A Comparative Study on Uses of Supratarsal Triamcinolone Injection, Topical Steroids and Cyclosporine in Cases of Refractory Vernal Keratoconjunctivitis

Anand, Smita; Varma, Shobhit; Sinha, Vidya Bhushan

doi:10.14260/jemds/2017/245

Cited by 3 publications

(5 citation statements)

References 6 publications

(5 reference statements)

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“…6 The patient develops disease-related and/or iatrogenic complications with irreparable ocular morbidity. 7 In our study, it was observed that prevalence of disease was more in males as compared to females, the male-female ratio being 1.75:1. The study conducted by Belfort et al reported a male-female ratio of 5:1 in patients of VKC below the age of 10 years; in patients of AKC male-female ratio was 1:1; in patients of PAC the male-female ratio was 1:4.…”

Section: Discussionmentioning

confidence: 50%

To Evaluate Efficacy of Cyclosporine 0.1% Eye Drops as Maintenance Therapy in Patients of Allergic Conjunctivitis

Raina¹,

Kai²,

Sharma³

et al. 2018

jemds

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BACKGROUND About 20-30% of world population is affected with allergic conjunctivitis. Topical steroids are considered as the mainstay of treatment for severe allergic conjunctivitis. However, steroids are associated with rise in intraocular pressure with subsequent glaucoma, cataract formation and increased susceptibility to microbial infections. This has produced a need to look for other options to treat allergic conjunctivitis. Cyclosporine appears to be a good candidate as it inhibits T-cell inhibition which is an important component of ocular surface inflammation. Aims and Objectives-To evaluate the efficacy and safety of cyclosporine 0.1% eye drops as maintenance therapy in patients of allergic conjunctivitis. MATERIALS AND METHODS This uncontrolled clinical trial study was conducted on 50 patients suffering from mild to moderate allergic conjunctivitis attending the Eye OPD of Government Medical College, Jammu who were receiving the treatment in the form of steroid (loteprednol) eyedrops and had shown improvement with control of both signs as well symptoms of allergy. These patients were put on cyclosporine 0.1% eye drops after stopping the previous medication and evaluated for signs and symptoms at baseline (day 0), 2 weeks, 4 weeks and 12 weeks. RESULTS Out of 50 patients, 2 patients were lost to follow-up after 2 nd week, 4 patients had to be shifted to steroids due to worsening of disease after 2 nd and 4 th week. Remaining 44 patients completed the study with male to female ratio of 1.75:1. All symptoms like itching, discharge, photophobia and watering showed significant improvement at 12 th week as compared to baseline. Signs of conjunctival hyperemia and papillary hypertrophy showed significant reduction from 4 th week onwards and were maximum at 12 th week. The other two signs of Horner Trantas spots and punctate keratitis also showed improvement, but it was not significant as compared to baseline scores. CONCLUSION Topical cyclosporine 0.1% eye drops can be used to control and improve signs and symptoms of allergic conjunctivitis after the acute phase has been treated with steroids. Also, cyclosporine is safe for topical use.

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Section: Discussionmentioning

confidence: 50%

To Evaluate Efficacy of Cyclosporine 0.1% Eye Drops as Maintenance Therapy in Patients of Allergic Conjunctivitis

Raina¹,

Kai²,

Sharma³

et al. 2018

jemds

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“…The remaining 13 records were evaluated in full-text form. Of these, 10 full-text articles were deemed eligible for our systematic review [11][12][13][14][15][16][17][18][19][20]. Figure 1…”

Section: Search Results and Study Selectionmentioning

confidence: 99%

“…Ocular side effects of corticosteroid injections are generally well-described and also seen in studies of this review. In two studies [11,14], 6-8% of patients experienced elevated intraocular pressure (IOP) for months following triamcinolone injections.…”

Section: Discussionmentioning

confidence: 99%

“…Seventy-eight patients were stratified into three groups with twenty-six patients in each. Supratarsal injection of triamcinolone led to the best outcome of the three groups, with resolution of the shield ulcer occurring in 97% of patients [11].…”

Section: None During Follow-upmentioning

confidence: 92%

“…Anand et al compared supratarsal injection of triamcinolone (20 mg) with 0.1% cyclosporine/triamcinolone and topical difluprednate [11]. Seventy-eight patients were stratified into three groups with twenty-six patients in each.…”

Section: None During Follow-upmentioning

confidence: 99%

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Surgical Treatment of Corneal Shield Ulcer in Vernal Keratoconjunctivitis: A Systematic Review

Azizi

Subhi

Rasmussen

2023

JPM

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Background: Vernal keratoconjunctivitis (VKC) severely affects the quality of life of affected patients. The development of a shield ulcer is considered one of the most severe late-stage complications, which when untreated leads to irreversible vision loss. In this systematic review, we outlined the results of surgical treatments of corneal shield ulcers in VKC. Methods: We searched 12 literature databases on 3 April 2023 for studies of patients with VKC in which shield ulcers were treated by any surgical treatment. Treatment results were reviewed qualitatively. Assessments of the risk of bias of individual studies were made using the Clinical Appraisal Skills Programme. Results: Ten studies with 398 patients with VKC were eligible for the qualitative review. Two categories of surgical approaches were described: supratarsal corticosteroid injection and debridement with or without amniotic membrane transplantation. Almost all patients experienced resolution or improvement of their shield ulcers, regardless of treatment modality. Time to healing was faster with surgical debridement. A small proportion experienced recurrence and side effects. Conclusions: Surgical treatment for shield ulcers in VKC seems highly effective, but careful post-operative treatment and follow-ups are necessary due to the risk of recurrence and potential side effects.

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Comparative efficacy of medical treatments for vernal keratoconjunctivitis in children and young adults: a systematic review with network meta‐analyses

Rasmussen

Schou

Bach‐Holm

et al. 2021

Acta Ophthalmologica

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To systematically review the literature on the treatment of vernal keratoconjunctivitis (VKC) in children and young adults and conduct comparative efficacy analysis on clinical signs and symptoms using network meta-analyses. Methods.We systematically searched the databases PubMed/MEDLINE, EMBASE, Cochrane Central and Web of Science on 21 October 2019 for randomized controlled trials (RCT). Studies considered had patients with VKC < 20 years of age randomized into either intervention (any medical intervention) or comparator (active treatment, placebo treatment or non-treatment control), where pre-defined outcomes (data from ≥2 weeks and as close as possible to 2 months) of symptoms (itching, tearing, photophobia and foreign body sensation) and signs (hyperaemia, punctate keratitis, Horner-Trantas dots and macropapillae) were reported. Risk of bias within studies was evaluated using the Cochrane risk of bias tool. Comparisons were made using network meta-analyses. Results.We identified 39 studies with data on 2046 individuals. Twenty-three studies were eligible for quantitative analyses. None were systemic therapy. Temporal trend analysis showed that an initial focus on topical mast cell stabilizers turned to a focus on calcineurin inhibitors and a more diverse variety of pharmacological strategies. Studies varied in population, treatment duration and quality. The quantitative analysis revealed that efficacy of different therapies differed substantially across important clinical signs and symptoms, but there was a general trend of superior efficacy when using topical corticosteroids with stronger efficacy of the more potent corticosteroids. Conclusion.We provide an overview of RCTs comparing the efficacy of treatments for VKC in children and young adults, which we find differs across symptoms and signs. Overall, we saw a general trend of superior efficacy with topical corticosteroids. However, our findings highlight the need for better studies, consensus on core outcomes and potential for individualized therapy.

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A Comparative Study on Uses of Supratarsal Triamcinolone Injection, Topical Steroids and Cyclosporine in Cases of Refractory Vernal Keratoconjunctivitis

Cited by 3 publications

References 6 publications

To Evaluate Efficacy of Cyclosporine 0.1% Eye Drops as Maintenance Therapy in Patients of Allergic Conjunctivitis

To Evaluate Efficacy of Cyclosporine 0.1% Eye Drops as Maintenance Therapy in Patients of Allergic Conjunctivitis

Surgical Treatment of Corneal Shield Ulcer in Vernal Keratoconjunctivitis: A Systematic Review

Comparative efficacy of medical treatments for vernal keratoconjunctivitis in children and young adults: a systematic review with network meta‐analyses

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