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Achten R, Thijs J, van der Wal M, van Luijk C, Bakker D, Knol E, van Luin M, El Amrani M, Delemarre E, Elfiky AMI, de Boer J, van Wijk F, de Graaf M, de Bruin-Weller M. Ocular surface disease in moderate-to-severe atopic dermatitis patients and the effect of biological therapy. Clin Exp Allergy 2024; 54:241-252. [PMID: 38332535 DOI: 10.1111/cea.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease for which new targeted therapies are currently available. Due to the increased rates of ocular surface disease (OSD) reported during treatment with these new targeted treatments, more insight into the occurrence and pathomechanism of OSD in moderate-to-severe AD patients is needed. Therefore, this review's first part highlights that most patients with moderate-to-severe AD already have characteristics of OSD before starting targeted treatment. Remarkably, not all AD patients with OSD report ocular symptoms. OSD in AD is associated with less conjunctival goblet cells (GC) compared to healthy controls. In addition, OSD severity in AD patients is associated with high AD activity, the presence of eyelid and/or facial eczema, and high levels of AD-related severity biomarkers in tear fluid. The second part of this review highlights that pre-existing ocular pathology (e.g. in combination with the use of ophthalmic medication or eyelid eczema) may be associated with the development of dupilumab-associated ocular surface disease (DAOSD). During dupilumab treatment, DAOSD (which can be new-onset OSD or worsening of pre-existing OSD) is observed in approximately one-third of the dupilumab-treated AD patients. Anti-inflammatory ophthalmic treatment improves DAOSD, and dose reduction of dupilumab may also be an effective treatment option. The pathomechanism of DAOSD is still not fully elucidated. In a prospective study low, but stable conjunctival GC numbers were observed in moderate-to-severe AD patients, before and during dupilumab treatment. However, the Mucin 5 AC (MUC5AC) expression of GCs decreased during dupilumab treatment, suggesting an impairment of the GC function by dupilumab treatment. In addition, higher dupilumab tear fluid levels were found in dupilumab-treated AD patients with moderate-to-severe OSD compared to patients with no or mild OSD, whereas the dupilumab serum levels are similar. Clinicians should be aware of the frequent occurrence of OSD in moderate-to-severe AD patients, and a low-threshold referral to an ophthalmologist is recommended.
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Affiliation(s)
- Roselie Achten
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith Thijs
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlot van der Wal
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Chantal van Luijk
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daphne Bakker
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edward Knol
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Matthijs van Luin
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mohsin El Amrani
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eveline Delemarre
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ahmed M I Elfiky
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joke de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
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Erdinest N, Noyman DBE, London N, Lavy I, Levinger N, Landau D, Solomon A, Morad Y, Naroo SA. Applications of topical immunomodulators enhance clinical signs of vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC): a meta-analysis. Int Ophthalmol 2024; 44:157. [PMID: 38522059 DOI: 10.1007/s10792-024-03097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE This meta-analysis aimed to review the safety and efficacy of topical cyclosporine A (CsA) and topical tacrolimus in allergic eye disease. METHODS A systematic search identified thirteen studies and a total of 445 patients for inclusion, making this the largest meta-analysis published on the subject. The current review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS Thirteen randomized control trials were included in the meta-analysis. Eleven studies used CsA as the treatment, and two used Tacrolimus. In total, 445 participants were included, of whom 76.6% were male. The mean age of participants across the included studies was 14 years. All studies reported clinical signs as evaluated by an examining clinician. Signs were usually assessed by anatomical region, with the most common regions being the conjunctiva and the cornea, and the most common signs assessed were hyperemia and papillae. Three studies accounted for more than 50% of the meta-analysis's weight. Effect size (d) ranged from - 2.37 to - 0.03, negative values favoring immunomodulators. Fixed Effect Meta-Analysis returned an SMD of - 0.81 (95% CI [- 0.98, - 0.65]). However, there was significant heterogeneity (I2 = 61%, Qw = 30.76) in the outcome measure (P = 0.0021); therefore, a random-effect meta-analysis was also completed in which the pooled SMD was - 0.98 (95% CI [- 1.26, - 0.69], τ2 = 0.16). CONCLUSIONS This study affirms the current scientific community's stance that immunomodulators effectively treat clinical signs, including blepharitis, conjunctival hyperemia, edema, papillae, and corneal damage in severe ocular allergic disease.
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | - Itay Lavy
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nadav Levinger
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Ophthalmology, Enaim Refractive Surgery Center, Jerusalem, Israel
| | - David Landau
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Abraham Solomon
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Morad
- Department of Ophthalmology, Asaf Harofeh Medical Center, Béer Yáakov, Israel
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
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Ali W, Alam Khan S, Ullah Khan F, Khan S, Khan WA, Zafar R, Moqeet MA. Long-Term Clinical Outcome of Tacrolimus Skin Ointment (0.03%) for the Treatment of Vernal Keratoconjunctivitis: A Quasi-Experimental Study. Cureus 2023; 15:e50579. [PMID: 38226116 PMCID: PMC10788690 DOI: 10.7759/cureus.50579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Background Vernal keratoconjunctivitis (VKC) is an allergic conjunctival inflammation with severe ocular complications if left untreated. The current management regimen is plagued with adverse effects, long-term problems, and clinical relapses. Tacrolimus offers an alternative treatment option, and long-term studies are needed to determine its efficacy. Methods A two-year follow-up based study was conducted on moderate to severe VKC patients, who were prescribed tacrolimus skin ointment. The 5-5-5 exacerbation scale was used for the monitoring and grading severity of the disease. Analysis of variance (ANOVA) and intergroup comparisons were conducted on exacerbation scale scores among follow-ups. Results A significant reduction was observed in the total score of severity from baseline (203.17±102.05) to three months' follow-up (69.94±70.54), and it kept reducing for 18 months post therapy. Similar results with statistically significant reduction were observed for all grades of the scale. The relapse rate was 5.71% within a month after therapy cessation, and none of the other patients showed relapse afterward. No significant ocular and systemic complications were observed during the study. Conclusion Tacrolimus is effective in the long-term management of VKC without the complications of conventional steroid-based therapy.
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Affiliation(s)
- Warda Ali
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Saad Alam Khan
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Fahim Ullah Khan
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Shama Khan
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Wajid A Khan
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Rabeeah Zafar
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Muhammad A Moqeet
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
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Alghamdi AH. Treatment of Steroid-Resistant Nodular Episcleritis With Tacrolimus: A Case Report. Cureus 2023; 15:e47057. [PMID: 38022063 PMCID: PMC10644324 DOI: 10.7759/cureus.47057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
A 46-year-old male, with no chronic medical illness, complained of pain, tearing, and redness for one-month duration, with no photophobia, discharge, or decrease in visual acuity. Examination revealed a small, painful, red swelling in the left sclera. Slit-lamp examination using a narrow bright slit beam revealed edema of the episcleral layer and injection of the superficial episcleral blood vessels. The rest of the anterior segment exam and fundoscopy were normal. The laboratory investigations and systemic workup were normal. The patient was initially treated with prednisolone acetate (Pred Forte) 1% every three hours per day for one week, and then four times per day for another week, and tapered gradually over eight weeks with systemic nonsteroidal anti-inflammatory drugs (NSAIDs) as diclofenac sodium for eight weeks with mild improvement of clinical symptoms, but the size of the lesion remained without any change and the patient started to have a relapse of symptoms at the end of the course. Topical tacrolimus drops of 0.1% concentration were prepared in the pharmacy under complete sterile precautions and were used four times per day for the following six weeks duration instead of the initial therapy (steroids and NSAIDs). Tacrolimus drops were then tapered gradually over another six weeks duration. The patient showed dramatic suppression of inflammation and exceptional remission of symptoms with complete resolution of the episcleritis. Topical tacrolimus is very effective in the treatment of nodular episcleritis, which is resistant to steroid therapy. Patients with nodular episcleritis suffer from prolonged bouts of inflammation that are characteristically more painful than the diffuse type and may be associated with other systemic diseases. The case is steroid-resistant nodular episcleritis, which did not respond to the usual treatment and showed a good response to treatment with tacrolimus, which was first introduced in episcleritis. Tacrolimus is being used in other ocular diseases, but its use in episcleritis is unique.
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Sivanandam A, Sattarova V, Areaux RG. Dupilumab-associated ectropion and punctal stenosis treated with tacrolimus ointment (0.03%) in a 15-year-old girl. J AAPOS 2022; 26:275-278. [PMID: 36113697 DOI: 10.1016/j.jaapos.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/27/2022] [Accepted: 07/11/2022] [Indexed: 10/14/2022]
Abstract
A 15-year-old Asian girl with severe atopic dermatitis was referred for dupilumab-associated blepharoconjunctivitis. Medical history was significant for severe atopic dermatitis. She was started on prednisolone acetate 1% ophthalmic suspension three times daily, and dupilumab injections were withheld after the initial visit. The patient was noted to have right lower eyelid ectropion, cicatricial occlusion, and severe punctal stenosis 6 weeks later. She was started on 0.03% tacrolimus ointment to the eyelid margin. Resolution of ectropion and restoration of punctal patency with residual stenosis were observed 4 weeks later. This is the first reported adolescent case of dupilumab-associated ectropion and punctal stenosis successfully treated with topical tacrolimus ointment.
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Affiliation(s)
- Abiram Sivanandam
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Victoria Sattarova
- Department of Ophthalmology and Neurosciences, University of Minnesota, Twin Cites
| | - Raymond G Areaux
- Department of Ophthalmology and Neurosciences, University of Minnesota, Twin Cites.
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Bernales A, Berger O, Hamada S. Topical tacrolimus for the treatment of external eye inflammation in children. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2039628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Osvaldo Berger
- Corneoplastic department. Queen Victoria Hospital. East Grinstead. United Kingdom
| | - Samer Hamada
- Corneoplastic department. Queen Victoria Hospital. East Grinstead. United Kingdom
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Topical Steroids and Antibiotics for Adult Blepharokeratoconjunctivitis (BKC): A Meta-Analysis of Randomized Clinical Trials. J Ophthalmol 2021; 2021:3467620. [PMID: 33520297 PMCID: PMC7817233 DOI: 10.1155/2021/3467620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/23/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose A meta-analysis was conducted to evaluate the efficacy and safety of topical treatments (including steroids and antibiotics) for adults with blepharokeratoconjunctivitis (BKC). Methods The following databases were searched for relevant randomised controlled trials (RCTs): China National Knowledge Infrastructure (CNKI), Web of Science, MEDLINE, PubMed, Embase, and Cochrane Central Register of Controlled Trials database (CENTRAL). Two reviewers selected studies and analyzed the risk of bias independently. The treatments were loteprednol 0.5%/tobramycin 0.3% (LE/T) and dexamethasone 0.1%/tobramycin 0.3% (DM/T). The efficacy outcome measures were change from baseline (CFB) in composite scores of ocular symptoms and signs; the CFB in the signs composite scores for blepharitis, conjunctivitis, and keratitis at each visit; the total ocular adverse event incidence (AEs); and the incidence of intraocular pressure (IOP) increase after treatment. Prepost mean differences (MDs) were compared for continuous outcome variables, and incidences were analyzed for dichotomous data. The pooled effect sizes were analyzed using 95% confidence intervals (CIs) in a fixed-effect model. Heterogeneity was evaluated using the Q-test and I2 statistic. Results The CFB to final visit in ocular symptoms and signs of BKC was not statistically different between the two treatments (95% CI, −0.33 to 1.50; MD = 0.58; P=0.21). The CFB in signs composite scores for blepharitis (95% CI, −0.16 to 0.48; MD = 0.16; P=0.32), conjunctivitis (95% CI, −0.55 to 1.76; MD = 0.61; P=0.30), and keratitis (95% CI, 0.00–0.28; MD = 0.14; P=0.05) was also similar with the two treatments. LE/T was a safer intervention than DM/T, with fewer overall adverse events (95% CI, 0.34–0.80; RR = 0.52; P=0.003) and significantly less elevation of intraocular pressure (IOP) (95% CI, 0.32–0.70; RR = 0.47; P=0.0002). Conclusions DM/T and LE/T are both effective treatments for BKC, but LE/T may be a safer intervention.
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Mahmoudi A, Malaekeh-Nikouei B, Hanafi-Bojd MY, Toloei M, Hosseini M, Nikandish M. Preliminary I n V ivo Safety Evaluation of a Tacrolimus Eye Drop Formulation Using Hydroxypropyl Beta Cyclodextrin After Ocular Administration in NZW Rabbits. Clin Ophthalmol 2020; 14:947-953. [PMID: 32273679 PMCID: PMC7108877 DOI: 10.2147/opth.s229405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/11/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Tacrolimus is an immunosuppressive drug with higher potency compared to cyclosporine A (as a useful immunosuppressant). We prepared an ophthalmic solution formulation of Tacrolimus using hydroxypropyl beta cyclodextrin (HP-ßCD). In the present study, safety of this formulation was investigated in rabbits. Materials and Methods Formulation containing HP-ßCD, Tacrolimus, Polyvinyl alcohol (PVA) and Benzalkonium Chloride in PBS 7.4 was prepared. Tacrolimus concentration in ophthalmic preparation was 0.05% w/v. Ten male New Zealand white rabbits were housed in clean separated cages. One drop of Tacrolimus prepared formulation and a placebo formulation were applied every 12 hrs in the right and left eyes respectively, for 28 days. Results This new aqueous formulation of Tacrolimus could improve Tacrolimus solubility about 42 times. Clinical examinations on the 1st, 3rd, 7th, 14th and 28th days of study showed transient redness and conjunctivitis in some cases of both control and intervention groups that was not persistent. At the end of the study, there were no statistical differences between the two groups in corneal epithelial defect, redness or pathological evaluations. Conclusion The results of this study suggest that eye drop formulation of CD-Tacrolimus is safe in preliminary evaluations and can be useful for further studies.
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Affiliation(s)
- Asma Mahmoudi
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bizhan Malaekeh-Nikouei
- Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Nanotechnology Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Yahya Hanafi-Bojd
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Department of Nanomedicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mojtaba Toloei
- Cellular and Molecular Research Center, Department of Anatomy, Birjand University of Medical Sciences, Birjand, Iran
| | - Mehran Hosseini
- Cellular and Molecular Research Center, Department of Anatomy, Birjand University of Medical Sciences, Birjand, Iran
| | - Malihe Nikandish
- Ophthalmology Department, Valiasr Hospital, Birjand University of Medical Sciences, Birjand, Iran
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Liang L, Shi WY. The effects of FK506 combined with natamycin in the treatment of experimental fungal keratitis by suppressing NLRP3 inflammasome activation. EUR J INFLAMM 2017. [DOI: 10.1177/1721727x17740305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to investigate the mechanisms of combination treatment with FK506 and natamycin on alleviating damage of the cornea in mouse model of fungal keratitis. In this study, the mouse model of fungal keratitis was created by intrastromal injection with Fusarium solani or Aspergillus flavus. The mice received 5% natamycin eye drops 6–8 times a day, or the mice received 0.05% FK506 eye drops 2 times per day for 21 consecutive days. Corneal damage was evaluated by H&E staining. The protein expression levels of NLRP3 were detected by immunohistochemistry. Moreover, the markers of inflammasome activation including NLRP3, ASC, caspase-1, IL-1β, and IL-18 were detected by western blot. Histopathological results showed increased corneal thickening, dense inflammatory cell infiltration, and loss of epithelial continuity in the corneas after fungal infection. In addition, NLRP3 positive signals were observed to be obviously increased in the corneas after A. flavus or F. solani infection compared to the control group. Furthermore, the NLRP3 inflammasome is induced by fungal infection, as evidenced by increased protein expression levels of NLRP3, ASC, caspase-1, and downstream cytokines, such as interleukin (IL)-1β and IL-18. However, the corneal damage was alleviated and the activation of the NLRP3 inflammasome was significantly inhibited by drug treatment. Besides, the treatment outcomes were better in combined treatment group than that in single-agent treatment group. In conclusion, FK506 combined with natamycin alleviate fungi-induced corneal damage by suppressing NLRP3 inflammasome activation.
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Affiliation(s)
- Li Liang
- Shandong University, Jinan, China
- Department of Ophthalmology, Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, Anhui Province, China
| | - Wei-Yun Shi
- Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China
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Shoughy SS, Jaroudi MO, Tabbara KF. Efficacy and safety of low-dose topical tacrolimus in vernal keratoconjunctivitis. Clin Ophthalmol 2016; 10:643-7. [PMID: 27103784 PMCID: PMC4827889 DOI: 10.2147/opth.s99157] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to evaluate the efficacy and safety of topical low-dose tacrolimus (0.01%) solution in patients with vernal keratoconjunctivitis (VKC). Patients and methods A total of 62 consecutive patients with VKC refractory to conventional treatment were included retrospectively. Tacrolimus 0.01% ophthalmic solution was administered to patients twice daily after discontinuation of all previous topical medications. The duration of treatment ranged from 1 month to 29 months. The clinical symptoms of itching, redness, foreign body sensation, and discharge and the clinical signs of conjunctival hyperemia, conjunctival papillary hypertrophy, limbal infiltration, Trantas dots, and superficial punctate keratopathy were graded as 0 (normal), 1+ (mild), 2+ (moderate), or 3+ (severe). Assessment was carried out before initiation of therapy and on the last visit after treatment. Results There were 62 patients with VKC comprising 49 male and 13 female patients. The median age was 12 years (range: 5–47 years). The mean visual acuity improved from 20/30 to 20/25 following treatment. There was statistically significant improvement in symptoms of itching (P<0.001), redness (P<0.001), foreign body sensation (P<0.001), and discharge (P<0.001). Statistically significant improvement was also observed in clinical signs of conjunctival hyperemia (P<0.001), limbal infiltration (P<0.001), Trantas dots (P<0.001), superficial punctate keratopathy (P<0.001), and conjunctival papillary hypertrophy (P<0.001). The solution form of tacrolimus was well tolerated. None of the patients developed elevation of intraocular pressure, cataract, or infectious keratitis. Conclusion Low-dose topical tacrolimus 0.01% solution is effective and safe in the management of patients with refractory VKC.
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Affiliation(s)
- Samir S Shoughy
- The Eye Center and The Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud O Jaroudi
- The Eye Center and The Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Khalid F Tabbara
- The Eye Center and The Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia; Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Wilmer Ophthalmological Institute of the Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hazarika AK, Singh PK. Efficacy of topical application of 0.03% tacrolimus eye ointment in the management of allergic conjunctivitis. J Nat Sci Biol Med 2015; 6:S10-2. [PMID: 26604594 PMCID: PMC4630738 DOI: 10.4103/0976-9668.166051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Allergic conjunctivitis is commonly observed eye diseases in Sikkim, India due to the abundance of seasonal pollens, environmental pollutants, and house dust. We evaluated the efficacy of topical 0.03% tacrolimus eye ointment in the management of simple allergic conjunctivitis. Materials and Methods: A prospective observational study was designed consisting of 41 patients with refractory simple allergic conjunctivitis, whose condition responded very poorly to conventional anti-allergic eye drops (azelastine, olopatadine, chlorpheniramine maleate, sodium chromoglycate). Simple allergic conjunctivitis cases were diagnosed and followed up evaluating both subjective and objective findings (itching, photophobia, tearing, chemosis, conjunctival congestion, tarsal papilla, and eyelid edema). Existing ocular treatment was discontinued at enrolment and 0.03% tacrolimus ointment was applied into the conjunctival sac of the affected eyes twice daily for 4 weeks followed by a 2 weeks washout period. Patients were followed up at the end of 1st week, 4th week, and at 7th week (2 weeks washout period). Results: Symptoms of simple allergic conjunctivitis (itching, tearing and photophobia) were significantly reduced at the end of 1st week. Signs such as conjunctival chemosis, congestion, tarsal papillae, and eyelid edema were effectively treated in all cases at the end of 1st week. At the end of 4th week, all cases were fully cured and none of the patient had any recurrences up to 7th week. Mean score at 1st day (9.6 ± 3.27) was significantly (P < 0.0001) reduced by 7th day (1.35 ± 1.19) of treatment. Conclusion: Topical application of tacrolimus ointment is an excellent alternative to anti-allergic and steroids eye drops for the treatment of simple allergic conjunctivitis as it significantly reduces recurrences.
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Affiliation(s)
- Ajit Kumar Hazarika
- Department of Ophthalmology, Sikkim Manipal Institute of Medical Sciences, Central Referral Hospital, Sikkim, India
| | - Prodip Kumar Singh
- Department of Ophthalmology, Sikkim Manipal Institute of Medical Sciences, Central Referral Hospital, Sikkim, India
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Pastor-Clerigues A, Serrano A, Milara J, Marti-Bonmati E, Lopez-Perez FJ, Garcia-Montanes S, Sanfeliu J, Saval-Victoria AC, Cortijo J. Evaluation of the Ocular Tolerance of Three Tacrolimus Topical Pharmaceutical Preparations by Bovine Corneal Opacity and Permeability Test. Curr Eye Res 2015; 41:890-6. [PMID: 26554729 DOI: 10.3109/02713683.2015.1082187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Tacrolimus ocular preparations are commonly employed in autoimmune or inflammatory ocular disorders. However, currently there are not yet approved ocular formulations. Tacrolimus ocular side effects have been reported in clinical use, so the evaluation of different pharmaceutical preparations is mandatory. In this study, the local corneal tolerance and safety profile of three common tacrolimus 0.03% pharmaceutical preparations were evaluated. MATERIAL AND METHODS Corneal irritation and permeability of tacrolimus preparations were evaluated with the bovine corneal opacity and permeability (BCOP) test. Complementary corneal hematoxylin/eosin and immunohistochemistry staining for tight junctions and adherent junctions E-cadherin, VE-cadherin and zonula occludens-1 were examined and scored to evaluate and to confirm corneal disruption and irritation scores obtained with the BCOP method. RESULTS Commercial brand ointment (Protopic®), topical compounded eye ointment (pharmacy elaboration) and tacrolimus suspension eye drops (elaborated from parenteral prograf®) were tested as potential ocular preparations to be used in clinics. Tacrolimus preparations hereby studied do not alter the opacity and permeability of the bovine cornea by more than three units, measured by the In Vitro Irritancy Score, neither affected the immunohistochemical parameters, composite score or transepithelial electrical resistance. CONCLUSIONS Tacrolimus preparations studied can be safely applied as a topical ocular treatment.
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Affiliation(s)
- Alfonso Pastor-Clerigues
- a Research Foundation of General Hospital of Valencia , Valencia , Spain.,b Hospital Pharmacy , University General Hospital Consortium , Valencia , Spain
| | - Adela Serrano
- a Research Foundation of General Hospital of Valencia , Valencia , Spain.,c CIBERES , Health Institute Carlos III , Valencia , Spain
| | - Javier Milara
- a Research Foundation of General Hospital of Valencia , Valencia , Spain.,b Hospital Pharmacy , University General Hospital Consortium , Valencia , Spain.,c CIBERES , Health Institute Carlos III , Valencia , Spain.,d Clinical Research Unit (UIC) , University General Hospital Consortium , Valencia , Spain
| | - Ezequiel Marti-Bonmati
- a Research Foundation of General Hospital of Valencia , Valencia , Spain.,b Hospital Pharmacy , University General Hospital Consortium , Valencia , Spain
| | | | | | - Joan Sanfeliu
- b Hospital Pharmacy , University General Hospital Consortium , Valencia , Spain
| | | | - Julio Cortijo
- a Research Foundation of General Hospital of Valencia , Valencia , Spain.,b Hospital Pharmacy , University General Hospital Consortium , Valencia , Spain.,c CIBERES , Health Institute Carlos III , Valencia , Spain.,d Clinical Research Unit (UIC) , University General Hospital Consortium , Valencia , Spain.,e Department of Pharmacology , Faculty of Medicine, University of Valencia , Valencia , Spain
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Effect of Topical Tacrolimus in the Treatment of Thygeson's Superficial Punctate Keratitis. Am J Ophthalmol 2015; 160:663-8. [PMID: 26133248 DOI: 10.1016/j.ajo.2015.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate topical tacrolimus ointment for treating Thygeson's superficial punctate keratitis (Thygeson SPK). DESIGN Retrospective interventional case series. METHODS setting: Institutional practice. PATIENT POPULATION The medical records of 14 patients (9 women; age range, 9-65 years) with Thygeson SPK were reviewed retrospectively. Diagnosis was based on the history and clinical examination. INTERVENTION Patients were treated with tacrolimus 0.03% eye ointment instilled into the lower fornix twice daily for the first 2 weeks, followed by nocturnal application. The clinical signs and symptoms were assessed after 1 month of treatment. The drug was tapered with disease improvement. MAIN OUTCOME MEASURE(S) Treatment efficacy and side effects. RESULTS All patients had bilateral disease (average duration, 6 years). All patients, except 2 who used the medication irregularly, had improved visual acuity (VA), symptoms, and signs as long as the medication was applied. Before treatment 28.57% of patients had VA between 20/30 and 20/50, with improvement after treatment to 20/25 or 20/20. Attempts to withdraw the medication resulted in recurrent disease, and, therefore, treatment was not curative during the study period. No significant local medication side effects were reported. CONCLUSION Tacrolimus eye ointment 0.03% was effective for controlling Thygeson SPK for a long period with good patient tolerance and no noticeable local or systemic side effects. During the average 6-year follow-up, treatment was not curative. Randomized studies are difficult to conduct because of the disease rarity.
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Sterile Corneal Infiltrates Secondary to Psoriasis Exacerbations: Topical Tacrolimus as an Alternative Treatment Option. Eye Contact Lens 2015. [PMID: 26222098 DOI: 10.1097/icl.0000000000000178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Psoriasis is a common chronic inflammatory skin disease. Ocular manifestations, which occur in 10% to 20% of cases of psoriasis, are usually bilateral and often present during an exacerbation of the psoriasis. Serious corneal involvement is rare but can be devastating. CASE REPORT Two cases of sterile corneal infiltrates secondary to an exacerbation of psoriasis are presented. Treatment involved the use of 0.02% topical tacrolimus ointment, which resulted in resolution of the symptoms and infiltrates. DISCUSSION AND CONCLUSION Topical tacrolimus may be considered as an alternative treatment option to corticosteroids in sterile corneal infiltrates.
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Abstract
PURPOSE OF REVIEW Allergic eye diseases comprise a spectrum of diseases, with each condition being characterized by a complex immunopathology. The more severe and chronic conditions, such as vernal keratoconjunctivitis and atopic keratoconjunctivitis, involve predominantly mast cells and eosinophils, while also being associated with a preponderance of T cells. Treatment with topical antihistamines or mast cell stabilizers is often unsatisfactory, and therapy depends on topical corticosteroids. Corticosteroids have significant side-effects with long-term use; therefore, they appear to be more appropriate for short-term pulse therapy. Immunomodulatory agents can also be used to inhibit T-cell activation and show encouraging results among patients with severe allergic eye conditions. The present review is an attempt to present a coherent picture of the recent investigations of topical immunomodulatory agents' therapy in severe allergic eye diseases, especially cyclosporine A and tacrolimus, and their mechanisms of action. RECENT FINDINGS Immunomodulatory agents are commonly indicated for the treatment of severe and prolonged allergic conjunctivitis. This article reviews the recent studies of these drugs and the development of immunomodulatory treatments for severe allergic eye diseases. SUMMARY Cyclosporine A and tacrolimus are currently available for the treatment of severe allergic conjunctivitis. These agents have led to improved therapeutic results for patients with severe and chronic allergic eye diseases.
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Pucci N, Caputo R, di Grande L, de Libero C, Mori F, Barni S, di Simone L, Calvani A, Rusconi F, Novembre E. Tacrolimus vs. cyclosporine eyedrops in severe cyclosporine-resistant vernal keratoconjunctivitis: A randomized, comparative, double-blind, crossover study. Pediatr Allergy Immunol 2015; 26:256-261. [PMID: 25712437 DOI: 10.1111/pai.12360] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vernal keratoconjunctivitis (VKC) is a chronic sight-threatening ocular disease. Topical cyclosporine A (Cyc) has been widely administered as a steroid-sparing drug, although in about 7-10% of cases, it has been ineffective. The purpose of this study was to evaluate the efficacy of 0.1% topical tacrolimus (Tcr) in patients with severe VKC who failed to respond to 1% Cyc eyedrops. METHODS Consecutive patients with severe, Cyc-resistant VKC were enrolled in a double-blind, comparative, crossover (DBCO) trial; all patients were treated with 1% Cyc in one eye and 0.1% Tcr in the other eye for 3 wk. After a washout period of 7 days, patients were instructed to cross over the medications for three additional weeks. Objective ocular score, subjective score, and quality-of-life questionnaires (QoLQ) were collected during the trial. Blood samples were drawn to assess several safety parameters. RESULTS Thirty patients have been enrolled (mean age 9.05 ± 2.12 yr). In each of the two phases of the DBCO trial, a significant improvement in objective and subjective scores was observed in the eyes treated with 0.1% Tcr (p < 0.001). Likewise, the quality of life significantly improved despite only half the eyes being successfully treated. Serum creatinine and blood parameters were constantly within the normal range, and both blood Cyc and Tcr concentrations remained below the lowest detectable levels. CONCLUSIONS Topical Tcr is very effective and safe in the short term for patients suffering from severe VKC resistant to topical Cyc.
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Affiliation(s)
- Neri Pucci
- Allergy Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Roberto Caputo
- Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | | | - Cinzia de Libero
- Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Francesca Mori
- Allergy Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Lorena di Simone
- Pharmaceutical Service, A. Meyer Children's Hospital, Florence, Italy
| | - Annamaria Calvani
- Pharmaceutical Service, A. Meyer Children's Hospital, Florence, Italy
| | - Franca Rusconi
- Epidemiology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Elio Novembre
- Allergy Unit, A. Meyer Children's Hospital, Florence, Italy
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Proniosome-derived niosomes for tacrolimus topical ocular delivery: In vitro cornea permeation, ocular irritation, and in vivo anti-allograft rejection. Eur J Pharm Sci 2014; 62:115-23. [DOI: 10.1016/j.ejps.2014.05.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/23/2014] [Accepted: 05/26/2014] [Indexed: 10/25/2022]
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The spectrum of oculocutaneous disease. J Am Acad Dermatol 2014; 70:795.e1-25. [DOI: 10.1016/j.jaad.2013.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/18/2013] [Accepted: 12/28/2013] [Indexed: 12/30/2022]
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O'Brien TP. Allergic conjunctivitis: an update on diagnosis and management. Curr Opin Allergy Clin Immunol 2014; 13:543-9. [PMID: 23974684 DOI: 10.1097/aci.0b013e328364ec3a] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The focus of this review is to provide a logical paradigm for the diagnosis and treatment of ocular allergies, with a focus on seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). RECENT FINDINGS Several classes of topical medications are currently available for the management of ocular allergies, including: lubricating agents, vasoconstrictors, antihistamines, mast cell stabilizers, and topical corticosteroids. SUMMARY SAC and PAC make up the vast majority of ocular allergy cases. A proactive approach to these diseases, anticipating the regional spring and fall allergen spikes, is needed for optimally managing these disorders. A multifaceted treatment regimen comprising patient education, lifestyle modification, and topical medications (such as antihistamines and/or mast cell stabilizers and corticosteroids) may be required in order to manage ocular allergies effectively. The appropriate treatment paradigm is based on the severity of the patients' signs and symptoms. For moderate-to-severe cases, especially chronic vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis, comanagement with an ophthalmologist is recommended.
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Affiliation(s)
- Terrence P O'Brien
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33418, USA.
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Wan XC, Dimov V. Pharmacokinetic evaluation of topical calcineurin inhibitors for treatment of allergic conjunctivitis. Expert Opin Drug Metab Toxicol 2014; 10:543-9. [PMID: 24490943 DOI: 10.1517/17425255.2014.884070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Topical calcineurin (Cn) inhibitors delivered via ophthalmic drop is emerging as a potential treatment for severe, immune-mediated forms of allergic conjunctivitis, such as vernal keratoconjunctivitis, atopic keratoconjunctivitis and giant papillary conjunctivitis. AREAS COVERED This article is based on a comprehensive literature search, with information taken from meta-analyses, systematic reviews, treatment guidelines and clinical studies in children and adults. The articles that have been selected evaluate the use of topical Cn inhibitors and their role in the treatment of allergic conjunctivitis. EXPERT OPINION Ophthalmic topical Cn inhibitors have been shown to be safe for short-term use, with minimal systemic absorption and toxicity. For patients with severe, refractory forms of allergic conjunctivitis, topical Cn inhibitors offer a promising treatment option and an alternative to steroidal therapies. The safety profile and efficacy data for topical cyclosporine are more robust compared to that of tacrolimus and pimecrolimus, although larger trials will be needed for all three agents. With more randomized controlled trials involving larger sample sizes and long-term follow-up to establish both efficacy and safety, ophthalmic Cn inhibitors offer exciting treatment possibilities for the prevention of morbidity associated with refractory allergic conjunctivitis.
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Affiliation(s)
- Xiao Chloe Wan
- University of Chicago, Department of Internal Medicine , 5841 South Maryland Ave MC 7082, Chicago, IL 60637 , USA
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Al-Amri AM. Long-term follow-up of tacrolimus ointment for treatment of atopic keratoconjunctivitis. Am J Ophthalmol 2014; 157:280-6. [PMID: 24439439 DOI: 10.1016/j.ajo.2013.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/11/2013] [Accepted: 10/14/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the long-term clinical outcomes of 0.1% tacrolimus dermatologic ointment (Protopic) in cases of refractory atopic keratoconjunctivitis (AKC). DESIGN Prospective, nonrandomized, noncontrolled case series. METHODS Twenty-two eyes from 11 patients with severe AKC who were treated with 0.1% tacrolimus ointment were followed prospectively. The mean age of the patients was 32.27 ± 12.7 years (range, 19-61 years). Each patient completed a follow-up period of at least 48 months, during which the signs and symptoms of AKC were assessed. Changes in the total scores of signs and symptoms from baseline were recorded at each visit, and the main outcome measure was the clinical response to topical tacrolimus treatment. RESULTS Dramatic improvements in clinical signs and symptoms were achieved 1 week after starting topical tacrolimus treatment, and complete clinical resolution was observed in almost all patients 6 weeks after starting treatment. Treatment was gradually reduced, with increasing intervals between applications. Eight patients remained asymptomatic for up to 3 years, although recurrence occurred in 3 patients who attempted to discontinue treatment. All patients complained of a mild burning sensation upon application of the ointment. No additional medications were required to provide relief, and no patient discontinued treatment because of adverse drug effects. No drug-related ocular complications were encountered, and no significant changes in visual acuity or refraction were documented. CONCLUSIONS Tacrolimus dermatologic ointment is a potentially safe and effective treatment for AKC cases refractory to standard treatment and may substitute for steroid treatments aimed at controlling disease activity.
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Abstract
Vernal keratoconjunctivitis (VKC) is a relatively rare, chronic form of ocular allergy that can potentially cause severe visual complications. Affecting mainly children and young adults, it is an IgE- and T cell-mediated disease, leading to a chronic inflammation in which eosinophil, lymphocyte and structural cell activation are involved. Treatment of VKC requires a multiple approach that includes conservative measures and pharmacologic treatment. Patients and parents should be made aware of the long duration of disease, its chronic evolution and possible complications. Treatment should be based on the duration and frequency of symptoms and the severity of corneal involvement. Mast cell stabilizers and antihistamines have been proven to be effective for the treatment of mild to moderate forms of VKC. In the most severe cases, topical steroids can be used as rescue medication to reduce conjunctival and corneal inflammation. Immunomodulators that have been investigated for VKC treatment include topical ocular preparations of cyclosporine A and tacrolimus. Topical cyclosporine A has been proven to be effective in the long-term treatment of VKC, significantly improving signs and symptoms without significant side effects.
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Lee YJ, Kim SW, Seo KY. Application for tacrolimus ointment in treating refractory inflammatory ocular surface diseases. Am J Ophthalmol 2013; 155:804-13. [PMID: 23394907 DOI: 10.1016/j.ajo.2012.12.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 12/12/2012] [Accepted: 12/12/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the therapeutic effects of topical tacrolimus ointment on refractory inflammatory ocular surface diseases. DESIGN Retrospective interventional consecutive case series. METHODS In Severance Hospital, Seoul, South Korea, 0.02% tacrolimus ointment was topically applied 1 to 3 times per day, depending on disease severity, for up to 31 months in eyes of 12 consecutive patients with refractory inflammatory ocular surface diseases who had previously been treated with steroid therapy. Seven patients had chronic cicatrizing conjunctivitis (6 cases caused by Stevens-Johnson syndrome and 1 attributable to ocular cicatricial pemphigoid); 4 had scleritis (3 necrotizing scleritis, 1 recurrent nodular scleritis); and 1 patient had Mooren ulcer with corneal perforation. The therapeutic outcomes after tacrolimus treatment were evaluated according to the following criteria: change in clinical findings (eg, decrease of hyperemia, ocular pain, epithelial defect, and pseudomembrane), intraocular pressure (IOP), and need for steroid therapy. RESULTS In all 3 groups, tacrolimus showed an immunosuppressive effect, especially on scleritis and Mooren ulcer. These effects included suppression of corneoscleral melting and reduction of hyperemia. In chronic cicatrizing conjunctivitis, simultaneous topical tacrolimus while tapering steroid therapy suppressed inflammatory relapse. The elevated IOP in steroid responders recovered to normal range after successful tapering of steroid. No adverse side effects were noted after 1.5 to 31 months of continuous tacrolimus treatment. CONCLUSION The use of topical tacrolimus ointment is effective in controlling refractory inflammatory ocular surface disease, and can reduce the need for steroid use while reducing inflammation recurrence.
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Use of Cyclosporine A and Tacrolimus in Treatment of Vernal Keratoconjunctivitis. Curr Allergy Asthma Rep 2013; 13:308-14. [DOI: 10.1007/s11882-013-0345-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Topical tacrolimus for the management of acute allergic conjunctivitis in a mouse model. Graefes Arch Clin Exp Ophthalmol 2013; 251:1717-21. [DOI: 10.1007/s00417-013-2333-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 03/13/2013] [Accepted: 03/18/2013] [Indexed: 10/27/2022] Open
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Kari O, Saari KM. Diagnostics and new developments in the treatment of ocular allergies. Curr Allergy Asthma Rep 2013; 12:232-9. [PMID: 22382607 DOI: 10.1007/s11882-012-0252-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
About 30% of people suffer from allergic symptoms, and 40% to 80% of them have eye symptoms. Atopic conjunctivitis is divided into seasonal allergic conjunctivitis and perennial allergic conjunctivitis. The treatment of seasonal allergic conjunctivitis is simple: antihistamines, anti-inflammatory agents, or cromoglycate. Perennial allergic conjunctivitis needs longer therapy with mast cell stabilizers and sometimes local steroids. Atopic keratoconjunctivitis requires long-term treatment of the lid eczema and keratoconjunctivitis. Vernal keratoconjunctivitis mainly affects children and young people. It commonly calms down after puberty. It demands intensive therapy, often for many years, to avoid serious complicating corneal ulcers. Giant papillary conjunctivitis is a foreign body reaction in contact lens users or patients with sutures following ocular surgery. Nonallergic eosinophilic conjunctivitis affects mostly middle-aged and older women with eosinophilic conjunctivitis and dry eye. Contact allergic blepharoconjunctivitis is often caused by cosmetics and eye medication. Work-related ocular allergies should be considered as a cause of resistant ocular symptoms in workplaces.
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Affiliation(s)
- Osmo Kari
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital, Finland.
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Ryu EH, Kim JM, Laddha PM, Chung ES, Chung TY. Therapeutic effect of 0.03% tacrolimus ointment for ocular graft versus host disease and vernal keratoconjunctivitis. KOREAN JOURNAL OF OPHTHALMOLOGY 2012; 26:241-7. [PMID: 22870021 PMCID: PMC3408527 DOI: 10.3341/kjo.2012.26.4.241] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 09/01/2011] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine whether topical tacrolimus might prove effective in the treatment of refractory anterior segment inflammatory diseases, and to evaluate its efficacy in eyes with ocular graft versus host disease (GVHD), and vernal keratoconjunctivitis (VKC). Methods Twenty-eight eyes of 14 patients with anterior segment inflammation refractory to steroid treatment were treated with 0.03% tacrolimus ointment at the Samsung Medical Center, Seoul, Korea from March 2008 through August 2009. Seven patients had ocular GVHD and seven had VKC. We evaluated the conjunctival and corneal inflammatory change at one, two, four, and eight weeks after treatment with a scoring system. Time to initial response of treatment and therapeutic effect between GVHD and VKC was also analyzed. After the eight-week treatment period, patients were divided into two groups (maintenance group and discontinuance group). Eight patients maintained the treatment for an additional four months, and six patients discontinued the treatments. Therapeutic effect was also compared between the groups at eight weeks and six months after treatment. Results The mean conjunctival and corneal inflammation score was reduced significantly at eight weeks after treatment (p < 0.0001). The therapeutic effect in conjunctival inflammation was first noted at week two after the initial treatment (p = 0.002); reduction in corneal inflammation was first noted at one week (p = 0.0009). When compared according to diagnosis, no therapeutic difference was detected between the groups (p > 0.05). Six months after treatment, we noted no therapeutic differences between the maintenance group and discontinuance group (p > 0.05). Conclusions 0.03% tacrolimus ointment was safe and effective for use in anterior segment inflammatory disease refractory to steroid.
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Affiliation(s)
- Eun Hye Ryu
- Department of Ophthalmology, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
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Treatment of Refractory Atopic Blepharoconjunctivitis with Topical Tacrolimus 0.03% Dermatologic Ointment. J Ocul Pharmacol Ther 2012; 28:94-6. [DOI: 10.1089/jop.2011.0143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Durrani K, Zakka FR, Ahmed M, Memon M, Siddique SS, Foster CS. Systemic Therapy With Conventional and Novel Immunomodulatory Agents for Ocular Inflammatory Disease. Surv Ophthalmol 2011; 56:474-510. [DOI: 10.1016/j.survophthal.2011.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 05/18/2011] [Accepted: 05/24/2011] [Indexed: 12/19/2022]
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Remitz A, Virtanen HM, Reitamo S, Kari O. Tacrolimus ointment in atopic blepharoconjunctivitis does not seem to elevate intraocular pressure. Acta Ophthalmol 2011; 89:e295-6. [PMID: 20064110 DOI: 10.1111/j.1755-3768.2009.01834.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Topical 0.005% tacrolimus eye drop for refractory vernal keratoconjunctivitis. Eye (Lond) 2011; 25:872-80. [PMID: 21475312 DOI: 10.1038/eye.2011.75] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of topical 0.005% tacrolimus eye drop for treatment of refractory vernal keratoconjunctivitis (VKC). METHODS This prospective study included 20 eyes of 10 patients with refractory VKC, who had active symptomatic disease despite conventional medications including topical steroids. After discontinuing all other medications, patients were treated with topical 0.005% tacrolimus eye drop four times a day. Changes in subjective symptoms and objective signs after treatment were evaluated, and development of possible complications was assessed. RESULTS Mean age of patients was 21.3±7.4 years and mean duration of VKC was 12.1±5.8 years. After starting tacrolimus eye drop, patients were followed for a mean duration of 10.7±3.7 months (range, 6-15 months). All symptoms including itching, redness, photosensitivity, foreign body sensation, and mucus discharge improved after the treatment; itching was the first symptom to show dramatic relief. In addition, there was improvement in objective signs including conjunctival hyperaemia, conjunctival papillary hypertrophy, giant papillae, limbal hypertrophy, corneal punctate epithelial erosions, and corneal pannus; conjunctival hyperaemia was the first sign to show improvement. No patient required addition of other medications including steroids for further relief. Any attempt to discontinue tacrolimus eye drop was associated with recurrence of patients' symptoms and signs, necessitating continued use of the medication during the entire follow-up time. No ocular complication related to tacrolimus was noted. CONCLUSION Topical 0.005% tacrolimus eye drop seemed to be a safe and effective treatment for steroid-resistant refractory VKC; however, long-term use was needed to control the disease.
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Topical Tacrolimus Ointment for Treatment of Intractable Atopic Keratoconjunctivitis: A Case Report and Review of the Literature. Cornea 2011; 30:462-5. [DOI: 10.1097/ico.0b013e3181d83875] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kari O, Saari KM. Updates in the treatment of ocular allergies. J Asthma Allergy 2010; 3:149-58. [PMID: 21437049 PMCID: PMC3047907 DOI: 10.2147/jaa.s13705] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Indexed: 01/05/2023] Open
Abstract
Allergic diseases have greatly increased in industrialized countries. About 30% of people suffer from allergic symptoms and 40%–80% of them have symptoms in the eyes. Atopic conjunctivitis can be divided into seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). The treatment of SAC is simple; antihistamines, anti-inflammatory agents, or chromoglycate. In severe cases of SAC, subcutaneous or sublingual immunotherapy is helpful. PAC needs longer therapy, often year round, with mast cell stabilizers, antihistamines, and sometimes local steroids. Atopic keratoconjunctivitis is a more severe disease showing chronic blepharitis often connected with severe keratitis. It needs, in many cases, continuous treatment of the lid eczema and keratoconjunctivitis. Blepharitis is treated with tacrolimus or pimecrolimus ointment. Conjunctivitis additionally needs corticosteroids and, if needed, cyclosporine A (CsA) drops are administered for longer periods. Basic conjunctival treatment is with mast cell-stabilizing agents and in addition, antihistamines are administered. Vernal keratoconjunctivitis is another chronic and serious allergic disease that mainly affects children and young people. It is a long-lasting disease which commonly subsides in puberty. It demands intensive therapy often for many years to avoid serious complicating corneal ulcers. Treatment is mast cell-stabilizing drops and additionally antihistamines. In relapses, corticosteroids are needed. When the use of corticosteroids is continuous, CsA drops should be used, and in relapses, corticosteroids should be used additionally. Nonallergic eosinophilic conjunctivitis (NAEC) is a less known, but rather common, ocular disease. It affects mostly middle-aged and older women. The eye symptoms of NAEC are largely similar to those seen in chronic allergic conjunctivitis. Basic therapy is mast cell-stabilizing drops. Eosinophilic inflammation needs additional corticosteroids. In severe cases, CsA drops are recommended. Antihistamines should be avoided. It is important to recognize the different forms of allergic ocular diseases and to start the treatment early and intensively enough to avoid chronicity of the disease and accompanying tissue destruction.
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Affiliation(s)
- Osmo Kari
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Ohashi Y, Ebihara N, Fujishima H, Fukushima A, Kumagai N, Nakagawa Y, Namba K, Okamoto S, Shoji J, Takamura E, Hayashi K. A randomized, placebo-controlled clinical trial of tacrolimus ophthalmic suspension 0.1% in severe allergic conjunctivitis. J Ocul Pharmacol Ther 2010; 26:165-74. [PMID: 20307214 DOI: 10.1089/jop.2009.0087] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To examine the efficacy of tacrolimus ophthalmic suspension 0.1% in treating severe allergic conjunctivitis. METHODS This was a multicenter, randomized, double-masked, placebo-controlled clinical trial. Fifty-six patients with severe allergic conjunctivitis in whom topical antiallergic agents and corticosteroids had been ineffective were randomized to tacrolimus or placebo treatment. Patients were treated either with tacrolimus or placebo twice-daily for 4 weeks. Severity of objective signs in palpebral and bulbar conjunctiva, limbus, and corneal involvement was assessed using 4 grades. Seven subjective symptoms were evaluated by visual analog scale (VAS) assessment. The primary efficacy endpoint was change in the total score of objective signs at the end of treatment. The secondary efficacy endpoints included change in the score for each objective sign and change in the VAS for each subjective symptom. Safety was assessed based on the severity and the incidence of adverse events. RESULTS Mean change from baseline in total score for objective signs was significantly greater in the tacrolimus (-5.6 + or - 5.1) than in the placebo group (-0.1 + or - 4.5; P < 0.001). Tacrolimus significantly improved giant papillae (P = 0.001) and corneal involvement (P = 0.005). Five subjective symptoms (itching, discharge, hyperemia, lacrimation, and foreign body sensation) were significantly better in the tacrolimus than in the placebo group. The most frequent treatment-related adverse event in the tacrolimus group was mild ocular irritation upon topical instillation, which was well-tolerated. CONCLUSION Tacrolimus ophthalmic suspension 0.1% is effective in treating severe allergic conjunctivitis.
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Affiliation(s)
- Yuichi Ohashi
- Department of Ophthalmology, University of Ehime School of Medicine, Shizukawa, Toon City Ehime, 7910295, Japan.
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Kari O, Haahtela T, Laine P, Turunen JP, Kari M, Sarna S, Laitinen T, Kovanen PT. Cellular characteristics of non-allergic eosinophilic conjunctivitis. Acta Ophthalmol 2010; 88:245-50. [PMID: 19930216 DOI: 10.1111/j.1755-3768.2009.01599.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study examines the histology of conjunctival biopsy samples from patients with persistent allergic eosinophilic conjunctivitis (AEC) or non-allergic eosinophilic conjunctivitis (NAEC). METHODS Fourteen patients with conjunctivitis and eosinophilia in cytology samples were included in the study. Seven had positive skin-prick tests (the AEC group) and seven had negative skin-prick tests (the NAEC group). Eight asymptomatic subjects with negative skin-prick tests served as a control group. In conjunctival biopsies eosinophils were identified with monoclonal antibodies. Mast cells were identified by specific immunostaining and tryptase-positive granules were counted around them. The percentage of degranulated mast cells was used as a measure of cell activation. Eosinophil and goblet cell numbers were counted, epithelial thickness was measured, and the symptoms were characterized and graded. RESULTS The numbers of eosinophils in biopsies were higher in patients with AEC than in healthy controls (p = 0.010). The proportion of activated mast cells tended to be higher in AEC patients (65%) than in NAEC patients (48%) or control subjects (40%). Patients with AEC had more goblet cells than control subjects (p = 0.049) and their epithelial layer was thicker (p = 0.054). Patients with AEC had more severe symptoms than control subjects (p = 0.0005), whereas the symptoms of NAEC patients did not differ statistically from those of controls (p = 0.065). CONCLUSIONS Patients with NAEC were characterized by mild eosinophilic inflammation and only minor structural conjunctival changes. The condition seems to run a relatively mild but persistent clinical course.
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Abstract
BACKGROUND Conjunctivitis is a highly prevalent ocular condition with potential complications that include visual impairment. Infectious causes include bacterial, viral, parasitic and fungal etiologies, while noninfectious conjunctivitis is typically owing to allergy, tear film dysfunction or chemical trauma. Treatment requires frequent dosing and often lacks complete efficacy. OBJECTIVE The goal of this review is to investigate therapies for conjunctivitis that are undergoing clinical study and development. These data are presented in light of currently available treatment options to provide an understanding of the present and future direction of conjunctivitis management. METHODS The Pharmaprojects database was searched for conjunctivitis therapies currently in development around the world. Current treatment guidelines for infectious and noninfectious conjunctivitis were researched through PUBMED and OVID databases. RESULTS Several new compounds, including antimicrobial, antihistamine, anti-inflammatory and immunomodulating drugs, along with a novel thiazolidinedione, are currently undergoing investigation for their potential use in conjunctivitis management. These ophthalmic agents show promise in improving clinical outcomes for infectious and noninfectious conjunctivitis.
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Affiliation(s)
- Catherine Origlieri
- STARx Allergy & Asthma Center, UMDNJ - New Jersey Medical School, 400 Mountain Avenue, Springfield, New Jersey, NJ 07081, USA
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Auw-Hädrich C, Reinhard T. [Treatment of chronic blepharokeratoconjunctivitis with local calcineurin inhibitors]. Ophthalmologe 2009; 106:635-8. [PMID: 19499228 DOI: 10.1007/s00347-009-1954-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Topical calcineurin inhibitors (cyclosporin A 1%, FK506, pimecrolimus) can be useful for treating chronic blepharokeratoconjunctivitis in addition to lid hygiene and lubricants. This treatment leads to an improvement of dry eye symptoms and reduces inflammation.
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Affiliation(s)
- C Auw-Hädrich
- Universitäts-Augenklinik, Killianstrasse 5, 79106 Freiburg.
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Attas-Fox L, Barkana Y, Iskhakov V, Rayvich S, Gerber Y, Morad Y, Avni I, Zadok D. Topical Tacrolimus 0.03% Ointment for Intractable Allergic Conjunctivitis: An Open-Label Pilot Study. Curr Eye Res 2009; 33:545-9. [DOI: 10.1080/02713680802149115] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kari O, Määttä M, Tervahartiala T, Peltonen S, Kari M, Hagström J, Sorsa T, Saari M, Haahtela T. Tear fluid concentration of mmp-8 is elevated in non-allergic eosinophilic conjunctivitis and correlates with conjunctival inflammatory cell infiltration. Graefes Arch Clin Exp Ophthalmol 2009; 247:681-6. [PMID: 19184080 DOI: 10.1007/s00417-009-1042-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 11/25/2008] [Accepted: 01/12/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To investigate tear fluid concentration of matrix metalloproteinase 8 (MMP-8) and its relation to conjunctival inflammatory cell infiltration in persistent non-allergic eosinophilic conjunctivitis (NAEC). METHODS Two groups were included: 26 consecutive adult patients with NAEC (conjunctival eosinophils at least 1+ [1-10 eosinophils/slide], skin prick test [SPT] to common allergens negative), and 26 asymptomatic adult persons (no conjunctival eosinophils, SPT negative). MMP-8 tear fluid concentrations were determined by immunofluorometric assay, and conjunctival brush cytology samples from NAEC patients were used for MMP-8 immunocytochemistry. Gelatin zymography was used to illustrate proteolytic activity within the tear fluid samples. RESULTS The mean MMP-8 concentration was significantly higher among NAEC patients (214.3 +/- 327.7 microg/l) than among healthy persons (50.4 +/- 62.3 microg/l, P < 0.0001). In the NAEC patients, tear fluid MMP-8 correlated with the numbers of conjunctival neutrophils (r = 0.66, P = 0.0002) as well as with goblet cells and columnar epithelial cells (r = 0.54 for both, P = 0.045), but not with the lymphocyte numbers (r = -0.36, P = 0.0741). By immunocytology, MMP-8 protein could also be detected in vivo in the inflammatory cell population within the conjunctiva. Zymography revealed that proteolysis was significantly higher in the NAEC group, and activated enzymes were practically found only in the NAEC group. CONCLUSIONS The results showed that NAEC is an inflammatory condition characterized by increased tear fluid MMP-8 levels, probably derived from both inflammatory and structural conjunctival cells. The increased proteolytic activity in NAEC patients may indicate risk of conjunctival structural changes (remodeling).
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Affiliation(s)
- Osmo Kari
- Division of Allergology, HUCH Skin and Allergy Hospital, Nyyrikintie 20, 02100, Espoo, Helsinki, Finland.
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Miyazaki D, Tominaga T, Kakimaru-Hasegawa A, Nagata Y, Hasegawa J, Inoue Y. Therapeutic Effects of Tacrolimus Ointment for Refractory Ocular Surface Inflammatory Diseases. Ophthalmology 2008; 115:988-992.e5. [PMID: 17900694 DOI: 10.1016/j.ophtha.2007.07.025] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 07/08/2007] [Accepted: 07/23/2007] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To investigate the therapeutic effects of topical tacrolimus ointment on refractory ocular surface inflammatory diseases. DESIGN Retrospective interventional consecutive case series. PARTICIPANTS Ten consecutive patients with severe ocular surface inflammatory diseases who were suspected to be steroid responders (elevation of intraocular pressure [IOP]) or were refractory to standard steroid therapy were studied. One patient had peripheral ulcerative keratitis with impending corneal perforation, 1 had a Mooren's ulcer, 2 had scleroperikeratitis, 5 had atopic keratoconjunctivitis, and 1 had vernal keratoconjunctivitis. METHODS The clinical findings and therapeutic responses after treatment with 0.02% topical tacrolimus ointment were determined by conventional ophthalmological examinations. MAIN OUTCOME MEASURES Resolution of the ocular surface diseases (e.g., decrease of hyperemia, ulceration, size of papillae) and IOP. The necessity to use steroids was also assessed. RESULTS In all cases, marked to moderate improvement was obtained, including suppression of the melting reaction of the inflamed cornea, remission of scleroperikeratitis, and reduction of a giant papilla and corneal epithelial defect in severe atopic keratoconjunctivitis. The elevated IOP was reduced in steroid responders after successful cessation of steroid therapy. No adverse side effect was noted for 2 to 26 months of continuous treatment. CONCLUSIONS Topical tacrolimus ointment is effective in treating refractory ocular surface inflammatory diseases and should be considered as an alternative to higher doses, steroid supplementation, or surgical intervention.
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Affiliation(s)
- Dai Miyazaki
- Division of Ophthalmology and Visual Science, Tottori University Medical School, Yonago, Japan.
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Current World Literature. Curr Opin Allergy Clin Immunol 2007; 7:454-5. [PMID: 17873589 DOI: 10.1097/aci.0b013e3282f0cf23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Atopic keratoconjunctivitis (AKC), the most severe and chronic form of ocular surface allergy-related disorder, is the ocular surface complication that some atopic dermatitis patients can suffer. Its wide range of severity, from mild and occasional problems to persistent and intense inflammation, makes it difficult to appropriately select uniform patients for clinical studies. This article proposes a new classification system for AKC based on clinical severity. RECENT FINDINGS Recent reports on AKC have contributed to a better understanding of the pathogenesis and clinical manifestations, and are offering new therapeutic candidates for AKC. No reports, however, have been found that address a classification of this disease. SUMMARY A new definition and classification for AKC is presented by this review, based on clinical severity, grading the main symptoms and signs. It intends to serve as a first forum of discussion among clinicians and other scientists working in the field of ocular surface inflammation. The final intention is to have a common language helping develop efficient clinical trials leading to successful approval of new therapeutic compounds for this blinding ocular surface condition.
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Affiliation(s)
- Margarita Calonge
- Ocular Immunology Clinical Unit and Ocular Surface Research Group, IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain.
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Leonardi A. New drug treatments for ocular allergies. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.3.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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