Abstract
BackgroundNo studies have been reported on the efficacy and safety of long-term (≥12 months) use of topical tacrolimus for refractory ocular surface inflammation in pediatric patients.MethodsMedical records of pediatric patients who were prescribed topical 0.02% tacrolimus ointment for refractory ocular surface inflammation between January of 2010 and March of 2018 were reviewed retrospectively. Changes in ocular surface signs during slit-lamp examination, clinical symptoms and concurrent steroid use were graded with a scoring system. The presence of side effects was also assessed. The changes in disease severity and patient symptoms were compared between baseline and after the treatment.ResultsAmong 72 patients (55% males, mean age 10.8 ± 3.9 years, range 3 to 17 years), 25 patients (48% males, mean age 11.4 ± 3.9 years) fully recovered, resulting in discontinuance of the ointment treatment before 12 months. Six patients experienced intolerable burning sensation, which required treatment cessation. Cessation days of those who quit were 1,5,14,20,26, and 35 days. Seven patients were lost during follow-up. Thirty-four patients (56% males, mean age 11.2 ± 4.2 years, range 3 to 17 years) were treated with tacrolimus ointment for over 12 months (average 23.1 ± 19.1 months, range 12 to 98 months). During the follow-up period, all patients showed improved clinical signs and symptoms, and no adverse reaction was noted.ConclusionsLong-term maintenance of topical tacrolimus 0.02% ointment is safe and effective in improving refractory ocular surface inflammation in pediatric patients.
Highlights
No studies have been reported on the efficacy and safety of long-term (≥12 months) use of topical tacrolimus for refractory ocular surface inflammation in pediatric patients
T helper 2 cells play a vital role in the pathogenesis of vernal keratoconjunctivitis (VKC) [2]
In atopic keratoconjunctivitis (AKC), both T helper 1 and 2 cytokines are expressed in the irritated conjunctiva [3]
Summary
No studies have been reported on the efficacy and safety of long-term (≥12 months) use of topical tacrolimus for refractory ocular surface inflammation in pediatric patients. The ocular surface inflammation management requires intense immunosuppression [1]. T helper 2 cells play a vital role in the pathogenesis of vernal keratoconjunctivitis (VKC) [2]. In atopic keratoconjunctivitis (AKC), both T helper 1 and 2 cytokines are expressed in the irritated conjunctiva [3]. Chronic ocular Graft-versus-host disease (GVHD) occurs by reactive T cell [4]. Topical steroids are the main treatment for these diseases. Prolonged steroid use can potentially cause severe adverse reactions, including steroid-induced glaucoma (SIG), posterior subcapsular cataract, and secondary infection [7]. Pediatric patients tend to show a more severe response to topical
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