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Peng R, Chi M, Xiao G, Qu H, Shen Z, Zhao Y, Hong J. The outcomes of corneal sight rehabilitating surgery in Stevens-Johnson syndrome: case series. BMC Ophthalmol 2024; 24:205. [PMID: 38711013 DOI: 10.1186/s12886-024-03461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE To summarize the outcomes of corneal sight rehabilitating surgery in Stevens-Johnson syndrome (SJS). METHODS This is a retrospective analysis of a consecutive case series. Twenty-four eyes of 18 SJS patients were included in this study. The ocular parameters, surgical procedures, postoperative complications, and additional treatments of the cases were reviewed. RESULTS A total of 29 corneal sight rehabilitating surgeries, which consists of 9 keratoplasties, 8 Keratolimbal allograft (KLAL) and 12 combined surgeries (keratoplasty and KLAL simultaneously) were performed on the 24 eyes. All patients were treated with glucocorticoid eyedrops and tacrolimus eyedrops for anti-rejection treatment without combining systemic immunosuppression, except two patients who were prescribed prednisone tablets for the management of systemic conditions. The mean follow-up period was 50.6 ± 28.1 months. The optimal visual acuity (VA) (0.74 ± 0.60 logarithm of the minimum angle of resolution [logMAR]) and endpoint VA (1.06 ± 0.82 logMAR) were both significantly better than the preoperative VA (1.96 ± 0.43 logMAR) (95% CI, p = 0.000). 57.1% patients (8/14) were no longer in the low vision spectrum, and 88.9% patients (8/9) were no longer blind. The mean epithelialization time was 7.1 ± 7.6 weeks. The success rate was 86.7%. Additional treatments for improving epithelialization included administration of serum eyedrops (n = 10), contact lens (n = 15), amniotic membrane transplantation (n = 6), and tarsorrhaphy (n = 8). Complications included delayed epithelialization (n = 4, over 12 weeks), glaucoma (n = 11), and severe allograft opacity (n = 4). Only one graft rejection was observed. CONCLUSIONS Keratoplasty and KLAL can remarkably enhance VA and improve low vision or even eliminate blindness for ocular complications of SJS. The outcome of the surgeries was correlated with the preoperative ocular situation and choice of operative methods.
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Affiliation(s)
- Rongmei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Miaomiao Chi
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Gege Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Hongqiang Qu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Zhan Shen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Yinghan Zhao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China.
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Lee D, Lee GW, Yoon SH. Relationship between ocular surface temperature and 0.1% cyclosporine a in dry eye syndrome with meibomian gland dysfunction. PLoS One 2023; 18:e0293472. [PMID: 37983211 PMCID: PMC10659158 DOI: 10.1371/journal.pone.0293472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023] Open
Abstract
To determine the relationship between ocular surface temperature (OST) and 0.1% cyclosporine A in patients with dry eye syndrome and meibomian gland dysfunction (MGD). This study retrospectively analyzed 35 eyes from 18 patients with dry eye disease (DED) and MGD, who were divided into two groups. Group 1 was treated with artificial tears, and eyelid margin scrubs without anti-inflammatory eye drops, while group 2 received the same treatment as group 1 along with 0.1% cyclosporine A. The ocular surface disease index (OSDI), tear meniscus height (TMH), noninvasive tear breakup time (NIBUT), lipid layer thickness (LLT), meibum quality score (MQS), and OST were measured at baseline and 1 month later. Nineteen and 16 eyes were included in groups 1 and 2, respectively. Both groups showed a significant decrease in OSDI and OST; however, the decrease was more significant in group 2. No other significant differences in TMH, NIBUT, and LLT were observed; however, MQS significantly differed in group 2. This study found that 0.1% CsA administration can relieve symptoms in patients with DED and MGD although there were no definite keratitis clues, such as epithelial erosion. In addition, the conjunctival temperature showed a correlation with symptom improvement.
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Affiliation(s)
- Donghun Lee
- Department of Ophthalmology, Daegu Catholic University of Medicine, Daegu, Republic of Korea
| | - Geun Woo Lee
- Department of Ophthalmology, Daegu Catholic University of Medicine, Daegu, Republic of Korea
| | - Sook Hyun Yoon
- Department of Ophthalmology, Daegu Catholic University of Medicine, Daegu, Republic of Korea
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Ali A, Bielory L, Dotchin S, Hamel P, Strube YNJ, Koo EB. Management of vernal keratoconjunctivitis: Navigating a changing treatment landscape. Surv Ophthalmol 2023:S0039-6257(23)00138-8. [PMID: 37890678 DOI: 10.1016/j.survophthal.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic, progressive, and potentially sight-threatening form of ocular inflammatory disease that primarily affects children and young adults. Prevalence varies by region, ranging from <2 per 10,000 in the United States to as high as 1,100 per 10,000 in parts of Africa. The rarity of VKC in developed countries can make differential diagnosis challenging, and treatment is often delayed until the disease is advanced, and symptoms are significantly impacting patients' quality of life. Although once viewed primarily as an immunoglobulin E-mediated condition, approximately 50% of patients with VKC do not exhibit allergic sensitization. It is now recognized that the immunopathology of VKC involves multiple inflammatory pathways that lead to the signs, symptoms, and conjunctival eosinophilic and fibroproliferative lesions that are a hallmark of the disease. We examine the evolution of our understanding of the immunopathology of VKC, the expanding VKC treatment armamentarium, the clinical implications of emerging treatment approaches, and future directions for VKC research and practice.
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Affiliation(s)
- Asim Ali
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Leonard Bielory
- Departments of Medicine, Allergy, Immunology and Ophthalmology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Stephanie Dotchin
- Department of Surgery, Section of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Hamel
- CHU Ste-Justine, Université de Montréal and McGill University Health Center, Montréal, Québec, Canada
| | - Yi Ning J Strube
- Department of Ophthalmology, Queen's University/Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Euna B Koo
- Stanford Byers Eye Institute, Palo Alto, California, USA
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Saha BC, Kumari R, Ambasta A. Comparision of efficacy and safety of 0.03% and 0.1% tacrolimus ointment in children with vernal keratoconjunctivitis. Ther Adv Ophthalmol 2023; 15:25158414231173532. [PMID: 37255622 PMCID: PMC10226287 DOI: 10.1177/25158414231173532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/14/2023] [Indexed: 06/01/2023] Open
Abstract
Background Topical immunosuppressants such as tacrolimus in different concentrations are a breakthrough in the management of recalcitrant vernal keratoconjunctivitis (VKC); however, there is a lacks of comparative studies to guide their use in VKC management. Objective To compare the efficacy and safety of tacrolimus 0.03% and 0.1% eye ointment in the treatment of recalcitrant VKC. Design A retrospective comparative single-centre observational study. Method We reviewed records of a total of 48 recalcitrant VKC patients treated with two different strengths of tacrolimus ointment between April 2016 and March 2017. Of these, 39 fulfilled the inclusion criteria and were categorized into two groups, A and B, depending on the use of strength of tacrolimus (0.03% and 0.1%) used, respectively. Group A had 18 patients, while group B had 21 patients. Thirty-six patients, 18 from each group, were finally analysed and compared. Records of patients were explored for the subjective symptoms and objective sign score of the patient at baseline and at each time point. The main outcome measures were composite scoring and comparison of total subjective symptom scores (TSSSs) and total objective sign scores (TOSSs) within and between the groups at each follow-up. Percentage of patient with significant reduction in symptom and sign scores as compared with baseline was considered success of treatment. Chi-square and t-tests were used for comparison of outcomes between both groups. Results Mixed variety was most commonly encountered type of VKC. The signs and symptoms were significantly reduced in patients with treatment in both groups (p = 0.001) in all types of VKC. However, in group B, there was significant improvement in the size of papillae (p = 0.04) as compared baseline in contrast to group A. Side effects like burning and stinging in group B were significantly higher as compared with group A. Conclusions Both strengths of tacrolimus (0.03% and 0.1%) are effective in all forms of recalcitrant VKC. Papillary component of VKC responds better with higher strength (0.1%) but is associated with more significant side effects. Different strengths of tacrolimus can be used strategically depending upon the severity and clinical type of VKC to intensify outcome and minimize side effects.
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Affiliation(s)
- Bhawesh Chandra Saha
- Department of Ophthalmology, All India
Institute of Medical Sciences, Patna, Bihar, India
| | | | - Anita Ambasta
- Regional Institute of Ophthalmology, Indira
Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Dogan CU, Tuzer C, Turker IC, Alkan AA, Culha D, Demir S. Topical cyclosporine versus allergen specific immunotherapy in perennial allergic conjunctivitis. Int Ophthalmol 2022:10.1007/s10792-022-02612-y. [PMID: 36513916 PMCID: PMC9747541 DOI: 10.1007/s10792-022-02612-y] [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] [Received: 08/29/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Symptom control in the long-term with less side effects is important in perennial allergic conjunctivitis, since would improve quality of life. This study aimed to assess the clinical efficacies of topical cyclosporin A and subcutaneous allergen immunotherapy (SCIT) in terms of sign control in perennial allergic conjunctivitis. METHODS This retrospective study included 20 adult patients with perennial allergic conjunctivitis and confirmed sensitization to house dust mites with skin prick test. Patients were assigned to either topical cyclosporine A treatment or SCIT. The participants were followed for 6 months, and signs scores were recorded at 1, 3 and 6 months. RESULTS Overall, both cyclosporine and immunotherapy groups showed significant improvements in papillary reaction (p = 0.011 and 0.003, respectively), limbal involvement (p = 0.031 and 0.001), and conjunctival hyperemia (p = 0.001 and p < 0.001) scores during the 6-month follow-up. However, only cyclosporine group showed a significant improvement in corneal involvement scores (p = 0.015) during the study period. When scores at different time points were compared, significant improvement in conjunctival hyperemia was evident at 6 months in both groups when compared to baseline (cyclosporine group, 0.7 ± 0.68 vs. 2.4 ± 0.84, 70.8% decrease, p = 0.01; immunotherapy group, 0.3 ± 0.48 vs. 2.3 ± 0.95, 87.0% decrease, p = 0.004), whereas for limbal involvement such an improvement was only evident in the immunotherapy group (0.1 ± 0.32 vs. 1.3 ± 0.95, 92.3% decrease, p = 0.01). CONCLUSIONS Allergen immunotherapy and cyclosporin A treatment may provide effective sign relief in perennial allergic conjunctivitis. It may represent an encouraging treatment option particularly for cases with perennial allergic conjunctivitis refractive to other treatments and positive skin prick test to a specific allergen (house dust in the present study). Long-term relief by SCIT would reduce the side effects of polypharmacotherapy. Larger studies with longer follow-up are warranted to confirm our findings.
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Affiliation(s)
- Ceylan Uslu Dogan
- Department of Ophthalmology, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Sciences, Cumhuriyet and Demokrasi Avenue, No:1, Istanbul, Turkey
| | - Can Tuzer
- Division of Allergy and Immunology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ibrahim Cagri Turker
- Department of Ophthalmology, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Sciences, Cumhuriyet and Demokrasi Avenue, No:1, Istanbul, Turkey
| | | | - Damla Culha
- Lotus Eye Aesthetics & Strabismus Clinic, Halaskargazi Street, Sisli/Istanbul, Turkey
| | - Semra Demir
- Division of Allergy and Immunology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Executive summary: Japanese guidelines for allergic conjunctival diseases 2021. Allergol Int 2022; 71:459-471. [PMID: 36096976 DOI: 10.1016/j.alit.2022.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Allergic conjunctival disease (ACD) is an inflammatory disease of the conjunctiva that is mainly caused by type I hypersensitivity response to allergens and accompanied by subjective symptoms and other findings induced by antigens. ACD is classified as allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. This article summarizes the third edition of the Japanese guidelines for allergic conjunctival diseases published in 2021 and outlines the diagnosis, pathogenesis, and treatment of ACD. Since the introduction of immunosuppressive eye drops, the treatment strategies for severe ACDs have significantly changed. To clarify the recommended standard treatment protocols for ACD, the advantages and disadvantages of these treatments were assessed using clinical questions, with a focus on the use of steroids and immunosuppressive drugs. This knowledge will assist healthcare providers and patients in taking an active role in medical decision making.
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Chen M, Ke B, Zou J, Gong L, Wang Y, Zhang C, Xu J, Wei A, Hong J. Combination Therapy of 0.1% Fluorometholone and 0.05% Azelastine in Eyes with Severe Allergic Conjunctival Diseases: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11133877. [PMID: 35807160 PMCID: PMC9267215 DOI: 10.3390/jcm11133877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023] Open
Abstract
This study sought to evaluate the efficacy of the isolated use of fluorometholone compared with the combined use of azelastine and fluorometholone for the treatment of severe allergic conjunctival disease (ACD). One hundred and eleven patients with severe ACD were randomized into two groups: one treated with topical 0.1% fluorometholone combined with 0.05% azelastine and the other with 0.1% fluorometholone alone. The Ocular Surface Disease Index (OSDI) and the signs of keratopathy, palpebral conjunctiva papillae and conjunctival congestion were scored before and at one, two and six weeks after treatment and compared between the groups. The intra-ocular pressure (IOP) was also monitored. There were no significant differences between the groups in the baseline mean scores of signs and OSDI scores, which gradually improved at all visits after therapy in both groups. Although the time effect was significant for all the parameters (all p < 0.001), the reduction in corneal involvement scores from week 2 to week 6 was insignificant in both groups (p = 0.460 for the steroids group and p = 0.074 for the combination group). All signs and symptoms were significantly more improved in the combination group than in the isolated group at each control visit. IOP remained stable at all visits (all p < 0.001), except one patient in each group had elevated IOP over 21 mmHg. While both the isolated use of fluorometholone and combined use of azelastine and fluorometholone are effective in alleviating the signs and symptoms of severe ACD, optimal response can be achieved with adjunctive treatment including azelastine.
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Affiliation(s)
- Minjie Chen
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
| | - Bilian Ke
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China;
| | - Jun Zou
- Department of Ophthalmology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China;
| | - Lan Gong
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
| | - Yan Wang
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
| | - Chaoran Zhang
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
| | - Jianjiang Xu
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
| | - Anji Wei
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
- Correspondence: (A.W.); (J.H.); Tel.: +86-21-64377134 (A.W. & J.H.); Fax: +86-21-64318258 (A.W. & J.H.)
| | - Jiaxu Hong
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, 28 Guiyi Road, Guiyang 550031, China
- Correspondence: (A.W.); (J.H.); Tel.: +86-21-64377134 (A.W. & J.H.); Fax: +86-21-64318258 (A.W. & J.H.)
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Vitamin D, the Vitamin D Receptor, Calcitriol Analogues and Their Link with Ocular Diseases. Nutrients 2022; 14:nu14112353. [PMID: 35684153 PMCID: PMC9183042 DOI: 10.3390/nu14112353] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
Abstract
The global prevalence of eye diseases continues to grow, bringing with it a reduction in the activity levels and quality of life of patients, and partial or complete blindness if left untreated. As such, there is considerable interest in identifying more effective therapeutic options and preventive agents. One such agent is vitamin D, known to have a range of anti-cancer, anti-angiogenic, anti-inflammatory and anti-oxidative properties, and whose deficiency is linked to the pathogenesis of a range of cardiovascular, cancer, and inflammatory diseases. This review presents the current stage of knowledge concerning the link between vitamin D and its receptor and the occurrence of eye disease, as well as the influence of analogues of calcitriol, an active metabolite of vitamin D. Generally, patients affected by various ocular disorders have vitamin D deficiency. In addition, previous findings suggest that vitamin D modulates the course of eye diseases and may serve as a marker, and that its supplementation could mitigate some disorders. However, as these studies have some limitations, we recommend further randomized trials to clarify the link between vitamin D and its activity with eye disease.
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Masini M, Brindisi G, Giovannini M, Pignataro E, Di Grande L, De Libero C, Nebbioso M, Mori F, Caputo R, Zicari AM. Impact of screen exposure on pediatric vernal Keratoconjunctivitis: a survey during the COVID-19 pandemic in Italy. Ital J Pediatr 2022; 48:74. [PMID: 35568956 PMCID: PMC9107013 DOI: 10.1186/s13052-022-01253-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 03/27/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 outbreak pushed the Italian government to start a strict lockdown, replacing school attendance with long-distance learning. This caused reduced exposure to sunlight but increased exposure to screens. Vernal keratoconjunctivitis (VKC) is a chronic inflammatory ocular condition in which exposure to light plays a cardinal role. We conducted an online survey to evaluate the impact of screen exposure on children with VKC during the COVID-19 lockdown. METHODS We performed a survey-based observational study, asking patients followed at the Allergology clinics of Meyer Children's University Hospital in Florence and of Policlinico Umberto I in Rome to provide grading on 6 subjective ocular clinical manifestations presented during the lockdown and to give an estimate of their hours/day of screen exposure. RESULTS Mean scores of signs and symptoms increased homogeneously when studying patients exposed to longer screen time. When comparing scores collected in 2019 to those in 2020, there was not a significant reduction in clinical manifestations, although the situation differed between the two centers due to geographical differences in sunlight exposure. CONCLUSION During the lockdown, there was a reduction in sunlight exposure but conversely an increase in the time spent in front of screens that correlated with the worsening of VKC signs and symptoms in direct proportion to the hours/day of screen exposure. Our results also showed a statistically significant difference in the relative impact of long-distance learning on VKC clinical manifestations in the different Italian regions.
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Affiliation(s)
- Marzio Masini
- Department of Maternal Infantile and Urological Sciences, Division of Pediatric Allergology and Immunology, Sapienza University of Rome, 00185, Rome, Italy.
| | - Giulia Brindisi
- Department of Maternal Infantile and Urological Sciences, Division of Pediatric Allergology and Immunology, Sapienza University of Rome, 00185, Rome, Italy
| | - Mattia Giovannini
- Pediatric Allergology Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Elia Pignataro
- Department of Maternal Infantile and Urological Sciences, Division of Pediatric Allergology and Immunology, Sapienza University of Rome, 00185, Rome, Italy
| | - Laura Di Grande
- Pediatric Allergology Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Cinzia De Libero
- Clinical Ophthalmology Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Marcella Nebbioso
- Department of Sense Organs, Sapienza University of Rome, 00185, Rome, Italy
| | - Francesca Mori
- Pediatric Allergology Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Roberto Caputo
- Clinical Ophthalmology Unit, Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Anna Maria Zicari
- Department of Maternal Infantile and Urological Sciences, Division of Pediatric Allergology and Immunology, Sapienza University of Rome, 00185, Rome, Italy
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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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11
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Rasmussen MLR, Schou MG, Bach‐Holm D, Heegaard S, Jørgensen CAB, Kessel L, Wiencke AK, Subhi Y. Comparative efficacy of medical treatments for vernal keratoconjunctivitis in children and young adults: a systematic review with network meta-analyses. Acta Ophthalmol 2022; 100:35-44. [PMID: 33779061 DOI: 10.1111/aos.14858] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To systematically review the literature on the treatment of vernal keratoconjunctivitis (VKC) in children and young adults and conduct comparative efficacy analysis on clinical signs and symptoms using network meta-analyses. METHODS We systematically searched the databases PubMed/MEDLINE, EMBASE, Cochrane Central and Web of Science on 21 October 2019 for randomized controlled trials (RCT). Studies considered had patients with VKC < 20 years of age randomized into either intervention (any medical intervention) or comparator (active treatment, placebo treatment or non-treatment control), where pre-defined outcomes (data from ≥2 weeks and as close as possible to 2 months) of symptoms (itching, tearing, photophobia and foreign body sensation) and signs (hyperaemia, punctate keratitis, Horner-Trantas dots and macropapillae) were reported. Risk of bias within studies was evaluated using the Cochrane risk of bias tool. Comparisons were made using network meta-analyses. RESULTS We identified 39 studies with data on 2046 individuals. Twenty-three studies were eligible for quantitative analyses. None were systemic therapy. Temporal trend analysis showed that an initial focus on topical mast cell stabilizers turned to a focus on calcineurin inhibitors and a more diverse variety of pharmacological strategies. Studies varied in population, treatment duration and quality. The quantitative analysis revealed that efficacy of different therapies differed substantially across important clinical signs and symptoms, but there was a general trend of superior efficacy when using topical corticosteroids with stronger efficacy of the more potent corticosteroids. CONCLUSION We provide an overview of RCTs comparing the efficacy of treatments for VKC in children and young adults, which we find differs across symptoms and signs. Overall, we saw a general trend of superior efficacy with topical corticosteroids. However, our findings highlight the need for better studies, consensus on core outcomes and potential for individualized therapy.
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Affiliation(s)
| | - Marianne Guldager Schou
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Daniella Bach‐Holm
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Steffen Heegaard
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | | - Line Kessel
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Anne Katrine Wiencke
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Yousif Subhi
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
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Shih EJ, Lin JC, Peng KL, Chen JL. Treating refractory corneal hydrops in a male patient with vernal keratoconjunctivitis and mental retardation: a case report. BMC Ophthalmol 2022; 22:36. [PMID: 35073856 PMCID: PMC8785578 DOI: 10.1186/s12886-021-02241-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background Keratoconus is the most common noninflammatory bilateral corneal ectasia. Vernal keratoconjunctivitis (VKC) and eye rubbing may be associated with keratoconus in children and young adults. Timely management of advanced keratoconus is important to improve visual quality. In addition, it is challenging to carry out VKC treatment with an intent to avoid the occurrence of punctate epithelial keratitis, ulceration, or corneal neovascularization on corneal grafts. Case presentation We report the case of an 18-year-old male patient with a long-term history of mental retardation due to megalencephaly presenting with acute onset of corneal hydrops with prominent bulging and refractory steroid-induced glaucoma of the right eye. The topography of the right eye was unavailable due to advanced ectasia, and that of the left eye revealed central steepening with inferior-superior dioptric asymmetry. According to the clinical findings, the patient was diagnosed with keratoconus. Because of progressive corneal opacity and neovascularization, the patient underwent penetrating keratoplasty (PK) with combination of interrupted and intrastromal running suturing after receiving a preoperative subconjunctival injection of bevacizumab in his right eye, followed by lower eyelid correction. After surgery, the patient was treated with 0.1% tacrolimus dermatological ointment, 0.1% cyclosporine eye drops, artificial tears, and 0.5% loteprednol for keratoplasty and VKC. Repeated education on avoiding eye rubbing was offered to the patient. Two years after PK treatment, his best-corrected visual acuity of the right eye successfully improved from hand motion at 10 cm preoperatively to 6/20 postoperatively. Conclusions Large-diameter PK with intrastromal suturing technique for advanced keratoconus could achieve better visual outcomes and avoid suture-related complications. In addition, tacrolimus dermatological ointment rather than tacrolimus topical eye drops or ointment showed satisfactory efficacy when combined with topical cyclosporine and steroid that no significant VKC reactivation were noted after PK.
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Jo YJ, Kim JH, Lee JS. The Therapeutic Effects of a 0.03% Tacrolimus Ointment on Childhood Phlyctenular Keratitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.7.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We explored the therapeutic effects of a 0.03% tacrolimus ointment (Protopic) on steroid-resistant phlyctenular keratitis in children. Methods: We enrolled seven eyes of five children with recurrent phlyctenular keratitis despite 3 months of steroid treatment. The topical steroids were tapered and the patients treated with a combination of 0.03% tacrolimus and 0.3% ofloxacin ointment. The logarithm of minimal angle of resolution (logMAR) visual acuity, corneal neovascularization status, and changes in corneal opacity between the baseline and final visit were checked on anterior photographs using Image J software. Results: The average patient age was 6.8 ± 3.0 years (range, 3-9 years) and the treatment duration 8.0 ± 2.0 days (range, 5-10 days). The baseline logMAR visual acuity was 0.42 ± 0.32 and the final value 0.19 ± 0.22. Visual acuity thus improved significantly after treatment (p = 0.026). Corneal neovascularization and phylctenulosis improved in all seven eyes; the fibrotic corneal opacity decreased in two eyes. Conclusions: Topical 0.03% tacrolimus ointment may usefully treat steroid-resistant phlyctenular keratitis of childhood.
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Gupta S, Singh P, Singh M, Naik M, Srivastava K. Is Interferon α-2b 1 MillionIU/mL Truly Better Than Tacrolimus 0.03% for Steroid-Resistant VKC ?: Our 2-Year Experience at a Tertiary Health-Care Centre. Clin Ophthalmol 2021; 15:2993-2999. [PMID: 34285466 PMCID: PMC8286782 DOI: 10.2147/opth.s322378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the efficacy of eye-drop interferon (IFN) α-2b 1 millionIU/mL with eye-ointment tacrolimus 0.03% in refractory vernal keratoconjunctivitis (VKC). Materials and Methods Fifty patients with VKC refractory to conventional treatment with topical corticosteroids and antihistamines after 4 weeks of regular use were selected retrospectively. Patients were divided into two groups depending on whether they received eye-ointment tacrolimus 0.03% three times a day or eye-drop IFN alpha-2b 1 millionIU/mL three times a day and were followed up for 24 months. The main outcome measures were total subjective symptom score (TSSS) and total objective ocular score (TOSS). Results Mean baseline TSSS was 7.24±1.98 in Group A (tacrolimus group) and 7.84±1.82 in Group B (IFN group), and it reduced to 1.12±0.83 in Group A and 0.62±0.41 in Group B at 6 months, which was statistically significant compared to the baseline score (p<0.05) as well as between the two groups. Mean baseline TOSS was 6.72±2.07 in Group A and 6.56±2.04 in Group B, and it improved to 1 month onwards to 1.52±0.87 in Group A and 1.0±0.71 in Group B at 6 months, which was statistically significant compared to the baseline score (p<0.05) as well as between the two groups. Side effects like stinging and burning sensations were seen in the tacrolimus group only. Conclusion Our study suggests that while both eye-drop IFN α-2b 1 millionIU/mL and eye-ointment tacrolimus eye ointment 0.03% are both safe and effective steroid-sparing agents in steroid-resistant VKC. IFN α-2b results in greater improvement in subjective symptoms and objective signs, has fewer side effects in long term and is better tolerated as compared to tacrolimus.
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Affiliation(s)
- Sukriti Gupta
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, New Delhi, 110029, India
| | - Priyanka Singh
- Department of Ophthalmology, ESI Medical College and Hospital, Faridabad, Haryana, 121012, India
| | - Mrityunjay Singh
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, New Delhi, 110029, India
| | - Mayuresh Naik
- Department of Ophthalmology, H.I.M.S.R & H.A.H. Centenary Hospital, New Delhi, 110062, India
| | - Kartikeya Srivastava
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, New Delhi, 110029, India
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15
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Long-Term Safety and Efficacy of Tacrolimus 0.1% in Severe Pediatric Vernal Keratoconjunctivitis. Cornea 2021; 40:1395-1401. [PMID: 34029239 DOI: 10.1097/ico.0000000000002751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the safety and efficacy of tacrolimus 0.1% eye drops in a large population of pediatric patients affected by a severe form of vernal keratoconjunctivitis (VKC) who responded poorly to cyclosporine eye drops. METHODS This is a retrospective study based on standardized clinical charts and data collection of consecutive patients affected by severe VKC who responded poorly to cyclosporine eye drops topical treatment but treated with tacrolimus 0.1% eye drops with a follow-up of 18 months. Four clinical signs were graded for analysis: hyperemia, tarsal papillae, giant papillae, and limbal papillae. The blood tests for kidney and liver function and the tacrolimus level were studied. Visits were scheduled at baseline and at 3, 6, 12, and 18 months. Patients received tacrolimus 0.1% eye drops in both eyes 2 times daily. RESULTS Four hundred thirty-one patients were included. Three hundred twenty-five patients were affected by a seasonal form, whereas the remaining 106 by a perennial form. Statistical analysis on each single score showed a positive relevance (P < 0.001) from baseline to all other visits. No local or systemic complications were recorded. CONCLUSIONS Tacrolimus has been proposed as a treatment for severe forms of VKC. This study has confirmed the safety and efficacy of tacrolimus 0.1% eye drops in a large pediatric population of patients affected by a severe form of VKC who responded poorly to cyclosporine eye drops.
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Roumeau I, Coutu A, Navel V, Pereira B, Baker JS, Chiambaretta F, Bremond-Gignac D, Dutheil F. Efficacy of medical treatments for vernal keratoconjunctivitis: A systematic review and meta-analysis. J Allergy Clin Immunol 2021; 148:822-834. [PMID: 33819510 DOI: 10.1016/j.jaci.2021.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/16/2021] [Accepted: 03/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vernal keratoconjunctivitis (VKC) is a severe type of allergic conjunctivitis for which treatment strategies are still under debate. OBJECTIVES This study sought to conduct a systematic review and meta-analysis to evaluate the efficacy of medical treatments for VKC. METHODS The PubMed, Cochrane Library, Embase, and ScienceDirect databases were searched to assess the efficacy of treatments for VKC. Random-effect meta-analyses on changes in clinical scores of symptoms and signs between baseline and after treatment, stratified on treatment classes, were computed. Meta-regressions were searched for potential influencing parameters. RESULTS Included were 45 studies (27 randomized controlled trials and 18 prospective cohort studies), 1749 patients (78% were men; mean age, 11.2 years), and 12 different treatment classes. Mast cell stabilizers (MCSs; usually considered as first-line therapy), cyclosporine, and tacrolimus were the most studied drugs (in three-quarters of studies). Overall, all clinical scores improved. Total symptom and sign score decreased for MCSs (effect size, -3.19; 95% CI, -4.26 to -2.13), cyclosporine (effect size, -2.06; 95% CI, -2.72 to -1.40), and tacrolimus (effect size, -2.39; 95% CI, -3.36 to -1.43). No significant differences were shown depending on treatment classes, concentration, age, sex, baseline activity scores, and atopy. Sensitivity analyses demonstrated similar results. CONCLUSIONS This study confirms the efficacy of MCSs in the treatment of VKC. Efficacy of cyclosporine and tacrolimus did not differ, suggesting that tacrolimus is a good alternative to cyclosporine for severe cases of VKC. Further studies are needed to compare other drugs and their precise place in treatment strategy.
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Affiliation(s)
- Inès Roumeau
- Ophthalmology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Adrien Coutu
- Ophthalmology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Valentin Navel
- Ophthalmology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France; Translational Approach to Epithelial Injury and Repair Department, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Génétique Reproduction et Développement, Clermont-Ferrand, France.
| | - Bruno Pereira
- Biostatistics Unit, Clinical Research and Innovation Direction, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Julien S Baker
- Hong Kong Baptist University, Centre for Health and Exercise Science Research, Physical Education and Health, Kowlon Tong, Hong Kong
| | - Frédéric Chiambaretta
- Ophthalmology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France; Translational Approach to Epithelial Injury and Repair Department, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Génétique Reproduction et Développement, Clermont-Ferrand, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department, University Hospital Necker Enfants Malades, Paris, France; Sorbonne Paris Cité University, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Cordeliers Search Centre, Paris, France
| | - Frédéric Dutheil
- Physiological and Psychosocial Stress Department, Laboratoire de Psychologie Sociale et Cognitive, Centre National de la Recherche Scientifique, Université Clermont Auvergne, Clermont-Ferrand, France; Preventive and Occupational Medicine Department, WittyFit, Centre Hospitalier Universitaire Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Faculty of Health, School of Exercise Science, Australian Catholic University, Melbourne, Australia
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17
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Abstract
A biomarker is a "characteristic that is measured as an indicator of normal biological processes, pathogenic processes, or responses to an exposure or intervention, including therapeutic interventions." Recently, calls for biomarkers for ocular surface diseases have increased, and advancements in imaging technologies have aided in allowing imaging biomarkers to serve as a potential solution for this need. This review focuses on the state of imaging biomarkers for ocular surface diseases, specifically non-invasive tear break-up time (NIBUT), tear meniscus measurement and corneal epithelial thickness with anterior segment optical coherence tomography (OCT), meibomian gland morphology with infrared meibography and in vivo confocal microscopy (IVCM), ocular redness with grading scales, and cellular corneal immune cells and nerve assessment by IVCM. Extensive literature review was performed for analytical and clinical validation that currently exists for potential imaging biomarkers. Our summary suggests that the reported analytical and clinical validation state for potential imaging biomarkers is broad, with some having good to excellent intra- and intergrader agreement to date. Examples of these include NIBUT for dry eye disease, ocular redness grading scales, and detection of corneal immune cells by IVCM for grading and monitoring inflammation. Further examples are nerve assessment by IVCM for monitoring severity of diabetes mellitus and neurotrophic keratitis, and corneal epithelial thickness assessment with anterior segment OCT for the diagnosis of early keratoconus. However, additional analytical validation for these biomarkers is required before clinical application as a biomarker.
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Zhao M, He F, Yang Y, Lin W, Qiu W, Meng Q, Zhang J, Zhou Z. Therapeutic efficacy of tacrolimus in vernal keratoconjunctivitis: a meta-analysis of randomised controlled trials. Eur J Hosp Pharm 2020; 29:129-133. [PMID: 33144336 PMCID: PMC9047954 DOI: 10.1136/ejhpharm-2020-002447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background and objective Tacrolimus has been widely used in recent years for treating allergic conjunctivitis, but there is currently no available meta-analysis regarding its therapeutic efficacy. This study systematically evaluated the effectiveness of tacrolimus in the treatment of allergic conjunctivitis. Methods Data obtained from literature searches of the PubMed, Cochrane Library, Embase, CNKI, and Wanfang databases were retrieved by combining medical subject words and free words. Literature was selected on the basis of established inclusion and exclusion criteria, and the extracted data were evaluated for risk of bias using RevMan 5.3 for meta-analysis. Results A total of 177 articles were retrieved, of which 5 articles were eventually selected, all of which involved tacrolimus treatment for vernal keratoconjunctivitis. A total of 203 samples were analysed. Results of the meta-analysis showed that the tacrolimus treatment group had significantly lower ocular objective sign scores (SMD −1.39, 95% CI −2.50 to −0.27; p<0.05) and had a significantly lower subjective symptom evaluation score (SMD −0.92, 95% CI −1.59 to −0.24; p<0.05) than the control group. Conclusion Current evidence shows that tacrolimus is effective in treating vernal keratoconjunctivitis.
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Affiliation(s)
- Min Zhao
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China.,College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Fazhong He
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Yang Yang
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Weijie Lin
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Wentao Qiu
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China.,College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Qian Meng
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Jianping Zhang
- College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Zhiling Zhou
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
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Kim SE, Nowak V, Quartilho A, Larkin F, Hingorani M, Tuft S, Dahlmann-Noor A. Systemic interventions for severe atopic and vernal keratoconjunctivitis in children and young people up to the age of 16 years. Cochrane Database Syst Rev 2020; 10:CD013298. [PMID: 33084033 PMCID: PMC8078190 DOI: 10.1002/14651858.cd013298.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) are severe and potentially sight-threatening allergic eye diseases characterised by chronic inflammation of the ocular surface. Both topical and systemic treatments are used. This Cochrane Review focuses on systemic treatments. OBJECTIVES To assess the effects of systemic treatments (including corticosteroids, NSAIDS, immunomodulators, and monoclonal antibodies), alone or in combination, compared to placebo or other systemic or topical treatment, for severe AKC and VKC in children and young people up to the age of 16 years. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE, Ovid Embase, the ISRCTN registry, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). There were no restrictions to language or year of publication. We last searched the electronic databases on 17 February 2020. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) that involved systemic treatments in children aged up to 16 years with a clinical diagnosis of AKC or VKC. We planned to include studies that evaluated a single systemic medication versus placebo, and studies that compared two or multiple active treatments. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. MAIN RESULTS No trial met the inclusion criteria of this Cochrane Review. No RCTs have been carried out on this topic. AUTHORS' CONCLUSIONS There is currently no evidence from randomised controlled trials regarding the safety and efficacy of systemic treatments for VKC and AKC. Trials are required to test efficacy and safety of current and future treatments. Outcome measures need to be developed which can capture both objective clinical and patient-reported aspects of the condition and treatments.
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Affiliation(s)
| | | | - Ana Quartilho
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Frank Larkin
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Stephen Tuft
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Annegret Dahlmann-Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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20
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Role of combined immunomodulator therapy in severe steroid intolerant vernal keratoconjunctivitis. Eye (Lond) 2020; 35:979-987. [PMID: 32518397 DOI: 10.1038/s41433-020-1013-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe the role of combined topical cyclosporine (CsA) 0.1% and tacrolimus 0.03% in cases with severe steroid intolerant vernal keratoconjunctivitis (VKC). METHODS Medical records of patients with acute exacerbation of VKC and steroid intolerance referred from glaucoma to cornea clinic were reviewed from March 2017 to December 2018. Eleven patients (22 eyes), (nine with steroid-induced glaucoma, two with steroid-induced cataract and glaucoma) were found. All were started on topical CsA 0.1% QID. Due to suboptimal response at 2 weeks, topical tacrolimus 0.03% BD was also included. RESULTS The mean total subjective score at presentation was 13 ± 1.4, which reduced to 11.2 ± 1.3 at 2 weeks of topical CsA therapy and further reduced to 5 ± 0 at 2 weeks of combination therapy (p < 0.001). The mean total objective score at presentation was 9.4 ± 1.4 that reduced to 8.0 ± 1.3 at 2 weeks of topical CsA therapy and further reduced to 4.3 ± 1.6 at 2 weeks of combination therapy (p < 0.001). Similar results were obtained in a sub-group analysis including the worse eye or right eye of the cases only. The absolute change in the total subjective and objective score was much more with combination therapy. Photophobia and conjunctival hyperemia resolved within 4 weeks of combined therapy. No recurrence was observed till 6 months follow-up. CONCLUSIONS Combined use of cyclosporine and tacrolimus may lead to rapid resolution of symptoms and reduced recurrence rate in cases with severe VKC where steroid has to be avoided.
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Leonardi A, Dupuis-Deniaud M, Bremond-Gignac D. Clinical efficacy assessment in severe vernal keratoconjunctivitis: preliminary validation of a new penalties-adjusted corneal fluorescein staining score. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2020; 8:1748492. [PMID: 32341771 PMCID: PMC7170307 DOI: 10.1080/20016689.2020.1748492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 06/11/2023]
Abstract
Introduction and objective: Vernal keratoconjunctivitis (VKC) is a rare allergic eye condition that occurs in children and is characterised by a combination of debilitating symptoms. Repeated use of topical corticosteroid rescue therapy is often necessary in severe forms. This study aims to assess the validity of a new composite endpoint: the penalties-adjusted corneal staining score (PACS-S) proposed as primary endpoint in VEKTIS trial evaluating the efficacy of a new corticosteroid-sparing treatment, VERKAZIA® (ciclosporin 1 mg/ml eye drops), in severe VKC patients. Methodology: This research comprised a systematic literature review to identify efficacy endpoints being proposed in clinical trials for pediatric patients with severe VKC, followed by a remote expert advisory board assessing the validity of the PACS-S. Results: While no agreed or validated endpoint for assessing efficacy in VKC was identified when VEKTIS trial started, the experts' board acknowledged a high face validity of PACS-S as a subjective integrated measure matching the current clinical practice. A fair external validity was considered with regards to VEKTIS trial secondary endpoints. Conclusion: PACS-S appears to be a reliable, valid and clinically meaningful primary endpoint that allows significant improvement over existing endpoints in severe VKC trials. Additional research is needed to validate this endpoint.
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Affiliation(s)
- Andrea Leonardi
- Ophthalmology Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | | | - Dominique Bremond-Gignac
- Hospital Necker Enfants Malades, APHP, and CNRS Unit FR 3636, Paris Descartes University, Paris, France
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AlHarkan DH. Management of vernal keratoconjunctivitis in children in Saudi Arabia. Oman J Ophthalmol 2020; 13:3-12. [PMID: 32174733 PMCID: PMC7050462 DOI: 10.4103/ojo.ojo_263_2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/07/2019] [Accepted: 11/25/2019] [Indexed: 11/06/2022] Open
Abstract
Vernal keratoconjunctivitis is a chronic inflammatory disease of the ocular surface and one of the worst types of allergic conjunctival diseases. Because of its chronic nature, it can damage the cornea, resulting in sight-threatening complications if left untreated. The disease affects mainly young children starting around the age of 7 years. We used keywords to search for published English articles in PUBMED, Google Scholar, EMBASE, and Cochrane Database of Systematic Reviews. Most of the published literature is focusing on general management of the disease and few publications focusing on treatment in the pediatric age group. We highlight the importance of how is the topical management differs between age groups. We focused on the importance of doing cycloplegic refraction for each child as the risk of keratoconus and oblique astigmatism is high in these cases. Furthermore, we highlight the importance of using eye lubricants as a therapeutic and preventive tool for the attacks of the disease. We highlight that most of the recent effective medications (especially the off-label ones) are not available in Saudi Arabia, such as tacrolimus, and some are only available to be prepared in tertiary center pharmacies as Cyclosporine A with higher concentrations.
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Affiliation(s)
- Dora Hamad AlHarkan
- Department of Ophthalmology, Medical College, Qassim University, Qassim, Saudi Arabia
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23
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Leonardi A, Silva D, Perez Formigo D, Bozkurt B, Sharma V, Allegri P, Rondon C, Calder V, Ryan D, Kowalski ML, Delgado L, Doan S, Fauquert JL. Management of ocular allergy. Allergy 2019; 74:1611-1630. [PMID: 30887530 DOI: 10.1111/all.13786] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 12/13/2022]
Abstract
The treatment and management of ocular allergy (OA) remain a major concern for different specialties, including allergists, ophthalmologists, primary care physicians, rhinologists, pediatricians, dermatologists, clinical immunologists, and pharmacists. We performed a systematic review of all relevant publications in MEDLINE, Scopus, and Web Science including systematic reviews and meta-analysis. Publications were considered relevant if they addressed treatments, or management strategies of OA. A further wider systematic literature search was performed if no evidence or good quality evidence was found. There are effective drugs for the treatment of OA; however, there is a lack an optimal treatment for the perennial and severe forms. Topical antihistamines, mast cell stabilizers, or double-action drugs are the first choice of treatment. All of them are effective in reducing signs and symptoms of OA. The safety and optimal dosing regimen of the most effective topical anti-inflammatory drugs, corticosteroids, are still a major concern. Topical calcineurin inhibitors may be used in steroid-dependent/resistant cases of severe allergic keratoconjunctivitis. Allergen-specific immunotherapy may be considered in cases of failure of first-line treatments or to modify the natural course of OA disease. Based on the current wealth of publications and on the collective experience, recommendations on management of OA have been proposed.
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Affiliation(s)
- Andrea Leonardi
- Ophthalmology Unit, Department of Neuroscience University of Padua Padua Italy
| | - Diana Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, Serviço de Imunoalergologia, Centro Hospitalar São João University of Porto, EPE – Porto Porto Portugal
| | - Daniel Perez Formigo
- Department of Ophthalmology Hospital Universitario de Torrejon Madrid Spain
- Faculty of Medicine University of Francisco de Vitoria (UFV) Pozuelo de Alarcon, Madrid Spain
| | - Banu Bozkurt
- Department of Ophthalmology, Faculty of Medicine Selcuk University Konya Turkey
| | - Vibha Sharma
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital Manchester University NHS Foundation Trust Manchester UK
| | - Pia Allegri
- Allergic Conjunctivitis Unit, Ocular Inflammatory Diseases Referral Center, Rapallo Hospital Ophthalmology DepartmentGenova Italy
| | - Carmen Rondon
- Allergy Unit, Regional University Hospital of Malaga, IBIMA UMA Malaga Spain
| | - Virginia Calder
- Department of Ocular Biology & Therapeutics UCL Institute of Ophthalmology London UK
| | - Dermot Ryan
- Allergy and Respiratory Research Group, Medical School, Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK
| | - Marek L. Kowalski
- Department of Immunology, Rheumatology, and Allergy Medical University of Lodz Lodz Poland
| | - Luis Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, Serviço de Imunoalergologia, Centro Hospitalar São João University of Porto, EPE – Porto Porto Portugal
| | - Serge Doan
- Service d’Ophtalmologie Hôpital Bichat and Fondation A. de Rothschild Paris France
| | - Jean L. Fauquert
- CHU Estaing Unité d’Allergologie de l’Enfant Clermont‐Ferrand Cedex1 France
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Fiorentini SF, Khurram D. Therapeutic effects of topical 0.03% Tacrolimus ointment in children with refractory vernal keratoconjunctivitis in Middle East. Saudi J Ophthalmol 2019; 33:117-120. [PMID: 31384152 PMCID: PMC6664310 DOI: 10.1016/j.sjopt.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 04/14/2019] [Accepted: 04/29/2019] [Indexed: 11/17/2022] Open
Abstract
Objective The purpose of this paper is to review the efficacy and safety profile in children treated with topical 0.03% Tacrolimus ointment for vernal keratoconjunctivitis in Middle East and to propose a treatment posology. According to recent studies, a complex non-IgE dependent mechanism plays a relevant role in the pathogenesis of vernal keratoconjunctivitis. Numerous cells and mediators have been found in the serum, conjunctiva and tears of patients with Vernal keratoconjunctivitis. Design This case series included 10 patients from a single centre, pediatric department of a tertiary hospital with active symptomatic vernal keratoconjunctivitis. All the patients had proliferative lesions and corneal involvement despite conventional medications, including topical steroids. All other medications, systemic and topical: steroids, antihistamines and cyclosporine, were unsuccessful. Patients were treated with topical 0.03% Tacrolimus ointment twice daily for 8 weeks and then once a day for the next two month followed by thrice a week for two months. The changes in symptoms and signs after treatment were evaluated, also the development of possible complications was assessed. Results The results showed a significant reduction in signs and symptoms after 4 weeks of the treatment. Clinical resolution of giant papillae and corneal lesions were seen within eight weeks and no additional drug was required during that period, except tear substitutes. Treatment was continued for period of two months and then slowly reduced. Conclusion The use of 0.03% Tacrolimus ointment is safe and effective in children refractory to conventional treatment of vernal keratoconjunctivitis even in high temperature climate as Middle East. Due to the effectiveness of the treatment, the dosage used may be proposed for conventional use.
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Affiliation(s)
- Sandra Flavia Fiorentini
- Moorfields Eye Hospital Dubai, United Arab Emirates
- Corresponding author at: Dubai Health Care City, PO Box 505054, District 1, Al Razi Building 64, Block E, Floor 3, Dubai, United Arab Emirates.
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Singhal D, Sahay P, Maharana PK, Raj N, Sharma N, Titiyal JS. Vernal Keratoconjunctivitis. Surv Ophthalmol 2019; 64:289-311. [DOI: 10.1016/j.survophthal.2018.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
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Kim SE, Quartilho A, Larkin F, Hingorani M, Tuft S, Dahlmann-Noor A. Systemic interventions for severe atopic and vernal keratoconjunctivitis in children and young people up to the age of 16 years. Hippokratia 2019. [DOI: 10.1002/14651858.cd013298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Soyang Ella Kim
- Royal Free London NHS Foundation Trust; Pond Street London UK NW3 2QG
| | - Ana Quartilho
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; London UK EC1V 2PD
| | - Frank Larkin
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Melanie Hingorani
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Stephen Tuft
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Annegret Dahlmann-Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; London UK EC1V 2PD
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Liu FY, Liu HY, Chu HS, Chen WL, Hu FR, Wang IJ. Dermatologic tacrolimus ointment on the eyelids for steroid-refractory vernal keratoconjunctivitis. Graefes Arch Clin Exp Ophthalmol 2019; 257:967-974. [DOI: 10.1007/s00417-019-04287-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/24/2019] [Accepted: 03/03/2019] [Indexed: 11/30/2022] Open
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Ghiglioni DG, Bruschi G, Gandini S, Osnaghi S, Peroni D, Marchisio P. Vitamin D serum levels in children with vernal keratoconjunctivitis and disease control. Int J Immunopathol Pharmacol 2019; 33:2058738419833468. [PMID: 30843446 PMCID: PMC6407325 DOI: 10.1177/2058738419833468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate whether the control of ocular symptoms with cyclosporine or with tacrolimus in eye drops allows to improve sun exposure and therefore serum level of vitamin D (VD; 25OHD), in the more severe forms of vernal keratoconjunctivitis (VKC). Out of 242 children followed for active VKC, 94 were treated with 1% cyclosporine or 0.1% tacrolimus eye drops, while the other 148 with mild VKC did not need to be treated with immunomodulators. VD serum levels were measured in spring and autumn in 71 children. In total, 60 of them were treated with cyclosporine eye drops (first group) and 11 (not responding to cyclosporine therapy previously) with 0.1% tacrolimus eye drops (second group) between March and November 2016. Pre-treatment median values of VD were 23.7 ng/mL in the first group and 23.8 in the second group, and post-treatment values increased up to 32.8 and 32.9 ng/mL, respectively. Before treatment, 33% presented a deficiency (25OHD < 20 ng/mL), and at the end of summer, only 4% were deficient. The overweight children had lower improvement in VD serum levels than children with a body mass index (BMI) lower than 85th percentile. Children in therapy with cyclosporine, but requiring the administration of local steroid therapy during the summer for control of the symptoms, showed a greater improvement in 25OHD serum levels in ng/mL (23-37 ng/mL) than children who did not require steroid therapy (24-35 ng/mL). Furthermore, there was a significant difference in change of 25OHD in children presenting limbal VKC (21-41 ng/mL) versus tarsal VKC (24-35 ng/mL) ( P = 0.04). Our study suggests that ocular treatment carried out with immunomodulator eye drops could allow for an improvement in 25OHD serum levels. In children with active VKC and at risk of 25OHD deficiency, likely due to avoidance of sun exposure, the role of other risk factors (BMI, phototype and treatment) on 25OHD serum levels should be considered.
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Affiliation(s)
- Daniele Giovanni Ghiglioni
- 1 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy
| | - Gaia Bruschi
- 1 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy
| | - Sara Gandini
- 2 Experimental Oncology Department, European Institute of Oncology, IRCCS, Milan, Italy
| | - Silvia Osnaghi
- 3 Department of Ophthalmology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Diego Peroni
- 4 Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Paola Marchisio
- 5 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Xu X, Cai Y. Therapeutic effects of Houttuynia eye drops combined with olopatadine hydrochloride eye drops on vernal keratoconjunctivitis. Exp Ther Med 2019; 17:1224-1227. [PMID: 30679995 PMCID: PMC6327635 DOI: 10.3892/etm.2018.7079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/14/2018] [Indexed: 01/23/2023] Open
Abstract
Therapeutic effects and safety of houttuynia eye drops combined with olopatadine hydrochloride eye drops on vernal keratoconjunctivitis (VK) were evaluated. A total of 926 patients with VK were collected in the Eye Hospital of Wenzhou Medical University from July 2011 to January 2017. Patients were divided into group A, B and C according to the use of different eye drops. Group A included 276 patients who were treated with houttuynia eye drops; group B included 305 patients who were treated with olopatadine hydrochloride eye drops; group C included 345 patients who were treated with houttuynia eye drops and olopatadine hydrochloride eye drops. Treatment was performed for 14 days. Eye symptoms before and after treatment, and at 1 h, 7 days and 14 days after drug administration were compared among groups to evaluate the therapeutic effect. At 1 h after drug administration, highest excellent rate was observed in group C, followed by group A, and good outcome rate was significantly higher in group C than in the other two groups (P<0.05), and effective rate was also significantly higher in group C than in the other two groups (P<0.05). At 7 days after treatment, excellent rate was significantly higher in group C than in the other two groups (P<0.05), and effective rate was higher in group C than in group B (P<0.05). At 14 days after treatment, excellent rate was significantly higher in group C than in the other two groups (P<0.05), while lowest good outcome rate and ineffective rate were found in group C, and no significant differences were found between group A and B (P>0.05). Houttuynia ophthalmic solution and olopatadine hydrochloride eye drops can both achieve good effect in the treatment of VK, and combined use of them can increase the efficacy and shorten treatment period. So, the combined treatment should be popularized.
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Affiliation(s)
- Xuegu Xu
- Department of Pharmacy, The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325003, P.R. China
| | - Yonghao Cai
- Department of Pharmacy, The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325003, P.R. China
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Varu DM, Rhee MK, Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ, Lin A, Musch DC, Mah FS, Dunn SP. Conjunctivitis Preferred Practice Pattern®. Ophthalmology 2019; 126:P94-P169. [DOI: 10.1016/j.ophtha.2018.10.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023] Open
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Yoon CH, Park JW, Ryu JS, Kim MK, Oh JY. Corneal Toxicity of Topical Tacrolimus Ointment in Mice with Corneal Epithelial Injury. J Ocul Pharmacol Ther 2018; 34:685-691. [PMID: 30222497 DOI: 10.1089/jop.2018.0054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To investigate the effect of tacrolimus ointment on corneal epithelium. Methods: Eight-week-old male BALB/c mice were divided into 3 groups. In group 1, no injury was made. In group 2, the central 2-mm corneal epithelium was scraped off. In group 3, the whole corneal and limbal epithelium was removed after absolute ethanol application. In each group, the corneas were observed and treated daily with 0.03% or 0.1% tacrolimus ointment (Protopic®). The viability of cultivated human corneal epithelial cells was also examined after 24-h incubation with various concentrations of tacrolimus. Results: Tacrolimus ointment significantly delayed the epithelial healing in corneas with epithelial injuries (groups 2 and 3) in dose- and frequency-dependent manners, whereas it did not have any effects on uninjured corneas (group 1). The proportion of terminal deoxynucleotidyl transferase-mediated nick end labeling-positive cells and mRNA levels of inflammatory cytokines were higher in tacrolimus-treated corneas, compared with controls. Tacrolimus did not directly reduce the viability of corneal epithelial cells in culture. Conclusions: Topical application of tacrolimus ointment onto the ocular surface induced toxicity in the cornea with epithelial defects through the impairment of epithelial healing and induction of apoptosis.
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Affiliation(s)
- Chang Ho Yoon
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jong Woo Park
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jin Suk Ryu
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
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Kim HY, Lee JE, Oh HN, Song JW, Han SY, Lee JS. Clinical efficacy of combined topical 0.05% cyclosporine A and 0.1% sodium hyaluronate in the dry eyes with meibomian gland dysfunction. Int J Ophthalmol 2018; 11:593-600. [PMID: 29675376 DOI: 10.18240/ijo.2018.04.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/05/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the efficacy of combined topical 0.05% cyclosporine A (CsA; Restasis®, Allergan pharmaceuticals, USA) and 0.1% sodium hyaluronate treatment in dry eyes with meibomian gland dysfunction (MGD). METHODS In a retrospective analysis, 53 patients (106 eyes) with MGD were enrolled and performed lid warm massage for 10min daily and be instilled preservative free sodium hyaluronate 0.1% eye drops 4 times daily. Patients were divided into subjects treated with topical 0.05% CsA and preservative free sodium hyaluronate vehicle (experimental group, n=74 eyes) and subjects treated with the preservative free sodium hyaluronate vehicle (control group, n=32 eyes). They were evaluated at baseline and 1, 2, and 3mo for subjective symptoms and objective signs including tear film break-up time (tBUT), Schirmer test, corneal staining (CS) score, lid margin telangiectasia (LMT), meibomian gland secretion (MGS), and conjunctival injection (CI). RESULTS In the short-term treatment, the experimental group showed a statistically significant improvement in the ocular surface disease index (OSDI; P<0.001), tBUT (P=0.004), Schirmer test score (P=0.008) and LMT (P=0.021) by repeated measure ANOVA. Additionally, mean changes from baseline in OSDI (P<0.001), tBUT (P=0.001), Schirmer test score (P=0.029), CS score (P=0.047), LMT (P=0.002), CI (P=0.030) were improved better in the experimental group than in the control group at 3mo. However, there was no significant difference between the two groups in MGS (P=0.67). CONCLUSION In dry eyes with MGD, 0.05% CsA improves the tear film stability as well as subjective ocular discomfort, and is effective in controlling lid margin inflammation.
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Affiliation(s)
- Ho-Yun Kim
- Department of Ophthalmology, Maryknoll Medical Center, Busan 48972, South Korea
| | - Ji-Eun Lee
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Ha-Na Oh
- Department of Ophthalmology, Inje University Baek Hospital, Busan 47392, South Korea
| | - Ju-Whan Song
- Department of Ophthalmology, Kosin University hospital, Busan 49267, South Korea
| | | | - Jong-Soo Lee
- Department of Ophthalmology, Pusan National University Hospital, Busan 49241, South Korea.,Medical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
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Topical Tacrolimus 0.03% for Maintenance Therapy in Steroid-Dependent, Recurrent Phlyctenular Keratoconjunctivitis. Cornea 2018; 37:168-171. [PMID: 29309358 DOI: 10.1097/ico.0000000000001440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy of topical tacrolimus 0.03% as steroid-free maintenance therapy in young patients with severe, recurrent phlyctenular keratoconjunctivitis (PKC). METHODS The medical records of 6 eyes of 5 patients (4 children and 1 young adult) with recurrent, steroid-dependent PKC were reviewed. The patients were treated with combined application of topical steroids and tacrolimus 0.03% in the active phase and maintained on topical tacrolimus alone after remission. RESULTS The clinical signs, symptoms, and visual acuities resolved in all patients after 25.2 ± 16.9 days of combined treatment with steroids and tacrolimus. After disease remission, the patients were maintained on topical tacrolimus 0.03% once daily alone for 8.4 ± 4.7 months, and no recurrence occurred during 10.6 ± 1.9 months of follow-up. Tacrolimus was successfully discontinued in 2 patients without further recurrence. There were no ocular side effects related to the use of topical tacrolimus. CONCLUSIONS Topical tacrolimus 0.03% was effective in maintaining long-term remission in patients with recurrent, steroid-dependent PKC.
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Comparative Evaluation of Tacrolimus Versus Interferon Alpha-2b Eye Drops in the Treatment of Vernal Keratoconjunctivitis: A Randomized, Double-Masked Study. Cornea 2018; 36:675-678. [PMID: 28399035 DOI: 10.1097/ico.0000000000001200] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Vernal keratoconjunctivitis (VKC) is a bilateral, chronic, external ocular inflammatory disorder that mainly affects patients in their first or second decade. This study was designed to compare tacrolimus and interferon alpha-2b (IFN alpha-2b) eye drops in the treatment of VKC. METHODS In this randomized, double-masked clinical trial, 40 consecutive patients with VKC were sent to a referral eye hospital in a tropical region southeast of Iran. Patients were randomly assigned to receive either 0.005% tacrolimus or IFN alpha-2b (1,000,000 units/cc). Chi-square and t tests were used for comparison of outcomes between both groups. RESULTS Mean ± SD age was 11.1 ± 5.2 years. Thirty-one patients (77.5%) were male. The mean duration of disease was 3.4 ± 2.9 years. In this study, the signs and symptoms were significantly reduced in patients after treatment in both groups (P = 0.0001). In the tacrolimus group, all patients responded to treatment whereas only one subject in the IFN group failed to respond (P = 0.99). Side effects in both groups were mild and tolerable. CONCLUSIONS This study indicated that both 0.005% tacrolimus and IFN alpha-2b are effective and appear to be safe in treatment of recalcitrant VKC.
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Abstract
PURPOSE OF REVIEW Contact lens-induced papillary conjunctivitis (CLPC) is a common ocular allergic disease in contact lens wearers. In its more severe form, it can cause giant papillary conjunctivitis, resulting in contact lens intolerance and the need to discontinue the use of contact lenses. This review presents the pathogenesis, clinical manifestations and management guidelines of this common disorder. RECENT FINDINGS Different types of contact lenses are associated with differences in the severity of CLPC. Refitting patients with silicone hydrogel contact lenses or with daily disposable contact lenses may improve the signs and symptoms of CLPC. The recent introduction of the topical immunomodulatory agent tacrolimus in other severe allergic eye diseases may apply in suppressing the allergic inflammation in CLPC as well. SUMMARY CLPC is a common ocular disorder in contact lens wearers, with a significant impact on the quality of vision. It should be promptly recognized by healthcare practitioners and managed by modifications of the types and wearing schedules of contact lenses, as well as novel treatment options with topical immunomodulators.
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36
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Individualize treatment for vernal keratoconjunctivitis based on clinical features and personal preferences. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ritonavir and Topical Ocular Corticosteroid Induced Cushing's Syndrome in an Adolescent With HIV-1 Infection. Pediatr Infect Dis J 2017; 36:502-503. [PMID: 28060049 DOI: 10.1097/inf.0000000000001534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cushing's syndrome after topical ocular corticosteroid use is extremely rare. We describe a case of symptomatic Cushing's syndrome in an adolescent male with sight-threatening vernal keratoconjunctivitis on antiretroviral therapy for HIV-1 infection that included ritonavir, a potent cytochrome p450 CYP3A4 inhibitor. CYP3A4 inhibition reduces the metabolism of exogenous corticosteroids leading to suppression of endogenous steroid production and Cushing's syndrome.
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Sacchetti M, Bruscolini A, Abicca I, Nebbioso M, La Cava M, Bonini S, Lambiase A. Current and emerging treatment options for vernal keratoconjunctivitis. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1300524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Marta Sacchetti
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Alice Bruscolini
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Irene Abicca
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marcella Nebbioso
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Maurizio La Cava
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Stefano Bonini
- Ophthalmology, Campus Bio-Medico University, Rome, Italy
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Wert AF, Posa D, Tsilochristou O, Schwerk N. Treatment of allergic children - Where is the progress (for the practicing allergist)? Pediatr Allergy Immunol 2016; 27:671-681. [PMID: 27614100 DOI: 10.1111/pai.12653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 12/12/2022]
Abstract
For any kind of therapeutic intervention in allergic diseases such as environmental control, pharmacological, or immunomodulating treatment including educational programs, children are addressed separately from adults. Health authorities like the Food and Drug Administration in the United States of America or the European Medicine Agency in Europe request a specific 'Pediatric investigational plan' with studies addressing dose-response relationship, safety, and efficacy for infants, children, and adolescents. During the last 2 years, promising advances have been reported for the treatment of a variety of allergic and immunologic disorders. This review summarizes the progress in the treatment of pediatric asthma and allergic diseases, based on publications of approximately the last 2.5 years (end of 2013 until May 2016) in and beyond this journal. Meanwhile, it highlights areas with promising novel therapeutic approaches, which are likely to change treatment for allergic children in the near future.
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Affiliation(s)
- A F Wert
- Department of Paediatric Pneumology Allergy and Neonatology, Hannover Medical School, Hannover, Germany.
| | - D Posa
- Department of Paediatric Pneumology & Immunology, Charité Medical School, Berlin, Germany
| | - O Tsilochristou
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London & Guy's, St. Thomas'National Health Service Foundation Trust, London, UK
| | - N Schwerk
- Department of Paediatric Pneumology Allergy and Neonatology, Hannover Medical School, Hannover, Germany
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Esposito S, Fior G, Mori A, Osnaghi S, Ghiglioni D. An Update on the Therapeutic Approach to Vernal Keratoconjunctivitis. Paediatr Drugs 2016; 18:347-55. [PMID: 27461427 DOI: 10.1007/s40272-016-0185-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vernal keratoconjunctivitis (VKC) is an inflammatory disease of the ocular surface. It commonly occurs in the first decade of life, has a wide geographical distribution, and usually occurs in warm, dry areas. The pathogenesis of VKC seems to have an immune, nervous, and endocrine basis. The most common eye symptoms are itching, discharge, tearing, eye irritation, redness of the eyes, and photophobia. Although VKC generally has a good prognosis, the lack of clarity regarding the origin of the disease makes treatment a challenge for pediatricians and ophthalmologists. The purpose of this review is to discuss the pathogenesis, clinical features, and diagnostic criteria in VKC, with a focus on its therapeutic management. The selection of a therapeutic scheme from the many available options is based on clinical features and the personal preferences of both physicians and patients. Due to the lack of uniform grading of disease severity, there is no worldwide consensus on first-line and second-line therapeutic approaches. The choice of treatment for long-term moderate to severe VKC includes topical cyclosporine or tacrolimus. Further data are needed to define the minimal effective concentration and the safety of these drugs in eye drops and to clarify the diagnosis of VKC in patients who require these drugs. Finally, while promising newly discovered drugs are expected to enter into clinical practice, further studies on their efficacy and safety are required.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Giulia Fior
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Alessandro Mori
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Silvia Osnaghi
- Oculistic Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Ghiglioni
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
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