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Erdinest N, Noyman DBE, London N, Lavy I, Levinger N, Landau D, Solomon A, Morad Y, Naroo SA. Applications of topical immunomodulators enhance clinical signs of vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC): a meta-analysis. Int Ophthalmol 2024; 44:157. [PMID: 38522059 DOI: 10.1007/s10792-024-03097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE This meta-analysis aimed to review the safety and efficacy of topical cyclosporine A (CsA) and topical tacrolimus in allergic eye disease. METHODS A systematic search identified thirteen studies and a total of 445 patients for inclusion, making this the largest meta-analysis published on the subject. The current review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS Thirteen randomized control trials were included in the meta-analysis. Eleven studies used CsA as the treatment, and two used Tacrolimus. In total, 445 participants were included, of whom 76.6% were male. The mean age of participants across the included studies was 14 years. All studies reported clinical signs as evaluated by an examining clinician. Signs were usually assessed by anatomical region, with the most common regions being the conjunctiva and the cornea, and the most common signs assessed were hyperemia and papillae. Three studies accounted for more than 50% of the meta-analysis's weight. Effect size (d) ranged from - 2.37 to - 0.03, negative values favoring immunomodulators. Fixed Effect Meta-Analysis returned an SMD of - 0.81 (95% CI [- 0.98, - 0.65]). However, there was significant heterogeneity (I2 = 61%, Qw = 30.76) in the outcome measure (P = 0.0021); therefore, a random-effect meta-analysis was also completed in which the pooled SMD was - 0.98 (95% CI [- 1.26, - 0.69], τ2 = 0.16). CONCLUSIONS This study affirms the current scientific community's stance that immunomodulators effectively treat clinical signs, including blepharitis, conjunctival hyperemia, edema, papillae, and corneal damage in severe ocular allergic disease.
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | - Itay Lavy
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nadav Levinger
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Ophthalmology, Enaim Refractive Surgery Center, Jerusalem, Israel
| | - David Landau
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Abraham Solomon
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Morad
- Department of Ophthalmology, Asaf Harofeh Medical Center, Béer Yáakov, Israel
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
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Ozaki M, Kobayashi T, Fujinaga A, Nishioka M, Shikichi K, Okano S, Sakai Y, Fujii S, Matsui N, Takasago M, Okada N, Yamasaki T, Kitahara T. Influence of filtering on the effective concentration and sterility of a 2% cyclosporine ophthalmic solution: a quality improvement perspective. J Pharm Health Care Sci 2023; 9:50. [PMID: 38148477 PMCID: PMC10752018 DOI: 10.1186/s40780-023-00323-9] [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: 09/20/2023] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Pharmaceutical companies do not sell formulations for all diseases; thus, healthcare workers have to treat some diseases by concocting in-hospital preparations. An example is the high-concentration 2% cyclosporine A (CyA) ophthalmic solution. Utilizing a filter in sterility operations is a general practice for concocting in-hospital preparations, as is the case for preparing a 2% CyA ophthalmic solution. However, whether filtering is appropriate concerning the active ingredient content and bacterial contamination according to the post-preparing quality control of a 2% CyA ophthalmic solution is yet to be verified. METHODS We conducted particle size, preparation concentration, and bacterial contamination studies to clarify aforementioned questions. First, we measured the particle size of CyA through a laser diffraction particle size distribution. Next, we measured the concentration after preparation with or without a 0.45-µm filter operation using an electrochemiluminescence immunoassay. Finally, bacterial contamination tests were conducted using an automated blood culture system to prepare a 2% CyA ophthalmic solution without a 0.45 μm filtering. Regarding the pore size of the filter in this study, it was set to 0.45 μm with reference to the book (the 6th edition) with recipes for the preparation of in-hospital preparations edited by the Japanese Society of Hospital Pharmacists. RESULTS CyA had various particle sizes; approximately 30% of the total particles exceeded 0.45 μm. The mean ± standard deviation of filtered and non-filtered CyA concentrations in ophthalmic solutions were 346.51 ± 170.76 and 499.74 ± 76.95ng/mL, respectively (p = 0.011). Regarding bacterial contamination tests, aerobes and anaerobes microorganisms were not detected in 14 days of culture. CONCLUSIONS Due to the results of this study, the concentration of CyA may be reduced by using a 0.45-µm filter during the preparation of CyA ophthalmic solutions, and furthermore that the use of a 0.45-µm filter may not contribute to sterility when preparing CyA ophthalmic solutions.
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Affiliation(s)
- Masakazu Ozaki
- Pharmacy Department , Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan.
| | - Toshihiko Kobayashi
- Division of Laboratory, Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
| | - Aki Fujinaga
- Division of Laboratory, Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
| | - Mitsuaki Nishioka
- Division of Laboratory, Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
| | - Kyoko Shikichi
- Division of Laboratory, Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
| | - Satoshi Okano
- Pharmacy Department , Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
| | - Yasuhito Sakai
- Pharmacy Department , Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
| | - Sayumi Fujii
- Pharmacy Department , Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
| | - Nobuaki Matsui
- Department of Pharmacy, Fukuyama City Hospital, 5-23-1, Zao-cho, 721- 8511, Fukuyama, Hiroshima, Japan
| | - Miwako Takasago
- Pharmacy Department , Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
| | - Naoto Okada
- Pharmacy Department , Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
| | - Takahiro Yamasaki
- Division of Laboratory, Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
- Department of Oncology and Laboratory Medicine, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
| | - Takashi Kitahara
- Pharmacy Department , Yamaguchi University Hospital, 1-1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
- Department of Clinical Pharmacology, Yamaguchi University Graduate School of Medicine, 1- 1-1, Minami-kogushi, 755-8505, Ube, Yamaguchi, Japan
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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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A comparative study between ciclosporine A eye drop (2%) and tacrolimus eye ointment (0.03%) in management of children with refractory vernal keratoconjunctivitis. Graefes Arch Clin Exp Ophthalmol 2021; 260:353-361. [PMID: 34453603 DOI: 10.1007/s00417-021-05356-0] [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: 04/06/2021] [Revised: 07/05/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the effects of ciclosporine A (2%) eye drop and tacrolimus (0.03%) eye ointment on children with vernal keratoconjunctivitis (VKC) who were not responding to corticosteroid eye drops. METHODS A prospective comparative study was carried out on children who were diagnosed with refractory VKC at the ophthalmology clinic in Benha University, Delta area, Egypt, during the period from October 2019 to February 2020. RESULTS Fifty-nine patients completed this study. Regarding the individual symptom score, redness, burning, photophobia, and foreign body sensation were significantly reduced in the tacrolimus group compared to those in the ciclosporine A group during the 1st week (p < 0.05). Moreover, the tacrolimus group showed a statistically significant reduction in burning and foreign body sensation at the 4th week (both p = 0.032), and in redness and burning sensation at the 12th week compared to those in the ciclosporine A group (p = 0.005 and 0.048, respectively). The tacrolimus group showed significantly lower mean scores for tarsal conjunctival papillary hypertrophy at the 1st week and 12th week (p = 0.037 and 0.046, respectively), and for punctate erosion and cobblestone papillae at the 1st week (p = 0.029 and 0.037, respectively) than the ciclosporine group. Failure of treatment was observed in 6 patients (19.35%) in the ciclosporine A group and in 5 patients (17.85%) in the tacrolimus group. No serious side effects were detected in any group. CONCLUSION A higher reduction in inflammatory symptoms and signs as well as compliance with tacrolimus 0.03% eye ointment than with ciclosporine A 2% eye drops was observed. Moreover, long-term medication for refractory cases is needed to control inflammation. Overall, our finding suggested that ciclosporine A eye drops and tacrolimus eye ointment could be considered as corticosteroid-sparing drugs in the management of children with refractory VKC.
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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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Figus M, Agnifili L, Lanzini M, Brescia L, Sartini F, Mastropasqua L, Posarelli C. Topical preservative-free ophthalmic treatments: an unmet clinical need. Expert Opin Drug Deliv 2020; 18:655-672. [PMID: 33280452 DOI: 10.1080/17425247.2021.1860014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: The main role of preservatives in eyedrops is to ensure sterility and microbiological integrity of the drug, and to facilitate the penetration of active compounds into the eye. However, several studies documented significant toxic effects induced by preservatives, especially on the ocular surface. Consequently, most of the ophthalmic medications became progressively available in preservative-free (PF) formulations.Areas covered: We analyzed pre-clinical and clinical studies on PF eyedrops with particular attention to common chronic diseases such as dry eye and glaucoma. We discussed about the pros and cons of using PF eyedrops, in terms of efficacy, safety, and social-economic aspects.Expert opinion: There are still unresolved issues that make hard for PF medications to definitively conquer the drug market. Despite robust pre-clinical evidences of less toxicity, the low number of randomized clinical trials does not permit to state that PF eyedrops have, in clinical practice, a similar efficacy or a higher safety compared to preserved forms. These aspects limit their use to chronic diseases requiring long-term therapies with multiple daily instillations, especially in the presence of concomitant ophthalmic diseases that expose to a risk of ocular surface worsening.
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Affiliation(s)
- Michele Figus
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Manuela Lanzini
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Lorenza Brescia
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Francesco Sartini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Chiara Posarelli
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
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Bremond-Gignac D, Doan S, Amrane M, Ismail D, Montero J, Németh J, Aragona P, Leonardi A. Twelve-Month Results of Cyclosporine A Cationic Emulsion in a Randomized Study in Patients With Pediatric Vernal Keratoconjunctivitis. Am J Ophthalmol 2020; 212:116-126. [PMID: 31770513 DOI: 10.1016/j.ajo.2019.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the safety and efficacy of cyclosporine A cationic emulsion (CsA CE) 0.1% eye drops in pediatric patients with severe active vernal keratoconjunctivitis (VKC). DESIGN Multicenter, double-masked, randomized controlled trial 8-month safety analysis. METHODS Of 169 patients (age range, 4-17 years) initially randomized in the 4-month VErnal KeratoconjunctiviTIs Study (VEKTIS), 142 entered the 8-month follow-up period during which CsA CE patients remained on their original regimen (CsA CE 4 times daily [QID, high-dose] or CsA CE twice daily [BID, low-dose] + vehicle BID) and vehicle patients were allocated to one of these 2 active regimens. Main outcome measures were safety, including treatment-emergent adverse events, and efficacy, including corneal fluorescein staining (CFS) score. RESULTS Improvements in CFS score, rescue medication use, key VKC symptoms (photophobia, tearing, itching, and mucous discharge), and quality of life (QoL) assessed by QUICK questionnaire observed with CsA CE compared with vehicle during the 4-month evaluation period remained stable during the 8-month follow-up period, with the high-dose regimen continuing to provide greater benefits in most efficacy measures. CsA CE was well tolerated. Treatment-related treatment-emergent adverse events during the 12-month study were reported in 15 (20.8%) and 11 (15.7%) of the CsA CE high-dose and low-dose patients, respectively, most commonly instillation site pain (13.9% and 7.1%, respectively). Laboratory data, vital signs, slit lamp examination, best-corrected distance visual acuity, and intraocular pressure raised no safety concerns. CONCLUSIONS Improvements in keratitis, symptoms, and QoL achieved after CsA CE treatment for 4 months remained stable over the 8-month follow-up period. CsA continued to maintain a favorable safety profile.
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Labib BA, Minhas BK, Chigbu DI. Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions. Clin Ophthalmol 2020; 14:837-852. [PMID: 32256043 PMCID: PMC7094151 DOI: 10.2147/opth.s207976] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/25/2020] [Indexed: 02/06/2023] Open
Abstract
Human adenovirus (HAdV) is the most common cause of infectious conjunctivitis, accounting for up to 75% of all conjunctivitis cases and affecting people of all ages and demographics. In addition to ocular complications, it can cause systemic infections in the form of gastroenteritis, respiratory disease, and dissemination in immunocompromised individuals. HAdV causes lytic infection of the mucoepithelial cells of the conjunctiva and cornea, as well as latent infection of lymphoid and adenoid cells. Epidemic keratoconjunctivitis (EKC) is the most severe ocular manifestation of HAdV infection, in which the presence of subepithelial infiltrates (SEIs) in the cornea is a hallmark feature of corneal involvement. SEIs have the tendency to recur and may lead to long-term visual disability. HAdV persistence and dissemination are linked to sporadic outbreaks of adenoviral keratoconjunctivitis. There is no FDA-approved antiviral for treating adenoviral keratoconjunctivitis, and as such, solutions should be proffered to handle the challenges associated with viral persistence and dissemination. Several treatment modalities have been investigated, both systemically and locally, to not only mitigate symptoms but reduce the course of the infection and prevent the risk of long-term complications. These options include systemic and topical antivirals, in-office povidone-iodine irrigation (PVI), immunoglobulin-based therapy, anti-inflammatory therapy, and immunotherapy. More recently, combination PVI/dexamethasone ophthalmic formulations have shown favorable outcomes and were well tolerated in clinical trials for the treatment of EKC. Possible, future treatment considerations include sialic acid analogs, cold atmospheric plasma, N-chlorotaurine, and benzalkonium chloride. Continued investigation and evaluation of treatment are warranted to reduce the economic burden and potential long-term visual debilitation in affected patients. This review will focus on how persistence and dissemination of HAdV pose a significant challenge to the management of adenoviral keratoconjunctivitis. Furthermore, current and future trends in prophylactic and therapeutic modalities for adenoviral keratoconjunctivitis will be discussed.
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Affiliation(s)
- Bisant A Labib
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USA
| | - Bhawanjot K Minhas
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USA
| | - DeGaulle I Chigbu
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USA
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Feizi S, Azari AA. Approaches toward enhancing survival probability following deep anterior lamellar keratoplasty. Ther Adv Ophthalmol 2020; 12:2515841420913014. [PMID: 32232195 PMCID: PMC7092383 DOI: 10.1177/2515841420913014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 02/07/2020] [Indexed: 12/16/2022] Open
Abstract
The greatest advantage of deep anterior lamellar keratoplasty over full-thickness corneal transplantation is the elimination of graft failure caused by endothelial rejection. Despite this advantage, a deep anterior lamellar keratoplasty graft can fail because of several factors, such as complications related to the donor-recipient interface, graft epithelial abnormalities, graft vascularization, stromal graft rejection, and recurrence of herpetic keratitis. Increased deep anterior lamellar keratoplasty graft survival is mainly built upon optimization of the ocular surface to provide a hospitable environment for the graft. Any predisposing factors for graft epithelial abnormalities, corneal neovascularization, and preexisting vernal keratoconjunctivitis should be identified and treated preoperatively. Prompt recognition and appropriate treatment of interface-related complications and stromal graft rejection usually result in good anatomic outcomes, with no detrimental effects on vision.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, 9th Boostan St., Pasdaran Ave., Tehran 16666, Iran
| | - Amir A Azari
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nebbioso M, Alisi L, Giovannetti F, Armentano M, Lambiase A. Eye drop emulsion containing 0.1% cyclosporin (1 mg/mL) for the treatment of severe vernal keratoconjunctivitis: an evidence-based review and place in therapy. Clin Ophthalmol 2019; 13:1147-1155. [PMID: 31308622 PMCID: PMC6616155 DOI: 10.2147/opth.s181811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/11/2019] [Indexed: 12/17/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC) is a rare, recurrent and multifactorial ocular disease, which typically flares up during spring and affects especially male children and adolescents. This condition does not usually respond to common treatments with antihistamines or mast cells stabilizers, whereas corticosteroids have effective results. Corticosteroids need to be carefully administered, to avoid adverse effects, mainly the secondary development of glaucoma, cataracts, or infections. Immunosuppressive agents, such as cyclosporin (CyA) or tacrolimus are, therefore, frequently employed in VKC patients. Only the 0.1% CyA (1 mg/mL) concentration has an approved and specific clinical indication for the treatment of VKC and this drug was given the denomination of orphan drug by the European Commission (EU/3/06/360) in 2006. So far, few studies have been conducted to evaluate the efficacy and the side effects of topical 0.1% CyA. Different topical CyA concentrations, ranging from 0.05% to 2%, and various types of formulation are available at the moment. In the future, 0.1% CyA will presumably take an important part in the management of VKC. The present review focuses on eye drops containing 0.1% CyA; however, more studies will be needed to define its long-term efficacy in the natural course of this severe ocular disease.
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Affiliation(s)
- Marcella Nebbioso
- Department of Sense Organs, Faculty of Medicine and Odontology, Umberto I Policlinic, Sapienza University of Rome, Rome 00185, Italy
| | - Ludovico Alisi
- Department of Sense Organs, Faculty of Medicine and Odontology, Umberto I Policlinic, Sapienza University of Rome, Rome 00185, Italy
| | - Francesca Giovannetti
- Department of Sense Organs, Faculty of Medicine and Odontology, Umberto I Policlinic, Sapienza University of Rome, Rome 00185, Italy
| | - Marta Armentano
- Department of Sense Organs, Faculty of Medicine and Odontology, Umberto I Policlinic, Sapienza University of Rome, Rome 00185, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Faculty of Medicine and Odontology, Umberto I Policlinic, Sapienza University of Rome, Rome 00185, Italy
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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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Leonardi A, Doan S, Amrane M, Ismail D, Montero J, Németh J, Aragona P, Bremond-Gignac D. A Randomized, Controlled Trial of Cyclosporine A Cationic Emulsion in Pediatric Vernal Keratoconjunctivitis. Ophthalmology 2019; 126:671-681. [DOI: 10.1016/j.ophtha.2018.12.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 11/24/2022] Open
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Ganesh S, Brar S, Bagare SN. Topical Cyclosporine (0.05%) for Management of Dry Eyes in Patients Undergoing Cataract Surgery-A Comparative Study. Open Ophthalmol J 2019. [DOI: 10.2174/1874364101913010034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
To assess the efficacy of topical cyclosporine 0.05% in the management of cataract surgery induced dry eye.
Methods:
This prospective, comparative, randomized, interventional study included 67 patients undergoing cataract surgery. The patients were randomized into three categories Group A: patients on topical lubricants and cyclosporine 0.05%, Group B: patients on topical lubricants only and Group C: patients not on any dry eye medication. Patients were given the respective treatment 2 weeks prior and 3 months after cataract surgery, along with an identical perioperative regimen of topical steroids, antibiotics and NSAIDs. Dry eye evaluation done 2 weeks pre-op, 1 week post-op and 3 months post-op consisted of a subjective questionnaire, tear osmolarity, Tear Break Up Time (TBUT) and Schirmer’s 1 without and with anaesthesia.
Results:
Pre-operatively, all the 3 groups were matched in terms of mean age, tear osmolarity, TBUT and Schirmer’s 1 without and with anaesthesia scores. At 3 months, patients treated with both topical lubricants and cyclosporine (0.05%)(Group A) showed improvement subjective questionnaire, tear osmolarity, TBUT and Schirmer’s 1 tests. Patients treated with lubricants only (Group B) showed a significant worsening in TBUT and tear osmolarity at 1 week, however, the values returned to baseline at 3 months.The control group (Group C) had the worst TBUT scores at the end of 3 months and showed the persistence of raised tear osmolarity, suggestive of a prolonged ocular inflammation resulting in patient dissatisfaction.
Conclusion:
Topical cyclosporine (0.05%) may be a useful adjuvant to prevent and treat cataract surgery associated with dry eye symptoms, especially in patients with pre-existing dry eye disease.
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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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Abstract
Vernal keratoconjunctivitis (VKC) is a chronic allergic conjunctivitis that is most often seen in young, males. Although most types of allergic conjunctivitis do not affect vision, VKC is unusual in that damage to the cornea from the condition can result in vision loss. Although it is typically seasonal, year-round symptoms can be seen, which can lead to uncertain diagnoses being made. Although the pathophysiology of VKC is better understood in recent years, allowing more targeted therapies, management of these patients can still be very challenging, and complications can occur. As such, aggressive management of VKC is necessary, especially since vision loss in the amblyogenic age range can be permanent.
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Affiliation(s)
- Hampton Addis
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bennie H Jeng
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
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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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Hopper JS, Holding E, Scurrell EJ, Featherstone H. Vernal-like conjunctivitis in a western lowland gorilla (Gorilla gorilla gorilla). Vet Ophthalmol 2017; 21:199-204. [PMID: 28058762 DOI: 10.1111/vop.12457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CASE DESCRIPTION A 17-year-old female western lowland gorilla presented with bilateral ocular discharge, conjunctivitis, and rhinitis that was investigated and treated over a 34-month period. Clinical findings, diagnostic results, treatment, and follow-up are described. CLINICAL FINDING A mild intermittent mucoid ocular discharge was initially noted. 10 months later, conjunctival hyperemia and thickening developed and progressed rapidly to a mass-like lesion covering the right eye. Hematology revealed eosinophilia. Conjunctival cytology revealed eosinophils and neutrophils, and histopathology revealed a chronic proliferative eosinophilic conjunctivitis. 21 months after, the ocular lesions were investigated the gorilla developed masses within both external nares. Histopathology of the nasal lesions revealed chronic-active eosinophilic rhinitis. TREATMENT AND OUTCOME Treatment of the gorilla was based on protocols recommended for human patients. Protocols for mild, moderate, and finally severe disease were used, involving topical and oral combinations of treatments. The gorilla eventually responded to systemic immunosuppressant therapy recommended for severe refractory disease. CLINICAL SIGNIFICANCE To the authors' knowledge, this is the first reported case of vernal-like conjunctivitis in a western lowland gorilla.
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Affiliation(s)
- Jane S Hopper
- Aspinall Foundation, Port Lympne Wild Animal Park, Aldington Road, Lympne, Kent, CT21 4PD, UK
| | - Ellen Holding
- Aspinall Foundation, Port Lympne Wild Animal Park, Aldington Road, Lympne, Kent, CT21 4PD, UK
| | - Emma J Scurrell
- Cytopath Ltd, PO Box 24, Ledbury, Hertfordshire, HR8 2YD, UK
| | - Heidi Featherstone
- Willows Veterinary Centre and Referral service, Highlands Road, Shirley, Solihull, West Midlands, B90 4NH, UK
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Gokhale NS. Systematic approach to managing vernal keratoconjunctivitis in clinical practice: Severity grading system and a treatment algorithm. Indian J Ophthalmol 2016; 64:145-8. [PMID: 27050351 PMCID: PMC4850811 DOI: 10.4103/0301-4738.179727] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vernal keratoconjunctivitis is an ocular allergy that is common in the pediatric age group. It is often chronic, severe, and nonresponsive to the available treatment options. Management of these children is difficult and often a dilemma for the practitioner. There is a need to simplify and standardize its management. To achieve this goal, we require a grading system to judge the severity of inflammation and an algorithm to select the appropriate medications. This article provides a simple and practically useful grading system and a stepladder algorithm for systematic treatment of these patients. Use of appropriate treatment modalities can reduce treatment and disease-related complications.
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Caputo R, Versaci F, Pucci N, de Libero C, Danti G, De Masi S, Mencucci R, Novembre E, Jeng BH. Very Low Prevalence of Keratoconus in a Large Series of Vernal Keratoconjunctivitis Patients. Am J Ophthalmol 2016; 172:64-71. [PMID: 27640005 DOI: 10.1016/j.ajo.2016.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the prevalence of keratoconus (KC) and other corneal abnormalities by means of videokeratography and tomography in a large series of patients affected by vernal keratoconjunctivitis (VKC). DESIGN Cross-sectional study. METHODS Setting: Single-center children's hospital. STUDY POPULATION A total of 651 consecutive patients with VKC and a control group of 500 were prospectively recruited between May 1, 2012 and September 30, 2013, with a minimum follow-up of 12 months. OBSERVATION PROCEDURE All patients were evaluated by means of a Scheimpflug camera combined with a Placido corneal topographer. Keratoconus, suspected keratoconus, or its absence were determined in each patient. The corneal symmetry index of front (SIf) and back curvature (SIb), shape indices, and thicknesses were compared between the 2 groups. MAIN OUTCOME MEASURES Prevalence of keratoconus and corneal indices modifications. RESULTS Five out of 651 patients (0.77%) demonstrated topographic signs of KC. Two of them were bilateral. All patients were older than 7 years of age, and the mean age was 11.54 years. Four other patients (0.61%) were classified as KC suspects by the screening program. Of 304 patients older than 11 years (mean age 14.4 years), 4 (1.32%) were found to have KCN, and 4 (1.32%) were KC suspects. The corneal indices of patients in the VKC group were extremely similar to those in the control group. (P > .05). CONCLUSIONS The prevalence of KC in our patient population, compared with previous reports in the literature, is much lower. The similar corneal indices in both groups suggest the absence of permanent corneal deformation due to VKC.
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Affiliation(s)
- Roberto Caputo
- Pediatric Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | | | - Neri Pucci
- Pediatric Allergology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Cinzia de Libero
- Pediatric Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Gioia Danti
- Pediatric Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Salvatore De Masi
- Statistics and Epidemiology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Rita Mencucci
- Ophthalmology Unit, Careggi Hospital, Florence, Italy
| | - Elio Novembre
- Pediatric Allergology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Bennie H Jeng
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland.
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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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Yücel OE, Ulus ND. Efficacy and safety of topical cyclosporine A 0.05% in vernal keratoconjunctivitis. Singapore Med J 2015; 57:507-10. [PMID: 26768065 DOI: 10.11622/smedj.2015161] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION While corticosteroids are an effective choice of treatment for severe vernal keratoconjunctivitis (VKC), their long-term use is restricted due to side effects. This study was conducted to evaluate the efficacy and safety of topical cyclosporine A (CsA) 0.05% in the treatment of VKC. METHODS A total of 30 patients with VKC that was resistant to topical corticosteroids, antihistamines and mast cell stabilisers were treated with topical CsA 0.05%. Patients were evaluated at Weeks 4, 8 and 12 after the initiation of therapy. Symptoms and signs observed before and after treatment were recorded and scores were assigned. Scores for symptoms and signs, the need for topical corticosteroids and ocular side effects were evaluated. RESULTS At baseline, the median values of the symptom and sign scores were 10.0 (range 5.0-18.0) and 6.0 (range 2.0-13.0), respectively. At Week 4 of treatment with topical CsA 0.05%, the median values of the symptom and sign scores were 3.0 (range 0-14.0) and 3.0 (range 0-8.0), respectively. The reductions in the symptom and sign scores were statistically significant. The reduction in the need for corticosteroid was statistically significant by Week 12 of therapy. No significant side effects were reported. CONCLUSION Topical CsA 0.05%, which can help to reduce corticosteroid usage, is an effective and safe alternative for the treatment of resistant VKC. Further studies are needed to determine the optimal duration of therapy and possibility of recurrence.
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Affiliation(s)
- Ozlem Eski Yücel
- Department of Ophthalmology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Nihal Demir Ulus
- Clinics of Ophthalmology, Eskisehir State Hospital, Eskişehir, Turkey
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Vichyanond P, Pacharn P, Pleyer U, Leonardi A. Vernal keratoconjunctivitis: a severe allergic eye disease with remodeling changes. Pediatr Allergy Immunol 2014; 25:314-22. [PMID: 24438133 DOI: 10.1111/pai.12197] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
Abstract
Vernal keratoconjunctivitis (VKC) is an unusually severe sight-threatening allergic eye disease, occurring mainly in children. Conventional therapy for allergic conjunctivitis is generally not adequate for VKC. Pediatricians and allergists are often not familiar with the severe clinical symptoms and signs of VKC. As untreated VKC can lead to permanent visual loss, pediatric allergists should be aware of the management and therapeutic options for this disease to allow patients to enter clinical remission with the least side effects and sequelae. Children with VKC present with severe ocular symptoms, that is, severe eye itching and irritation, constant tearing, red eye, eye discharge, and photophobia. On examination, giant papillae are frequently observed on the upper tarsal conjunctiva (cobblestoning appearance), with some developing gelatinous infiltrations around the limbus surrounding the cornea (Horner-Trantas dot). Conjunctival injections are mostly severe with thick mucus ropy discharge. Eosinophils are the predominant cells found in the tears and eye discharge. Common therapies include topical antihistamines and dual-acting agents, such as lodoxamide and olopatadine. These are infrequently sufficient and topical corticosteroids are often required for the treatment of flare ups. Ocular surface remodeling leads to severe suffering and complications, such as corneal ulcers/scars. Other complications include side effects from chronic topical steroids use, such as increased intraocular pressure, glaucoma, cataract and infections. Alternative therapies for VKC include immunomodulators, such as cyclosporine A and tacrolimus. Surgery is reserved for those with complications and should be handled by ophthalmologists with special expertise. Newer research on the pathogenesis of VKC is reviewed in this article. Vernal keratoconjunctivitis is a very important allergic eye disease in children. Complications and remodeling changes are unique and can lead to blindness. Understanding of pathogenesis of VKC may lead to better therapy for these unfortunate patients.
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Affiliation(s)
- Pakit Vichyanond
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Comparison of the effects of topical cyclosporine a 0.05%, cyclosporine a 2%, epinastine hydrochloride 0.05%, and prednisolone acetate 1% on allergic inflammation in an experimental allergic conjunctivitis model. Cornea 2014; 32:1465-9. [PMID: 24055903 DOI: 10.1097/ico.0b013e3182a3655d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the effects of topical cyclosporine A 0.05%, cyclosporine A 2%, epinastine hydrochloride 0.05%, and prednisolone acetate 1% in an experimental allergic conjunctivitis model. METHODS Forty Wistar albino male rats were randomly divided into 5 groups. All the rats were immunized by an intraperitoneal injection of 100 μg of ovalbumin. After 2 weeks, topical treatment was administered: cyclosporine A 0.05% 4 times a day to group 1, cyclosporine A 2% 4 times a day to group 2, epinastine HCl 0.05% 2 times a day to group 3, and prednisolone acetate 1% 4 times a day to group 4 for the following 7 days. Group 5 was designated as the control group. Both eyes of the rats were enucleated on the 22nd day of the study. The excised sections were stained by toluidine blue for mast cell count and by hematoxylin-eosin for histopathological evaluation. RESULTS The 2 solutions of cyclosporine A and epinastine were more effective than prednisolone acetate (P < 0.05) when compared with the control in histopathological scoring. There were statistically significant differences between the treatment groups and the control group (P < 0.05); however, no differences were observed between the treatment groups in the mast cell number. CONCLUSIONS Topical 0.05% cyclosporine A is as effective as 2% cyclosporine A and epinastine in suppressing mast cell-mediated type I allergic conjunctivitis in an experimental allergic conjunctivitis model.
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Wan KHN, Chen LJ, Rong SS, Pang CP, Young AL. Topical cyclosporine in the treatment of allergic conjunctivitis: a meta-analysis. Ophthalmology 2013; 120:2197-203. [PMID: 23743438 DOI: 10.1016/j.ophtha.2013.03.044] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 03/25/2013] [Accepted: 03/27/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of topical cyclosporine versus placebo in the treatment of allergic conjunctivitis. DESIGN Systematic review and meta-analysis. PARTICIPANTS Seven qualified studies incorporating 306 eyes of 153 patients were analyzed. METHODS Searches of randomized controlled trials were conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. MAIN OUTCOME MEASURES We assessed the methodologic quality of individual included trials and performed meta-analyses using the random effects model if P<0.1 in the test for heterogeneity, or otherwise used the fixed effects model. We assessed scores of composite signs and symptoms, reduction in steroid eye drop use in steroid-dependent patients, and safety outcomes (i.e., stinging or burning sensation). RESULTS At 2 weeks of follow-up or longer, evidence suggests a statistically significant improvement in the composite signs (standardized mean difference [SMD], -1.21; 95% confidence interval [CI], -1.80 to -0.62; I(2) = 71%) and symptoms (SMD, -0.84; 95% CI, -1.51 to -0.16; I(2) = 80%) after topical cyclosporine treatment for allergic conjunctivitis regardless of the dosage of treatment. There was a significant reduction (mean difference, -61.16; 95% CI, -101.61 to -20.72; I(2) = 58%) in the use of steroid eye drops in patients with steroid-dependent allergic conjunctivitis. Stinging or burning sensation (odds ratio, 2.56; 95% CI, 0.19-35.06; I(2) = 73%) was common in both the cyclosporine and placebo groups. CONCLUSIONS This systematic review and meta-analysis suggests topical cyclosporine could be an effective and safe treatment method for allergic conjunctivitis. Further randomized controlled trials with larger sample sizes and standardized outcome measurements, follow-up periods, and cyclosporine concentrations are warranted to determine the short- and long-term efficacy and safety and the minimal effective dosage of topical cyclosporine for allergic conjunctivitis.
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Affiliation(s)
- Kelvin Ho-Nam Wan
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Use of Cyclosporine A and Tacrolimus in Treatment of Vernal Keratoconjunctivitis. Curr Allergy Asthma Rep 2013; 13:308-14. [DOI: 10.1007/s11882-013-0345-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gokhale NS, Samant R, Sharma V. Oral cyclosporine therapy for refractory severe vernal keratoconjunctivitis. Indian J Ophthalmol 2012; 60:220-3. [PMID: 22569387 PMCID: PMC3361821 DOI: 10.4103/0301-4738.95878] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report the success of oral cyclosporine therapy in a patient with severe vision-threatening vernal keratoconjunctivitis. A child presented with severe allergy which was not controlled with topical steroids, cyclosporine and mast cell stabilizers. Oral steroids were required repeatedly to suppress inflammation. Child showed a dramatic improvement and stabilization with oral cyclosporine therapy. Oral cyclosporine therapy can be tried in severe vision-threatening allergy refractory to conventional therapy.
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Affiliation(s)
- Nikhil S Gokhale
- Gokhale Eye Hospital and Eyebank, Dadar, Mumbai, Maharashtra, India
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González-López JJ, López-Alcalde J, Morcillo Laiz R, Fernández Buenaga R, Rebolleda Fernández G. Topical cyclosporine for atopic keratoconjunctivitis. Cochrane Database Syst Rev 2012:CD009078. [PMID: 22972132 DOI: 10.1002/14651858.cd009078.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Atopic keratoconjunctivitis (AKC) is a chronic ocular surface non-infectious inflammatory condition that atopic dermatitis patients may suffer at any time point in the course of their dermatologic disease and is independent of its degree of severity. AKC is usually not self resolving and it poses a higher risk of corneal injuries and severe sequelae. Management of AKC should prevent or treat corneal damage. Although topical corticosteroids remain the standard treatment for patients with AKC, prolonged use may lead to complications. Topical cyclosporine A (CsA) may improve AKC signs and symptoms, and be used as a corticosteroid sparing agent. OBJECTIVES To determine the efficacy and gather evidence on safety from randomised controlled trials (RCTs) of topical CsA in patients with AKC. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 6), MEDLINE (January 1946 to July 2012), EMBASE (January 1980 to July 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to July 2012), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to July 2012), OpenGrey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en), the IFPMA Clinical Trials Portal (http://clinicaltrials.ifpma.org/no_cache/en/myportal/index.htm) and Web of Science Conference Proceedings Citation Index- Science (CPCI-S). We did not use any date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 9 July 2012. We also handsearched the following conference proceedings: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, International Council of Opthalmology and Societas Ophthalmologica Europaea from 2005 to July 2011. SELECTION CRITERIA We included randomised controlled trials only. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. Due to the small number of studies and the diversity of outcome measures, interventions and participants, we presented results narratively. MAIN RESULTS We found three RCTs with a total of 58 participants that were eligible for inclusion. There was significant variability between the trials in interventions, methodology and outcome measures and therefore we did not perform meta-analysis.One study reported on the use of 2% CsA in maize oil and two on the use of a commercial emulsion of 0.05% CsA. Of these three studies, one showed a beneficial effect of topical CsA in controlling signs and symptoms of AKC, one in controlling signs of AKC and one did not show evidence of an improvement. Only two studies analysed the effect of topical CsA in reducing topical steroid use; one showed a significant reduction in topical steroid use with CsA, but the other did not show evidence of this improvement. No serious adverse events were reported in the trials. AUTHORS' CONCLUSIONS This systematic review highlights the relative scarcity of controlled clinical trials assessing the efficacy of topical CsA therapy in AKC and suggests that evidence on the efficacy and safety of topical CsA treatment in patients with CsA remains limited. However, the data suggest that topical CsA may provide clinical and symptomatic relief in AKC and may help to reduce topical steroid use in patients with steroid-dependent or steroid-resistant AKC. No serious adverse events were reported. Reported adverse events in patients treated with topical CsA include intense stinging and eyelid skin maceration. One patient in the placebo group developed a severe allergic response to maize antigens. However, the total number of patients in the trials was too small to assess the safety of this treatment.Additional well-designed and powered RCTs of topical CsA in AKC are needed. Ideal study designs should include adequate randomisation and concealment of allocation; masking of participants, personnel and outcome assessors; adequate follow-up periods and minimisation of attrition bias; and comparison groups with similar clinical and epidemiologic characteristics. Samples should be large enough to provide sufficient statistical power to assess the safety of CsA and to detect clinically relevant treatment effect sizes of the primary outcomes. Analyses should be appropriate to the study's design and outcome measures. Moreover, standardisation of outcome measures and follow-up periods across studies would be beneficial to maximise study comparability.
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Okumus S, Coskun E, Tatar MG, Kaydu E, Yayuspayi R, Comez A, Erbagci I, Gurler B. Cyclosporine a 0.05% eye drops for the treatment of subepithelial infiltrates after epidemic keratoconjunctivitis. BMC Ophthalmol 2012; 12:42. [PMID: 22900547 PMCID: PMC3504581 DOI: 10.1186/1471-2415-12-42] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 08/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the treatment with topical 0.05% cyclosporine A (CsA) in patients with subepithelial corneal infiltrates (SEI). METHODS We reviewed 16 patients (22 eyes) before and after the treatment with 0.05% CsA eye drops. All patients had been treated previously with topical corticosteroids without any improvement and also they had to stop the medication secondary to intraocular pressure elevation. The objective data recorded included best-corrected visual acuity (BCVA), evaluation of corneal subepithelial infiltrate scores (CSIS), intraocular pressure (IOP) prior to treatment and the last follow-up visit. RESULTS Six males (37.5%) and 10 females (62.5%), mean age of 35.2 ± 16.6 years, were included. The patients' average topical CsA use duration was 5.1 ± 3.5 months (1 - 13 months). The average follow up time of the patients was 9.2 ± 4.7 months (4 - 22 months). One patient, although he didn't have a 0 scale of SCIS, did not show up for follow up examinations after six months. The mean BCVA (logarithm of the minimum angle of resolution) before and after the treatment were 0.15 ± 0.15 and 0.07 ± 0.07 respectively, CSIS 1.68 ± 0.89 and 0.23 ± 0.53 respectively, IOP 18.50 ± 3.82 and 16.86 ± 2.76 mmHg respectively. There were statistically significant improvements in BCVA (p=0.002), reduction of CSIS (p=0.002) and reduction of IOP (p<0.001) prior to treatment and the last follow-up visit. 18 eyes (81.9%) showed clinical improvement and 4 (18.1%) had decreased SEI which did not fully disappear during the treatment period. The eyes which reached CSIS score 0 (18 eyes) were treated with CsA for 1 - 13 months; while the eyes which had clinical improvement but had not CSIS score 0 (4 eyes) were decided to discontinue of CsA treatment in last follow-up visit. There were recurrences in 2 eyes 3 months after the treatment. Patients reported reduction in the severity of symptoms after the treatment. Most of the patients reported no foreign body sensation, glare, or other side effects with topical CsA treatment. Overall, patients noted an improvement in vision and satisfaction with topical 0.05% CsA treatment. CONCLUSIONS Topical 0.05% CsA is a safe and effective alternative treatment in patients with SEI who do not respond to other treatment modalities or have undesired side effects from topical steroids.
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Affiliation(s)
- Seydi Okumus
- University of Gaziantep, Faculty of Medicine, Department of Ophthalmology, Gaziantep, Turkey.
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Caputo R, Pucci N, Mori F, De Libero C, Di Grande L, Bacci G. Surgical Debridement Plus Topical Cyclosporine a in the Treatment and Vernal Shield Ulcers. Int J Immunopathol Pharmacol 2012; 25:775-80. [DOI: 10.1177/039463201202500326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vernal Keratoconjunctivitis (VKC) is a severe chronic bilateral inflammation of the ocular surface characterized by seasonal exacerbations. Long-term prognosis is generally good; however, 6% develop sequelae responsible for permanent visual impairment. Corneal involvement is almost always present, consisting of punctate keratitis, shield ulcers (3–11%) and late corneal neovascularization. In recent years, topical cyclosporine A preparations at 2% in oil or at 1% in polyvinyl alcohol, have been successfully proposed for long term VKC treatments. It has been previously proven that medical treatment is not always sufficient, especially when it is employed to treat shield ulcer plaques. In such conditions, surgery may be effective for avoiding long term complications such as amblyopia, strabismus, infections and corneal perforation. In this paper, we show the efficacy of surgical debridement by means of simple scraping associated with topical cyclosporine treatment for the management of vernal shield ulcers complicated with plaques.
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Affiliation(s)
- R. Caputo
- Pediatric Ophthalmology Unit, University of Florence, Italy
| | - N. Pucci
- Allergy and Clinical Immunology Unit Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
| | - F. Mori
- Allergy and Clinical Immunology Unit Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
| | - C. De Libero
- Pediatric Ophthalmology Unit, University of Florence, Italy
| | - L. Di Grande
- Allergy and Clinical Immunology Unit Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
| | - G.M. Bacci
- Pediatric Ophthalmology Unit, University of Florence, Italy
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Guglielmetti S, Dart JKG, Calder V. Atopic keratoconjunctivitis and atopic dermatitis. Curr Opin Allergy Clin Immunol 2010; 10:478-85. [DOI: 10.1097/aci.0b013e32833e16e4] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Topical treatment with 1% cyclosporine for subepithelial infiltrates secondary to adenoviral keratoconjunctivitis. Cornea 2010; 29:638-40. [PMID: 20458220 DOI: 10.1097/ico.0b013e3181c33034] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the treatment with topical 1% cyclosporine A (CsA) in patients with subepithelial corneal infiltrates (SEIs). METHODS We retrospectively reviewed the records of 9 patients (12 eyes) before and after the treatment with CsA 1% eyedrops twice daily. All patients had been treated with topical corticosteroids previously without improvement or had to stop the medication secondary to intraocular pressure elevation. The objective data recorded included best-corrected Snellen visual acuity, intraocular pressure, number of medications in use, and evaluation of severity of SEIs (improved, stable, or worse). For their subjective evaluation, patients were asked to complete a questionnaire based on the last follow-up visit. RESULTS Five males (56%) and 4 females (44%), mean age of 47 +/- 13 years, were included. Mean follow-up on CsA was 13 +/- 7 months. The mean best-corrected Snellen visual acuity (logarithm of the minimum angle of resolution) before and after treatment was 0.42 +/- 0.40 and 21 +/- 0.28, respectively, with no statistically significant improvement. There was statistically significant reduction in the number of medications before and after treatment from 1.88 +/- 1.05 to 1.22 +/- 0.44, respectively (P = 0.049). Six patients (66%) showed clinical improvement, and 3 (34%) were stable during the treatment period. Patients reported statistically significant reduction in the severity of symptoms before and after the treatment. Most of the patients reported no foreign body sensation, glare, or other side effects with topical CsA treatment. Overall, patients noted an improvement in vision and satisfaction with CsA treatment. CONCLUSIONS Topical CsA 1% is a safe and effective alternative treatment in patients with SEIs who do not respond to other treatment modalities or have unwanted side effects from topical steroids.
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Kumar S, Gupta N, Vivian AJ. Modern approach to managing vernal keratoconjunctivitis. Curr Allergy Asthma Rep 2010; 10:155-62. [PMID: 20425012 DOI: 10.1007/s11882-010-0101-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vernal keratoconjunctivitis (VKC), an allergic inflammation of the conjunctiva affecting mainly children and adolescents, is categorized under the rubric of allergic conjunctivitis. Lack of uniform diagnostic and predefined staging criteria has been a bottleneck in formulating fixed guidelines to treat VKC. This lack of consensus among clinicians/researchers regarding diagnostic and grading standards has prevented us from making comparisons between the outcomes of different studies. To treat VKC, selection of a drug from many available options should be based on the duration and frequency of symptoms, grade and inflammation of giant papillae, and severity of corneal involvement. Consideration also should be given to the patient's specific needs. The basic tenet of treatment is optimal control of symptoms with a minimum of toxic side effects resulting from prolonged use of medication.
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Affiliation(s)
- Sunil Kumar
- Toronto Western Hospital, 5th Floor West Wing, 339 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
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Pucci N, Caputo R, Mori F, De Libero C, Di Grande L, Massai C, Bernardini R, Novembre E. Long-Term Safety and Efficacy of Topical Cyclosporine in 156 Children with Vernal Keratoconjunctivitis. Int J Immunopathol Pharmacol 2010; 23:865-71. [DOI: 10.1177/039463201002300322] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic and potentially sight-threatening disease. Topical corticosteroids (Cs) seem to be the only effective treatment for this condition, although severe side effects may occur owing to their prolonged use. More recently, cyclosporine (Cyc) eye drops have been reported as a valid alternative, but so far such treatment has only been successfully experimented for a short time and in small numbers of patients. The aim of our study is to evaluate the long term safety and efficacy of topical cyclosporine eye drops in children suffering from VKC. Over a period of 7 years we followed a large group of children suffering from severe VKC. They were selected to start cyclosporine eye drop treatment, because of the prompt relapse of their disease as soon as they stopped topical corticosteroids administration. All patients were followed-up in an ambulatory care assessment. A total of 156 children with VKC were treated with topical cyclosporine eye drops over a period ranging from two to seven years [mean time 3.8±1.09 years] during the seasonal relapse [range 9–66 months; mean time 24.7±10.4 months]. Two formulations, at 1% and 2% (82% and 18% respectively) concentrations, of cyclosporine eye drops were made. The dosage administered was one drop in each eye from two to four times a day, depending on the severity of the disease and the season. The ocular objective scores were determined and compared every year, at the beginning and at the end of each treatment period. Blood samples were collected once a year in order to check both kidney and liver functions, as well as cyclosporine serum levels. We enrolled 156 patients (mean age 8.31±2.79 years; 116 males and 40 females) who were followed-up over a period of 7 years [156 (100%) children during the first and the second year; 138 (88.5%) patients until the third year; 90 (57.7%) until the fourth year; 32 (20.5%) until the fifth year; 10 (6.4%) until the sixth year and 2 (1.3%) until the seventh year]. The ocular objective scores significantly improved (p<.001) over the years when comparing them at the beginning and the end of each seasonal treatment period, except for the last year. Over the treatment period, non-significant changes were recorded in terms of kidney and liver enzymatic activities and also in terms of cyclosporine serum levels. Cyclosporine eye drops, either at 1% or 2% concentrations, resulted safe and effective for long-term treatment of VKC in 156 children. The lack of significance of the score results during the seventh year can be explained by the small number of subjects treated for such a long period. A systematic ocular examination and both liver and kidney functional investigations allowed us to exclude the possibility of local or systemic side effects due to cyclosporine. If either transient or long-lasting, the occurrence of burning was referred by some of the patients treated, but none of them required to discontinue the drug. In conclusion, this is the first study showing that topical cyclosporine is easily handled even by children, with safe and effective results even when it is used over a long period of time. Our findings, though encouraging, need to be confirmed by further studies.
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Affiliation(s)
| | - R. Caputo
- Clinical Ophthalmology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
| | | | - C. De Libero
- Clinical Ophthalmology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
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Lee SH, Lee JS, You IC, Park YG, Yoon KC. Study of Utilization Pattern and Compliance with Topical 0.05% Cyclosporine Emulsion in Korean Dry Eye Patients. Chonnam Med J 2010. [DOI: 10.4068/cmj.2010.46.2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seung-Hyun Lee
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jun-Sung Lee
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - In-Cheon You
- Department of Ophthalmology, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Yeong-Geol Park
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Kyung-Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea
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Im SK, Yoon KC. Factors Affecting Compliance With 0.05% Cyclosporine Emulsion in Patients With Dry Eye Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.7.921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seong Kyu Im
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea
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Ebihara N, Ohashi Y, Uchio E, Okamoto S, Kumagai N, Shoji J, Takamura E, Nakagawa Y, Nanba K, Fukushima A, Fujishima H. A large prospective observational study of novel cyclosporine 0.1% aqueous ophthalmic solution in the treatment of severe allergic conjunctivitis. J Ocul Pharmacol Ther 2009; 25:365-72. [PMID: 19441889 DOI: 10.1089/jop.2008.0103] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of a novel cyclosporine 0.1% aqueous ophthalmic solution in a large population with vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC). METHODS A prospective observational postmarketing study was initiated in Japan. A total of 594 patients with VKC or AKC were started on this drug within 1 year after market launch (January 2006) and completed a 6-month follow-up. These patients were observed clinically, and subjective ocular symptoms (itching, discharge, tearing, photophobia, foreign body sensation, and pain), objective signs (hyperemia, swelling, follicle, papillae, and giant papillae for the tarsal conjunctiva; hyperemia and edema for the bulbar conjunctiva; Trantas dots and swelling for the limbus; and corneal involvement), and adverse events were recorded. RESULTS All scores for symptoms and signs significantly decreased from Month 1 through Month 6 of treatment in both VKC and AKC. Median total symptom scores at baseline, Month 1, and Month 6 were 6, 2, and 1, respectively, for VKC, and 7, 3, and 2, respectively, for AKC. Similarly, median total sign scores were 12, 7, and 5, respectively, for VKC, and 14, 10, and 7, respectively, for AKC. The percentage of patients able to complete topical cyclosporine 0.1% therapy within 6 months due to alleviation of symptoms was higher for VKC (44.4%) than for AKC (21.9%). In both VKC and AKC, approximately 30% of steroid users were able to discontinue topical steroids. Adverse drug reactions (ADRs) were found in 12.0% of patients, and the most common ADR was eye irritation (4.4%). Infectious corneal complications were observed in five AKC patients, including two cases of bacterial corneal ulcer and three cases of herpetic keratitis; all of these patients were concomitantly using topical steroids. CONCLUSIONS Topical cyclosporine 0.1% is an effective and safe treatment for VKC and AKC.
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Affiliation(s)
- Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University School of Medicine, 2-1-1 Hongo, Tokyo, Japan.
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Abstract
Cyclosporine has been used successfully as a systemic immunomodulator for more than two decades, and numerous studies have investigated its mechanisms of action. In 2003 an ophthalmic formulation, cyclosporine 0.05% ophthalmic emulsion, was approved by the FDA to treat dry eye disease. Topical cyclosporine emulsion has also been investigated for treatment of other ocular surface disorders that may have an immune-based inflammatory component. In these trials, cyclosporine 0.05% ophthalmic emulsion has shown efficacy for management of posterior blepharitis, ocular rosacea, post-LASIK dry eye, contact lens intolerance, atopic keratoconjunctivitis, graft-versus-host disease, and herpetic stromal keratitis. As these disorders are often refractory to other available treatments, ophthalmic cyclosporine is a welcome nontoxic adjunct or replacement to potentially toxic topical or systemic immunosuppressive therapies.
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Abstract
Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, at times asymmetrical, seasonally exacerbated, allergic inflammation of the ocular surface, involving tarsal and/or bulbar conjunctiva. Though the allergic nature of this entity has been accepted for a long time, the accumulation of a large amount of immunological data has proved that the pathogenesis of VKC is much more complex than a mere type 1 hypersensitivity reaction. In the past several years, many clinical and experimental studies about the cells and mediators involved in initiating and perpetuating the ocular allergic inflammation have shown that T helper type 2 cells and their cytokines, corneal fibroblasts and epithelium along with various growth factors play an important role in the pathogenesis of VKC. Based on this information about the pathogenesis of VKC newer, more selective drugs like anti-chemokine receptor antibodies and leukotriene receptor antagonists are under evaluation. Cyclosporine has been shown to be effective in the treatment of VKC but further randomized control trials are required to establish the minimum effective concentration.
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Affiliation(s)
- Sunil Kumar
- Department of Ophthalmology, Mohammad Dossary Hospital, Al Khobar, Saudi Arabia.
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40
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Lee SH, Im SK, Woo JM, Yoon KC. Long-term Evaluation After Topical Cyclosporine Treatment in Dry Eye Patients With Graft-Versus-Host Disease. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.1.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seung Hyun Lee
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Seoung Kyu Im
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Je-Moon Woo
- Department of Ophthalmology, Ulsan Hospital, Ulsan University Medical School, Ulsan, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
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Keklikci U, Soker SI, Sakalar YB, Unlu K, Ozekinci S, Tunik S. Efficacy of topical cyclosporin A 0.05% in conjunctival impression cytology specimens and clinical findings of severe vernal keratoconjunctivitis in children. Jpn J Ophthalmol 2008; 52:357-362. [DOI: 10.1007/s10384-008-0577-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 05/26/2008] [Indexed: 11/28/2022]
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Abstract
Vernal conjunctivitis is a bilateral, seasonal, external ocular inflammatory disease of unknown cause. Afflicted patients experience intense itching, tearing, photophobia, and mucous discharge, and usually demonstrate large cobblestone papillae on their superior tarsal conjunctiva and limbal conjunctiva. It primarily affects children, may be related to atopy, and has environmental and racial predilections. Although usually self-limited, vernal conjunctivitis can result in potentially blinding corneal complications. Treatment of chronic forms of ocular allergies may necessitate collaborative efforts between the ophthalmologist and the allergist or immunologist.
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Affiliation(s)
- Jason Jun
- Tufts University School of Medicine, Boston, MA, USA
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Abstract
Allergic conjunctivitis is common, especially during the allergy season. Consultation with the allergist to perform skin tests or in vitro tests may be useful and confirmatory in the diagnosis of ocular allergy. If treatment is necessary, antihistamines, mast cell stabilizers, and nonsteroidal anti-inflammatory drugs are safe and reasonably effective. Corticosteroids are an order of magnitude more potent than noncorticosteroids; however, they have attendant side effects that are best monitored by the ophthalmologist. The development of "modified" corticosteroids has been a boon to the treatment of ocular allergy because these drugs may reduce potential side effects without sacrificing potency.
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Affiliation(s)
- Leonard Bielory
- Division of Allergy, Immunology, and Rheumatology, UMDNJ-New Jersey Medical School, 90 Bergen Street, DOC Suite 4700, Newark, NJ 07103, USA
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Abstract
A 22-year-old male patient presented with complaints of pain and redness in the right eye. Slitlamp examination revealed giant papillae on both tarsal conjunctivae, bilateral punctate corneal epitheliopathy and a 2.9 x 2.9 mm epithelial defect in the right eye. The diagnosis was bilateral vernal keratoconjunctivitis with shield ulcer in the right eye. Treatment was commenced with prednisolone (1%) eye drops four times daily and sodium hyaluronate (0.1%) eye drops eight times daily. After one week, the patient had improved symptomatically but the epithelial defect remained unchanged. Topical cyclosporine (0.05%) applied eight times per day was added to the regimen of topical corticosteroid and artificial tears. Three weeks after commencing combined therapy, the shield ulcer had healed completely, leaving a corneal opacity that negatively stained with fluorescein. The patient was followed for five months and no recurrence of ulcer was noted, despite the discontinuation of topical cyclosporine and prednisolone. Simultaneous institution of topical corticosteroid, artificial tears and topical cyclosporine seems to augment the therapeutic efficacy of each other and may be a promising regime in the management of shield ulcer.
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Affiliation(s)
- Sunil Kumar
- Mohamad Dossary Hospital, Al Khobar, Saudi Arabia
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Byun YJ, Kim TI, Seo KY. The Short-Term Effect of Topical Cyclosporine A 0.05% in Various Ocular Surface Disorder. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.3.401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Yeo-Jue Byun
- The Institute of Vision Research, Department of Ophthalmology, College of Medicine, Yonsei University, Seoul, Korea
| | - Tae-Im Kim
- The Institute of Vision Research, Department of Ophthalmology, College of Medicine, Yonsei University, Seoul, Korea
| | - Kyung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, College of Medicine, Yonsei University, Seoul, Korea
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Bonini S, Gramiccioni C, Bonini M, Bresciani M. Practical approach to diagnosis and treatment of ocular allergy: a 1-year systematic review. Curr Opin Allergy Clin Immunol 2007; 7:446-9. [PMID: 17873587 DOI: 10.1097/aci.0b013e3282ef868b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW A 1-year systematic review in the field of ocular allergy was carried out to select new information which may be useful for a practical approach to allergic conjunctivitis. RECENT FINDINGS Out of the 56 articles listed by PubMed, 27 papers were included in the review following a consensus achieved among the authors who had independently reviewed all abstracts. Selected articles were classified according to their main focus: antihistamines, omalizumab, new treatments for vernal keratoconjunctivitis and inflammatory ocular disorders, and sublingual immunotherapy. SUMMARY The data reviewed are discussed with the aim of underlining unmet needs and making recommendations for future studies on diagnosis and treatment of ocular allergy which may better guide clinical practice in this important area of allergy and clinical immunology.
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MESH Headings
- Administration, Sublingual
- Anti-Allergic Agents/immunology
- Anti-Allergic Agents/therapeutic use
- Antibodies, Anti-Idiotypic
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Conjunctivitis, Allergic/diagnosis
- Conjunctivitis, Allergic/drug therapy
- Conjunctivitis, Allergic/immunology
- Conjunctivitis, Allergic/therapy
- Histamine H1 Antagonists/immunology
- Histamine H1 Antagonists/therapeutic use
- Humans
- Immunotherapy
- Keratoconjunctivitis/diagnosis
- Keratoconjunctivitis/drug therapy
- Keratoconjunctivitis/immunology
- Keratoconjunctivitis/therapy
- Omalizumab
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Bonini S, Sacchetti M, Mantelli F, Lambiase A. Clinical grading of vernal keratoconjunctivitis. Curr Opin Allergy Clin Immunol 2007; 7:436-41. [PMID: 17873585 DOI: 10.1097/aci.0b013e3282efb726] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of the present review is to provide an overview on the clinical features of vernal keratoconjunctivitis on the basis of cases series presented in the literature. Furthermore, a new grading system of vernal keratoconjunctivitis based on the severity of the disease is proposed. Different treatment options are discussed based on the clinical grade of vernal keratoconjunctivitis. RECENT FINDINGS Recent epidemiological studies on the demographic, clinical and immunologic features of vernal keratoconjunctivitis are presented. The efficacy and complications of treatments are described. SUMMARY Diagnosis and treatment of patients is a challenge for ophthalmologists as no precise diagnostic criteria have been established, the pathogenesis is unclear, and antiallergic treatments are often unsuccessful. This review describes old and new concepts of vernal keratoconjunctivitis diagnosis and treatment: the clinical features, the diagnostic criteria, the common features between this and other ocular allergies and the therapeutic strategies. On the basis of this knowledge, a new grading system is introduced based on clinical signs and symptoms of ocular surface inflammation. This new grading of vernal keratoconjunctivitis may help clinicians and researchers to classify disease activity and to establish a common agreement for treatments.
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Affiliation(s)
- Stefano Bonini
- Department of Ophthalmology, University of Rome Campus Bio-Medico, Rome, Italy.
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