Systemic Tacrolimus in the Treatment of Severe Atopic Keratoconjunctivitis

Stumpf, Thomas; Luqmani, Nabeel; Sumich, Peter; Cook, Stuart D.; Tole, Derek

doi:10.1097/01.ico.0000240091.11854.14

Cited by 44 publications

(21 citation statements)

References 4 publications

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“…Topical cyclosporine brings temporary symptomatic relief, but has very little effect on cobblestone papillae [7,8], shield corneal ulcers and limbal vascularization [9]. Systemic tacrolimus may show beneficial effects; however, it may be associated with various adverse effects, and the therapy needs to be monitored by experienced clinicians [10]. Amniotic membrane implantation is also used as a therapeutic contact lens in the treatment of persistent corneal epithelial defects and vernal plaques unresponsive to conventional medical treatment with short-term successful results [15].…”

Section: Discussionmentioning

confidence: 99%

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Supratarsal injection of triamcinolone acetonide and childhood allergic keratoconjunctivitis

et al. 2012

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To evaluate the efficacy and safety of supratarsal injection of triamcinolone acetonide in the treatment of refractory allergic keratoconjunctivitis in childhood. Thirty-five patients (70 eyes) with severe allergic keratoconjunctivitis were included in this study. Fifteen patients (42.8%) had atopic keratoconjunctivitis (AKC) and 20 (57.2%) had vernal keratoconjuncivitis (VKC). All patients underwent a bilateral supratarsal injection of 20 mg triamcinolone acetonide. Mean follow-up was 28 months (range 14-38). All patients showed a significant symptomatic improvement and partial resolution of clinical features of keratoconjunctivitis within the first 2 weeks. Corneal complications related to keratoconjunctivitis disappeared in all patients. One patient with VKC experienced ocular hypertension. No patient with AKC showed side-effects. Severe relapse of the disease was noted in 10% of eyes with VKC and in 6.7% of eyes with AKC after a mean follow-up of 9 and 11 months, respectively. Supratarsal injection of triamcinolone acetonide is effective and safe in patients with severe chronic allergic keratoconjunctivits to relieve severe inflammation associated with this disease.

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Section: Discussionmentioning

confidence: 99%

“…Recently, a number of new therapeutic agents have been tested in cases of severe CAC including topical cyclosporine and systemic tacrolimus [7][8][9][10]; however, most of these treatment modalities remain relatively efficient [9,10].…”

Section: Introductionmentioning

confidence: 99%

Supratarsal injection of triamcinolone acetonide and childhood allergic keratoconjunctivitis

et al. 2012

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“…Previously, systemic tacrolimus in the form of oral preparation has successfully been used in refractory severe AKC. 25,26 Furthermore, to treat allergic disease, some studies have used either a commercially available 0.03-0.1% 'skin' ointment applied to eyelids 17,18,20,27 or fornix, 21 or they have used their own-made 0.02-0.1% ointment for the eye. 22,23 Because it is more convenient to use an eye drop rather than an ointment, Sengoku et al 28 used 0.01-1% eye drop in an animal study of ocular allergy and Ohashi et al 24 used an 0.1% ophthalmic suspension for a clinical study.…”

Section: Discussionmentioning

confidence: 99%

Topical 0.005% tacrolimus eye drop for refractory vernal keratoconjunctivitis

Kheirkhah

Zavareh

Farzbod

et al. 2011

Eye

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Purpose To evaluate the efficacy and safety of topical 0.005% tacrolimus eye drop for treatment of refractory vernal keratoconjunctivitis (VKC). Methods This prospective study included 20 eyes of 10 patients with refractory VKC, who had active symptomatic disease despite conventional medications including topical steroids. After discontinuing all other medications, patients were treated with topical 0.005% tacrolimus eye drop four times a day. Changes in subjective symptoms and objective signs after treatment were evaluated, and development of possible complications was assessed. Results Mean age of patients was 21.3±7.4 years and mean duration of VKC was 12.1±5.8 years. After starting tacrolimus eye drop, patients were followed for a mean duration of 10.7 ± 3.7 months (range, 6-15 months). All symptoms including itching, redness, photosensitivity, foreign body sensation, and mucus discharge improved after the treatment; itching was the first symptom to show dramatic relief. In addition, there was improvement in objective signs including conjunctival hyperaemia, conjunctival papillary hypertrophy, giant papillae, limbal hypertrophy, corneal punctate epithelial erosions, and corneal pannus; conjunctival hyperaemia was the first sign to show improvement. No patient required addition of other medications including steroids for further relief. Any attempt to discontinue tacrolimus eye drop was associated with recurrence of patients' symptoms and signs, necessitating continued use of the medication during the entire follow-up time. No ocular complication related to tacrolimus was noted. Conclusion Topical 0.005% tacrolimus eye drop seemed to be a safe and effective treatment for steroid-resistant refractory VKC; however, long-term use was needed to control the disease.

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“…A retrospective study was reported describing three cases in which low-dose systemic tacrolimus was used in patients with refractory AKC [9]. These patients were given between 0.02 and 0.08 mg/kg tacrolimus (a lower dose than required for prevention of allograft rejection).…”

Section: Atopic Conjunctivitismentioning

confidence: 98%

Future directions in therapeutic interventions for conjunctival inflammatory disorders

Pflugfelder

Stern

2007

Current Opinion in Allergy &Amp; Clinical Immunology

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Systemic Tacrolimus in the Treatment of Severe Atopic Keratoconjunctivitis

Abstract: Low-dose systemic tacrolimus is a safe and effective treatment of some patients with severe AKC, which is refractory to conventional treatment. Such patients need careful monitoring for side effects, and the long-term benefits need to be assessed as part of a clinical trial.

Cited by 44 publications

References 4 publications

Supratarsal injection of triamcinolone acetonide and childhood allergic keratoconjunctivitis

Supratarsal injection of triamcinolone acetonide and childhood allergic keratoconjunctivitis

Topical 0.005% tacrolimus eye drop for refractory vernal keratoconjunctivitis

Future directions in therapeutic interventions for conjunctival inflammatory disorders

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