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

Roee Arnon,Irit Rozen-Knisbacher,Dina Mostovoy,Dina Goldberg,Adi Sharabi–Nov,Nir Stanescu,Yulia Niazov,Tal Yahalomi

doi:10.1007/s10792-021-02174-5

Roee Arnon, Irit Rozen-Knisbacher + Show 6 more

Open Access

https://doi.org/10.1007/s10792-021-02174-5

Copy DOI

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. This retrospective, nonrandomized case series enrolled 85 patients with VKC. Patients were classified 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 first line treatment (tacrolimus 1st line), tacrolimus ointment after topical steroid drops treatment (tacrolimus 2nd line) and topical steroid drops or artificial tears alone (topical steroid and tears group). Significant improvements in clinical signs and symptoms were achieved under tacrolimus treatment 14months in the moderate group and 5months 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. Tacrolimus 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.

Highlights

Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, and sometimes severe ocular allergy
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)
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

Summary

Introduction

Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, and sometimes severe ocular allergy. The diagnosis of VKC is based on the patient’s clinical history and symptoms. There is no consensual grading system, and several scales have been developed with emphasis on severity of symptoms from no inflammatory changes to severe changes.[4] The most common symptoms of VKC are itching, photophobia, burning, and tearing.[5] Other symptoms are foreign body sensation and pain upon wakening.[6] Depending on the conjunctival site involved, 3 forms of VKC can be characterized: tarsal (palpebral), limbal (bulbar), and mixed.[3] The palpebral form is characterized by large tarsal papillae, ranging from 1 to 7–8 mm, which are known as cobblestone papillae. The limbal form includes conjunctival hyperemia, which are limbal nodules that appear as gray, jelly-like, elevated lumps with vascular cores. The mixed type has the clinical findings of the other two forms. Corneal involvement, which is sometimes referred to as a 4th form of VKC, includes superficial punctate keratitis, epithelial macroerosions, gelatinous limbal hypertrophy, and plaque formation. Untreated cases can progress to an oval shaped corneal epithelial defect, known as shieldulcer, in up to 11% of the cases.[1, 5, 7]

Objectives

Methods

Results

Discussion

Conclusion