Efficacy, Safety and Steroid-sparing Effect of Topical Cyclosporine A 0.05% for Vernal Keratoconjunctivitis in Indian Children

Arkendu Chatterjee,Samir Kumar Bandyopadhyay,Sabyasachi Bandyopadhyay

doi:10.18502/jovr.v14i4.5439

Arkendu Chatterjee, Samir Kumar Bandyopadhyay + Show 1 more

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https://doi.org/10.18502/jovr.v14i4.5439

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Abstract

PurposeTo evaluate the efficacy, safety, and steroid-sparing effect of topical cyclosporine A (Cs A) 0.05% in patients with moderate to severe steroid dependent vernal keratoconjunctivitis (VKC).MethodsA prospective, comparative, placebo controlled study was carried out on 68 VKC patients, with 34 patients treated with topical Cs A 0.05% and the remaining 34 with topical carboxymethyl cellulose 0.5% (placebo). Both groups also received topical loteprednol etabonate 0.5%. Symptom (itching, photophobia, tearing, and discharge) score, sign (tarsal and limbal papillae, corneal involvement, and conjunctival hyperemia) score, and drug score (steroid drop usage/day/eye) were recorded at baseline and each follow-up visit. The intraocular pressure (IOP) measurement and evaluation of any ocular side effects were carried out.ResultsSignificant reduction in symptom score and sign score was seen in both groups. Cs A group significantly showed more reduction in symptom (P 0.0001 in all follow-up visits) and sign (P 0.0001 in all follow-up visits) scores compared to the placebo group. At day 7, mean steroid usage reduced from 4 to 3.44 0.5 and 3.79 0.4 in Cs A and placebo groups, respectively (P 0.0001). Steroid drops completely stopped in 21 patients at day 60 in the Cs A group compared to none in the placebo group. No significant rise in IOP or any side effects were noted in either group.ConclusionTopical Cs A 0.05% is effective and safe in patients with moderate to severe VKC with good steroid-sparing effect.

Highlights

We aimed to evaluate the safety, efficacy, and possible steroid-sparing effect of topical cyclosporine A (Cs A) 0.05% in an aqueous solution compared to placebo in Indian children with Vernal keratoconjunctivitis (VKC) concurrently treated with topical loteprednol etabonate (LE) 0.5%
Patients were randomly allocated either into Cs A group (34 patients treated with topical Cs A 0.05% plus topical LE 0.5%) or placebo group (34 patients treated with carboxymethyl cellulose 0.5% and topical LE 0.5%) according to a computer generated predetermined randomization list
VKC was diagnosed based on the presence of itching, tearing, mucoid discharge, photophobia, tarsal and limbal papillae, corneal involvement, and conjunctival hyperemia

Summary

Introduction

Vernal keratoconjunctivitis (VKC) is a seasonal bilateral chronic allergic inflammatory disease of the ocular surfaces, mainly occurring in. Eosinophils, and their mediators play a major role in the clinical manifestation of the disease.[5]

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