The use of prophylactic eye drops during high-dose cytosine arabinoside therapy

Abstract

An ocular toxic reaction presenting as conjunctivitis or keratitis develops in a significant number of patients who are treated with high‐dose cytosine arabinoside (ara‐C). Although eye drops containing glucocorticoid reportedly decrease the incidence, they do not totally eliminate this side effect. In comparing this technique with artificial tears, both were found to be equally effective. The primary mechanism by which eye drops decrease ocular toxic reactions associated with high‐dose ara‐C is presumably due to dilution of intraocular concentrations of ara‐C.

Reduced efficacy of topical corticosteroid in preventing cytarabine-induced kerato-conjunctivitis in patients receiving high-dose cytarabine and total body irradiation for allogeneic hematopoietic stem cell transplantation

“…13 The possible mechanism for this frequent and vigorous application of eye drops in preventing cytarabineinduced ocular toxicity is the dilution of cytarabine excreted onto the surface of eyes. 13 Another possible explanation for the reduced efficacy of topical corticosteroid in preventing kerato-conjunctivitis observed in the present study is the difference in the topical corticosteroid used (0.1% betamethasone) as compared with those in other studies (1% prednisolone or 0.1% dexamethasone). 1,3,12,13 Further, the frequency of administration differs among the studies.…”

“…Another promising prophylaxis is frequent and vigorous application of eye drops with artificial tears (two drops, every 4 h), which was also shown as effective as topical corticosteroid in preventing cytarabine-induced corneal toxicity. 13 The possible mechanism for this frequent and vigorous application of eye drops in preventing cytarabineinduced ocular toxicity is the dilution of cytarabine excreted onto the surface of eyes. 13 Another possible explanation for the reduced efficacy of topical corticosteroid in preventing kerato-conjunctivitis observed in the present study is the difference in the topical corticosteroid used (0.1% betamethasone) as compared with those in other studies (1% prednisolone or 0.1% dexamethasone).…”

“…13 Another possible explanation for the reduced efficacy of topical corticosteroid in preventing kerato-conjunctivitis observed in the present study is the difference in the topical corticosteroid used (0.1% betamethasone) as compared with those in other studies (1% prednisolone or 0.1% dexamethasone). 1,3,12,13 Further, the frequency of administration differs among the studies. Therefore, using different glucocorticoid or more frequent administration could contribute to decrease cytarabine-induced ocular toxicity.…”

Anterior uveitis as a complication of treatment with high dose cytosine‐arabinoside

“…Conjunctivitis and keratitis are very common and usually appear on days 6-8 of the treatment, unless prophylactic treatment with saline or corticosteroid eye drops are given [6]. Slit lamp examination typically demonstrates corneal microcysts and punctate epithelial erosions.…”

Asymmetric Anterior Uveitis as a Delayed Complication of Treatment with Systemic High-dose Cytosine–Arabinoside: A Case Report and Literature Review

“…While some studies have shown topical prednisolone 1% to be more effective than placebo, 8 others report that artificial tears are equally effective. 9 This gives further credence to the theory that dilution plays an important role in reducing toxicity. Some reports prefer dexamethasone to prednisolone due to a 5-to 7-fold higher anti-inflammatory activity and a greater capacity to penetrate the lipid-rich corneal epithelium.…”