Purpose: To evaluate the efficacy, safety, and steroid-sparing effect of topical cyclosporine A (Cs A) 0.05% in patients with moderate to severe steroid dependent vernal keratoconjunctivitis (VKC).
Methods: A prospective, comparative, placebo controlled study was carried out on 68 VKC patients, with 34 patients treated with topical Cs A 0.05% and the remaining 34 with topical carboxymethyl cellulose 0.5% (placebo). Both groups also received topical loteprednol etabonate 0.5%. Symptom (itching, photophobia, tearing, and discharge) score, sign (tarsal and limbal papillae, corneal involvement, and conjunctival hyperemia) score, and drug score (steroid drop usage/day/eye) were recorded at baseline and each followup visit. The intraocular pressure (IOP) measurement and evaluation of any ocular side effects were carried out.
Results: Significant reduction in symptom score and sign score was seen in both groups. Cs A group significantly showed more reduction in symptom (P < 0.0001 in all follow-up visits) and sign (P < 0.0001 in all follow-up visits) scores compared to the placebo group. At day 7, mean steroid usage reduced from 4 to 3.44 ± 0.5 and 3.79 ± 0.4 in Cs A and placebo groups, respectively (P < 0.0001). Steroid drops completely stopped in 21 patients at day 60 in the Cs A group compared to none in the placebo group. No significant rise in IOP or any side effects were noted in either group.
Conclusion: Topical Cs A 0.05% is effective and safe in patients with moderate to severe VKC with good steroid-sparing effect.
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5. Leonardi A. Management of Vernal keratoconjunctivitis. Ophthalmol Ther 2013;2:73–88.
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7. Gokhale NS. Systematic approach to managing vernal keratoconjunctivitis in clinical practice: severity grading system and a treatment algorithm. Indian J Ophthalmol 2016;64:145–148.
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Purpose: To evaluate the efficacy, safety, and steroid-sparing effect of topical cyclosporine A (Cs A) 0.05% in patients with moderate to severe steroid dependent vernal keratoconjunctivitis (VKC).
Methods: A prospective, comparative, placebo controlled study was carried out on 68 VKC patients, with 34 patients treated with topical Cs A 0.05% and the remaining 34 with topical carboxymethyl cellulose 0.5% (placebo). Both groups also received topical loteprednol etabonate 0.5%. Symptom (itching, photophobia, tearing, and discharge) score, sign (tarsal and limbal papillae, corneal involvement, and conjunctival hyperemia) score, and drug score (steroid drop usage/day/eye) were recorded at baseline and each followup visit. The intraocular pressure (IOP) measurement and evaluation of any ocular side effects were carried out.
Results: Significant reduction in symptom score and sign score was seen in both groups. Cs A group significantly showed more reduction in symptom (P < 0.0001 in all follow-up visits) and sign (P < 0.0001 in all follow-up visits) scores compared to the placebo group. At day 7, mean steroid usage reduced from 4 to 3.44 ± 0.5 and 3.79 ± 0.4 in Cs A and placebo groups, respectively (P < 0.0001). Steroid drops completely stopped in 21 patients at day 60 in the Cs A group compared to none in the placebo group. No significant rise in IOP or any side effects were noted in either group.
Conclusion: Topical Cs A 0.05% is effective and safe in patients with moderate to severe VKC with good steroid-sparing effect.
1. Leonardi A. Vernal keratoconjunctivitis: pathogenesis and treatment. Prog Retin Eye Res 2002;21:319–339.
2. Leonardi A, Secchi AG. Vernal keratoconjunctivitis. Int Ophthalmol Clin 2003;43:41–58.
3. Vichyanond P, Pacharn P, Pleyer U, Leonardi A. Vernal keratoconjunctivitis: a severe allergic eye disease with remodeling changes. Pediatr Allergy Immunol 2014;25:314–322.
4. Ozlem EY, Nihal DU. Efficacy and safety of topical Cyclosporine A 0.05% in vernal keratoconjunctivitis. Singapore Med J 2016;57:507–510.
5. Leonardi A. Management of Vernal keratoconjunctivitis. Ophthalmol Ther 2013;2:73–88.
6. Allansmith MR, Ross RN. Ocular allergy and mast cell stabilizers. Surv Ophthalmol 1986;30:229–244.
7. Gokhale NS. Systematic approach to managing vernal keratoconjunctivitis in clinical practice: severity grading system and a treatment algorithm. Indian J Ophthalmol 2016;64:145–148.
8. McGhee CN, Dean S, Danesh-Meyer H. Locally administered ocular corticosteroids: benefits and risks. Drug Saf 2002;25:33–55.
9. Oner V, Turkeu FM, Tas M, Iscan Y. Topical loteprednol etabonate 0.5% for treatment of vernal keratoconjunctivitis: efficacy and safety. Jpn J Ophthalmol 2012;56:312– 318.
10. Eliaçık M, Erdoğan F, Bayramlar H, Karaman S, Gülkılık G. Comparison of efficacy and safety of Loteprednol etabonate 0.5% versus fluorometholone acetate 0.1% for the treatment of vernal keratoconjunctivitis in pediatric subjects. Nobel Med 2014;11:76–82.
11. Wu LQ, Chen X, Lu H, Cheng JW, Wei RL. Loteprednol etabonate in the treatment of allergic conjunctivitis: a meta-analysis. Curr Med Res Opin 2015;31:1509–1518.
12. Fukushima A, Yamaguchi T, Ishida W, Fukata K, Liu FT, Ueno H. Cyclosporin A inhibits eosinophilic infiltration into the conjunctiva mediated by type IV allergic reactions. Clin Exp Ophthalmol 2006;34:347–353.
13. Kari O, Saari KM. Updates in the treatment of ocular allergies. J Asthma Allergy 2010;3:149–158. 14. Daniell M, Constantinou M, Vu HT, Taylor HR. Randomised controlled trial of topical ciclosporin A in steroid dependent allergic conjunctivitis. Br J Ophthalmol 2006;90:461– 464.
15. Tatlipinar S, Akpek EK. Topical cyclosporin in the treatment of ocular surface disorders. Br J Ophthalmol 2005;89:1363–1367.
16. Baiza-Duran LM, González-Villegas AC, Contreras-Rubio Y, Juarez-Echenique JC, Vizzuett-Lopez IV, Suarez- Sanchez R, et al. Safety and efficacy of topical 0.1% and 0.05% cyclosporine A in an aqueous solution in steroiddependent vernal keratoconjunctivitis in a population of Mexican children. J Clin Exp Ophthalmol 2010;1:115. doi: 10.4172/2155-9570.1000115
17. Hingorani M, Moodaley L, Calder VL, Buckley RJ, Lightman S. A randomized placebo-controlled trial of topical cyclosporine A in steroid-dependent atopic keratoconjunctivitis. Ophthalmology 1998;105:1715–1720.
18. Pucci N, Novembre E, Cianferoni A, Lombardi E, Bernardini R, Caputo R, et al. Efficacy and safety of cyclosporine eyedrops in vernal keratoconjunctivitis. Ann Allergy Asthma Immunol 2002;89:298–303.
19. Spadavecchia L, Fanelli P, Tesse R, Brunetti L, Cardinale F, Bellizzi M, et al. Efficacy of 1.25% and 1% topical cyclosporine in the treatment of severe vernal keratoconjunctivitis in childhood. Pediatr Allergy Immunol 2006;17:527–532.
20. Keklikci U, Soker SI, Sakalar YB, Unlu K, Ozekinci S, Tunik S. Efficacy of topical cyclosporine A 0.05% in conjunctival impression cytology specimens and clinical findings of severe vernal keratoconjunctivitis in children. Jpn J Ophthalmol 2008;52:357–362.
21. Akpek EK, Dart JK, Watson S, Christen W, Dursun D, Yoo S, et al. A randomized trial of topical cyclosporine 0.05% in topical steroid-resistant atopic keratoconjunctivitis. Ophthalmology 2004;111:476–482.
22. De Smedt S, Nkurikiye J, Fonteyne Y, Tuft S, De Bacquer D, Gilbert C, et al. Topical ciclosporin in the treatment of vernal keratoconjunctivitis in Rwanda, central Africa: a prospective, randomised, double-masked, controlled clinical trial. Br J Ophthalmol 2012;96:323–328.
23. Wu MM, Yau GS, Lee JW, Wong AL, Tam VT, Yuen CY. Retrospective review on the use of topical cyclosporin a 0.05% for pediatric allergic conjunctivitis in Hong Kong Chinese. Scient World J 2014;2014:396987. doi: 10.1155/2014/396987
24. Keklikci U, Dursun B, Cingu AK. Topical cyclosporin A 0.05 % eye drops in the treatment of vernal keratoconjunctivitis. Randomized placebo-controlled trial. Adv Clin Exp Med 2014;23:455–461.
