating, destructive lesion. 6. The mechanism of the therapeutic action of ACTH and cortisone in ocular disease is as yet undetermined. The present indications are that it is due to a direct action of the adrenocortical hormones on the mesenchymal fraction of the inflamed tissue.
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