Abstract
Administration of eye drops containing antihistamines or sodium cromoglycate and its derivatives for the treatment of allergic keratoconjunctivitis is often insufficient and usually requires the addition of corticosteroids. However, the risk of complications, such as glaucoma and cataract, limits the use of corticosteroids to short courses, resulting in inadequate long-term treatment response. Immunosuppressive drugs have been considered as a valid alternative to steroids for atopic keratoconjunctivitis and vernal keratoconjunctivitis. This study aimed to evaluate the use of topical tacrolimus (TCL) in improving the clinical signs of severe allergic keratoconjuctivitis in children. Patients with severe allergic keratoconjunctivitis associated with corneal epitheliopathy, gelatinous limbal infiltrates, and/or papillary reaction, along with a history of recurrences and resistance to conventional topical anti-allergy agents, were included in this open clinical trial. Patients were treated with 0.03% TCL ointment for ocular use. A severity score ranging from 0 to 9, with 9 being the highest and 0 being the lowest, was assigned based on signs observed on biomicroscopy prior to and following TCL treatment. Analyses included 66 eyes of 33 patients. After a mean follow-up period of 13 months (range, 12-29 months), TCL treatment significantly decreased the mean symptom score severity for the right (from 5.56 ± 1.18 to 2.76 ± 1.5; p<0.001) and left (from 5.94 ± 1.16 to 2.86 ± 1.64; p<0.001). Topical TCL was effective and significantly improved the clinical signs of allergic keratoconjuctivitis in children. Thus, it is a potential new option for severe and challenging cases of ocular allergy.
Highlights
Ocular allergies constitute a heterogeneous group of frequently recurring inflammatory diseases of the ocular surface, with manifestations that range from mild to severe
Patients with severe allergic keratoconjunctivitis associated with corneal epitheliopathy, gelatinous limbal infiltrates, and/or papillary reaction, along with a history of recurrences and resistance to conventional topical anti-allergy agents, were included in this open clinical trial
The objective of the present study was to evaluate the use of topical TCL for the treatment of severe allergic keratoconjunctivitis in children
Summary
Ocular allergies constitute a heterogeneous group of frequently recurring inflammatory diseases of the ocular surface, with manifestations that range from mild to severe. AKC and VKC are the most severe forms because of the possibility of visual impairment caused by corneal scarring, irregular astigmatism, cataract, and glaucoma[2,3]. Glaucoma and cataract secondary to corticosteroid therapy are potential causes of blindness, which is a concern especially in young patients. Medical treatment, including preservative-free artificial tears, topical nonsteroidal anti-inflammatory drugs, and topical antihistamines or mast cell stabilizers are used for milder cases. More severe cases are treated with a combination of antihistamines or mast cell stabilizers and topical or systemic corticosteroids, which is given either as an intensive short-term therapy or as a long-term treatment regimen[4]. The use of immunomodulators, such as cyclosporin A, is reserved for cases with steroid-dependent allergic keratoconjunctivitis or when the use of corticosteroids is contraindicated, for example in patients with advanced glaucoma[5]. In severe cases refractory to medical treatment, surgical treatment, including excision of the tarsal papillae, superficial keratectomy with or without amniotic membrane graft, and eyelid surgery, may be performed
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