When to start tacrolimus ointment for vernal keratoconjunctivitis? A proposed treatment protocol

Abstract

The aim of this study was to compare treatment regimens of tacrolimus and of topical steroids for VKC and suggest a treatment protocol according to our clinical experience. MethodsThis retrospective, nonrandomized case series enrolled 85 Patients with VKC. Patients were classi ed clinically according to severity (mild, moderate, severe) and were treated according to a suggested protocol. Analysis was made according to treatment received: tacrolimus ointment as rst line treatment (tacrolimus 1st line), tacrolimus ointment after topical steroid drops treatment (tacrolimus 2nd line) and topical steroid drops or arti cial tears alone (topical steroid and tears group). ResultsSigni cant improvements in clinical signs and symptoms were achieved under tacrolimus treatment 14 months in the moderate group and 5 months in the severe group. The longest duration of treatment was for tacrolimus 2nd line group (p=0.031) and the mean number of visits in the clinic was the highest. The mean number of topical treatments per day was higher in the topical steroid and tears group (2.6 times) than in the two tacrolimus groups (1.3 times for both). The mean time needed to achieve disease remission or relief did not differ between the tacrolimus 1st line and 2nd line groups. ConclusionTacrolimus treatment is effective and safe for VKC. Tacrolimus as 1st line treatment may be preferred for severe cases, for faster disease remission compared to tacrolimus as 2nd line treatment; and with fewer topical treatments per day compared to topical steroids. Key MessagesWe suggest a treatment protocol for VKC. Mild cases: 1 month course of topical steroids twice a day combined with arti cial tears. Moderate cases: 1 month of topical steroids 3-4 times a day and arti cial tears. Severe cases: tacrolimus 0.03% ointment combined with arti cial tears.

Vernal Keratoconjunctivitis: Immunopathological Insights and Therapeutic Applications of Immunomodulators

“…Currently, there are no established protocols for VKC treatment using immunomodulators. A treatment protocol that has been proposed includes initiating 0.03% tacrolimus as a first line of therapy for severe VKC, increasing the dose to 0.1% if no improvement is noted, or for cases that do not show improvement with corticosteroid therapy [ 146 ]. Patients who received tacrolimus as first-line treatment were shown to have shorter treatment periods and follow-up durations compared to patients who received tacrolimus as second-line treatment.…”

“…Monitoring these patients closely every 2–4 weeks initially is advised, as tacrolimus can take up to one month to take effect. Gradual tapering of the treatment is initiated once improvement in clinical signs and symptoms is noted [ 146 ]. In a study evaluating the efficacy and safety of prolonged treatment of severe VKC with topical 0.1% tacrolimus, it was demonstrated that 2 years of treatment was effective in improving clinical scores and remission rates, with limited adverse effects compared to a group treated for 6 months [ 133 ].…”