Topical Cyclosporin A in the Treatment of Anterior Segment Inflammatory Disease

Holland, Edward J.; Olsen, Timothy W.; Ketcham, Jeffrey M.; Florine, Craig W.; Krachmer, Jay H.; Purcell, John J.; Lam, Sheridan; Tessler, Howard H.; Sugar, Joel

doi:10.1097/00003226-199309000-00008

Cited by 140 publications

(60 citation statements)

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“…Anecdotally, topical steroid will relieve discomfort and inflammation in some patients with mild/moderate disease activity but has not reduced the activity of severe inflammatory disease or the progression of scarring. Topical ciclosporin has been used in only four reported cases of whom two had some response; 88 we have little experience with this for ocular MMP and it is probable that the poor results reported for systemic therapy with ciclosporin may have inhibited further investigation of this modality. As a result, systemic immunomodulatory therapy is currently the standard of care for these MMP patients.…”

Section: Use Of Systemic Immunomodulation To Control Immunemediated Imentioning

confidence: 95%

The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on

Dart

2017

Eye

104

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This review is in two sections. The first section summarises 35 conditions, both common and infrequent, causing cicatrising conjunctivitis. Guidelines for making a diagnosis are given together with the use of diagnostic tests, including direct and indirect immunofluorescence, and their interpretation. The second section evaluates our knowledge of ocular mucous membrane pemphigoid, which is the commonest cause of cicatrizing conjunctivitis in most developed countries. The clinical characteristics, demographics, and clinical signs of the disease are described. This is followed by a review and re-evaluation of the pathogenesis of conjunctival inflammation in mucous membrane pemphigoid (MMP), resulting in a revised hypothesis of the autoimmune mechanisms causing inflammation in ocular MMP. The relationship between inflammation and scarring in MMP conjunctiva is described. Recent research, describing the role of aldehyde dehydrogenase (ALDH) and retinoic acid (RA) in both the initiation and perpetuation of profibrotic activity in MMP conjunctival fibroblasts is summarised and the potential for antifibrotic therapy, using ALDH inhibition, is discussed. The importance of the management of the ocular surface in MMP is briefly summarised. This is followed with the rationale for the use of systemic immunomodulatory therapy, currently the standard of care for patients with active ocular MMP. The evidence for the use of these drugs is summarised and guidelines given for their use. Finally, the areas for research and innovation in the next decade are reviewed including the need for better diagnostics, markers of disease activity, and the potential for biological and topical therapies for both inflammation and scarring.

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Section: Use Of Systemic Immunomodulation To Control Immunemediated Imentioning

confidence: 95%

The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on

Dart

2017

Eye

104

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“…69 In ophthalmology, topically applied CsA was fi rst used to inhibit experimental corneal allograft reaction; 70 later it became an important agent that can be used in various ocular surface infl ammations. 71,72 CsA, which is a fungal derived peptide, has potent immunosuppressive properties which prevent the transcription of cytokine genes in activated T cells. 73 At this point, the question is what kind of characteristics makes CsA one of the most highly potent immunosuppressive drugs?…”

Section: Topical 005% Cyclosporinementioning

confidence: 99%

The role of inflammation and antiinflammation therapies in keratoconjunctivitis sicca

Gümüş

Cavanagh

2008

OPTH

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Purpose: To review and integrate recent advances in identifying the role of infl ammation in the pathogenesis of dry eye conditions and the biological rationale and practical clinical aspects of newer, antiinfl ammatory theories. Methods: A comprehensive literature survey. Results and conclusion: Keratoconjunctivitis Sicca (KCS) is a multifactorial and complex disorder in which ocular surface infl ammations play a central role. Identifi cation of specifi c CD4-T-Cell pathways and the recent recognition of targeting of alpha-fodrin suggest a case for novel new therapeutic aspects such as anti-CD4 monoclonal antibodies, systemic linoleic and gamma-linolenic acids, and omega-6 essential fatty acids. Replacement of tear volume with nonpreserved wetting agents and standard typical antiinfl ammatory corticosteroid and/or cyclosporine A continues to be central current conventional therapy for KCS. Keywords: dry eye, keratoconjunctivitis sicca, antiinfl ammatory therapy Dry eye disease or keratoconjunctivitis sicca (KCS) is a common disorder which refers to a spectrum of ocular surface diseases with multiple etiologies.1 KCS is associated with symptoms of ocular discomfort such as burning, sense of dryness, foreign body sensation, ocular pain, and is sometimes associated with photophobia, blurred vision, visual fatigue, and sight-threatening corneal complications in severe cases. 2,3Epidemiologic studies have stated that more than 6% of the population complains of dry eye symptoms, and this ratio increases to 15% over the age of 65. [4][5][6] Most of the studies have also found an increasing prevalence with aging and greater prevalence among women due to the hormonal status. 4,6,7 Pathogenesis of KCS has not been completely clarified. Even though KCS has been thought of classically and basically as a condition of tear deficiency, whether caused by decreased lacrimation or excessive evaporation, it is a complex disorder. Many clinicopathological entities involving tear film, lacrimal glands, eyelids, and a wide spectrum of ocular surface cells, including epithelial, inflammatory, immune, and goblet cells may play a role in its pathogenesis. 2,8Over the past years, as a result of numerous studies, new concepts of pathogenesis have shown that KCS seems to be caused by infl ammation mediated by T-cell lymphocytes. [9][10][11] This fi nding has also been augmented by the studies investigating the role of antiinfl ammatory therapies. For instance, the treatment of KCS gained a new dimension with the approval of topical 0.05% cyclosporine A (Restasis) (Allergan, Inc., package insert for Restasis) by the US Food and Drug Administration. Consequently, because of the increasing importance of the role of infl ammation and the use of cyclosporine eye drops, the goal of this review article is to provide the readers with an overview of Clinical Ophthalmology downloaded from https://www.dovepress.com/ by 35.167.132.9 on 10-May-2018 For personal use only.Powered by TCPDF (www.tcpdf.org)

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“…Os pacientes sob imunossupressão sistêmica devem ter acompanhamento rigoroso por especialista com experiência na área, pois essas drogas apresentam uma série de efeitos colaterais potencialmente letais 55 . O uso de Ciclosporina-A tópica tem sido preconizado por alguns autores no tratamento de doenças inflamatórias da superfície ocular e prevenção de rejeição em transplante de córnea 57 . Entretanto, os resultados são controversos.…”

Section: Tratamentounclassified

Atualização no tratamento das ceratoconjuntivites cicatriciais

Gomes

2000

Arq. Bras. Oftalmol.

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Topical Cyclosporin A in the Treatment of Anterior Segment Inflammatory Disease

Cited by 140 publications

References 0 publications

The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on

The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on

The role of inflammation and antiinflammation therapies in keratoconjunctivitis sicca

Atualização no tratamento das ceratoconjuntivites cicatriciais

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