Topical Cyclosporine Research Articles

Frequency of efficacy of topical cyclosporine 0.05% eye drops in the management of dry eyes

Aim: To determine the efficacy of cyclosporine 0.05% for the management of patients of dry-eye disease presenting at tertiary care hospital. Methods: This cross sectional study was conducted at Department of Ophthalmology, Sahiwal Medical College, Sahiwal from March 2020 to September 2020 over the period of 6 months.Total 310 patients of dry eye were included in this study after scrutinized by inclusion criteria. All the selected patients were managed with cyclosporine 0.05% and efficacy of the drug was assessed. Results: Total 310 patients of dry eye disease were recruited. Mean age was 47.15 ± 3.61 years and mean duration of dry eye disease was 11.10 ± 1.75 months. Out of 310 patients, treatment was found effective in 225 (73%) patients. Efficacy of treatment was noted in 172(96.63%) male patients and in 53(40.15%) female patients. Significantly higher rate of efficacy was noted in male patients as compared to female patients with p value 0.000. Conclusion: Results of present study showed higher improvement rate of dry eye symptoms in cases of dry eye managed with cyclosporine 0.05%. Male patients were more victim of dry eye as compared to female patients and statistically significant association of efficacy with gender was observed. No association of efficacy of treatment with age group and duration of disease was observed. Keywords: Dry eye, cyclosporine, inflammation, immunomodulator agents.

PSS3 Topline Patient-Reported Outcome Results from a Multicenter, Open-Label, Phase 4 Study of Repository Corticotropin Injection in Patients with Refractory Severe Noninfectious Keratitis

Repository corticotropin injection (RCI; Mallinckrodt Pharmaceuticals) is a naturally sourced complex mixture of adrenocorticotropic hormone analogs and other pituitary peptides approved for the treatment of keratitis. This analysis of topline patient-reported outcome results from a multicenter, open-label, phase 4 study of RCI in patients with refractory severe noninfectious keratitis was conducted to assess quality of life (QoL) and symptomatic improvements (NCT04169061). Patients were ≥18 years old with severe keratitis despite previous treatment with topical cyclosporine, lifitegrast, or an immunosuppressant. Patients received 80 U RCI subcutaneously twice weekly for 12 weeks. Analyses evaluated the change from baseline through week 12 on the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire, Visual Analogue Scale (VAS), and Ocular Discomfort Score (ODS). One-sample t tests (null hypothesis: no change) were used for statistical analyses, with significance vs baseline determined as p<0.05. Analyses were performed using the modified intent-to-treat (mITT) population (patients who received ≥1 dose of RCI and contributed any postbaseline efficacy data). Topline results in the mITT population (N=35) showed significant improvements from baseline at every time point assessed after initiation of RCI treatment in 4 of 6 dimensions of the IDEEL questionnaire (ie, emotional impact, impact on daily activities, symptom bother, and treatment-related bother scores); significant improvements from baseline at weeks 6 and 12 were observed for the IDEEL impact on work score. VAS scores for eye discomfort, eye dryness, foreign body sensation, pain, and photophobia significantly improved at all measured time points after initiation of RCI. ODS showed significant improvements from baseline at every time point assessed after RCI initiation for the overall score and for the symptoms of dryness, grittiness, and stinging. Topline results of this open-label study showed that RCI significantly improved QoL and symptom measures in patients with refractory severe noninfectious keratitis.

Real‐world treatment patterns of patients with atopic dermatitis in Japan: Analysis of the JMDC Claims Database

AbstractObjectivesThis study was conducted to assess changes in the real‐world treatment of atopic dermatitis (AD) in Japan.MethodsPatients from the JMDC Claims Database with ≥1 confirmed diagnosis of AD, an identifiable medical care start date for AD, and ≥2 AD–related treatments on separate dates between January 1, 2005, and May 31, 2019, were included; data were analyzed on a yearly basis.ResultsIn total, 411,102 patients were included. The average age of patients increased from 12.0 to 18.8 years between 2005 and 2017. In any given year, the prevalence of AD was highest in patients aged &lt;2 years and lowest in patients aged ≥50 years. Dermatology (65.1%‐69.5% from 2005 to 2017) and clinics (92.3%‐93.4%) were the main department and medical facility, respectively, providing daily medical care for AD. The proportion of patients who were given the thymus and activation‐regulated chemokine test increased from 2008 to 2017 (0.03%‐3.5%). From 2005 to 2017, the proportion of patients who received moisturizer (68.8%‐79.1%), topical calcineurin inhibitors (8.2%‐17.8%), very strong topical corticosteroids (26.0%‐40.6%), strongest topical corticosteroids (3.5%‐7.8%), cyclosporine (0.01%‐0.3%), or phototherapy (0.06%‐1.8%) increased, and the proportion of patients who received topical non‐steroidal anti‐inflammatory drugs (12.0%‐3.1%) decreased. Annual costs for medication associated with AD per person/visit increased between 2005 and 2017; however, the ratio of medication to total cost did not.ConclusionsThe results of this analysis show that Japanese patients used increasingly potent treatments for AD, and overall AD‐related medication costs increased between 2005 and 2017.

Dry Eye Treatment with Topical Cyclosporine 0.1% in Chondroitin Sulfate Ophthalmic Emulsion

PurposeTo evaluate the efficacy of topical cyclosporine 0.1% in chondroitin sulfate emulsion for the treatment of dry eye.MethodsThis retrospective multicenter study included 100 eyes of 50 dry eye patients aged ≥18 years, with preoperative ocular surface disease index (OSDI) score >12 or corneal staining grade >1 (in either eye) who underwent dry eye treatment with topical cyclosporine 0.1% in chondroitin sulfate emulsion (Klarity-C, ImprimisRx) for 3 months. Postoperative evaluation included comparison of the changes in OSDI score and corneal staining grade after 3 months of treatment from baseline.ResultsFrom baseline to 3 months, a statistically significant improvement in mean OSDI scores (38.19 vs 24.18, p <0.001) as well as mean corneal staining grade (3.62 vs 2.20, p <0.001) was observed. The proportion of subjects with severe dry eye decreased from 62% to 20% and more than one-third (34%) of patients were in the normal OSDI range. The percentage of eyes with corneal staining grade of 2 or 3 decreased from 21% (baseline) to 8% at 3 months; 50% of the eyes had corneal staining grade of 0. The treatment was found to be safe with no adverse events observed in the study.ConclusionDry eye treatment with twice daily cyclosporine 0.1% in chondroitin sulfate emulsion was found to be safe and effective in reducing signs and symptoms of dry eye.

Les modalités d’utilisation de la ciclosporine locale pour l’allergie oculaire

Of the common allergic conjunctivitis in children, rare forms present more severe prognosis which include vernal keratoconjunctivitis and atopic keratoconjunctivitis. Vernal keratoconjunctivitis affects children mainly boys from 3 to 15 years old and represents a serious, descolarizing pathology affecting quality of life of the child. Atopic keratoconjunctivitis clearly affects adults more frequently with moderate to severe degrees of severity. Thus, the last few years have had the objective of developing innovative therapies to improve the management of these severe keratoconjunctivitis. It is essential to recognize the clinical form of these eye allergies for the implementation of appropriate treatment. Topical corticosteroids, although most often effective, can create dependence and moreover cause iatrogenic or even severe visual impairment complications. The latest studies on ciclosporin which is an immunosuppressive agent, have demonstrated major steroid-sparing effects. The proper use of topical cyclosporine must be well monitored. Nowadays, topical ciclosporine at 0.1%, has received the AMM for the indication of vernal keratoconjunctivitis and a new dosage at 2% received the AMM for the treatment of keratoplasty. Tacrolimus ointment having more powerful effects than cyclosporine is of interest in severe vernal keratoconjunctivitis and in fact especially in atopic keratoconjunctivitis. Therefore, in addition Tacrolimus treats atopic eyelid eczema. The various latest generation antiallergics can be useful in combination in ocular allergy. In very severe cases, Omalizumab, a human monoclonal antibody produced by the so-called recombinant DNA technique, selectively binds human immunoglobulin E (IgE) and has shown its effectiveness combined with ciclosporine in recent studies. Topical ciclosporine used appropriately can be a steroid-sparing agent in severe ocular allergy and improve the quality of life of children.

Eye amputation following lifitegrast treatment for ocular graft-versus-host disease: First case report

Graft-versus-host disease (GVHD) is a common complication in patients undergoing allogeneic stem cell transplantation for acute myeloblastic leukemia that could be very difficult to treat. Lifitegrast 5% (Xiidra@, Novartis), a new immunosuppressive eye drop, was recently approved by the FDA for the treatment of severe dry eye and is currently under review by the European Medicines Agency. In France, lifitegrast has been approved by the French authorities for temporary use in refractory dry eye syndrome resistant to tear substitutes and topical cyclosporine. To date, serious complications have been reported only exceptionally. In this article, we report the case of a 65-year-old patient with a medical history of acute myeloid leukemia (AML) diagnosed in 2015 who received a first matched related donor transplant. In 2019, this patient developed chronic GVH involving the skin, oral mucosa and eye. Despite taking topical and systemic medications for 3 months, the patient did not report relief of ocular symptoms. Therefore, lifitegrast was prescribed. To our knowledge, we report the first case of corneal perforation in which evisceration was required following treatment with topical lifitegrast for chronic GVH. In the case presented here, it can be assumed that the underlying mechanisms leading to corneal perforation are multifactorial. Using drug accountability criteria, lifitegrast appears to be strongly associated with the development of bacterial keratitis and corneal perforation.

Topical Cyclosporine A 0.05% for the Treatment of Dry Eye Disease

&#x0D; &#x0D; &#x0D; Dry eye disease (DED) is a common clinical condition that challenges ophthalmologists. Topical Cyclosporine A is an anti-inflammatory therapy being approved by the Food and Drug Administration (FDA) for the therapy for DED. This study aimed to evaluate the efficacy and pa- tient tolerability of topical Cyclosporine A 0.05% for the treatment of DED. A total of 87 patients diagnosed with DED were included in this study. Dry eye symptoms (foreign body sensation, burn- ing, and pain) were scored. As a baseline measurement, the tear break-up time test (TBUT) and the Schirmer’s test were performed for all the patients. Cyclosporine A 0.05% was given topically twice daily to all the patients for four months. They were followed up every month for a period of four months. The clinical signs (Schirmer’s test, the TBUT), and the symptoms scores, were record- ed for each visit. The mean age of the patients was 57.25±9.70 years (Range 32 - 80 years); 25 males (28.7%) and 62 females (71.3%). Out of them, 23 (26.4%) cases had Sjögren’s syndrome, and 12 (13.7%) cases had previous LASIK (laser in-situ keratomileusis). The symptoms score of the cases improved from (4.95±1.73) pretreatment to (0.40±.70) four months after treatment (P &lt;0.001). The Schirmer’s test results improved from (4.10 ±1.089) pretreatment to (10.80±2.40) four months post-treatment (P &lt;0.0001), and the TBUT test results improved from (5.54±1.77 s) pre- treatment to (12.95±3.12 s) four months post-treatment (P &lt;0.0001). Only seven patients (8%) de- veloped ocular side effects in the form of redness, pain, and systemic side effects in the form of headache. In conclusion, Cyclosporine A 0.05% eye drops is an effective treatment for DED, im- proving both signs and symptoms of DED with few ocular side effects.&#x0D; &#x0D; &#x0D;

Efficacy of 2% Rebamipide Suspension for Vernal Keratoconjunctivitis: A Clinical Comparison with Topical Immune Modulators Cyclosporine and Tacrolimus

ABSTRACT Purpose To compare the efficacy of 2% rebamipide suspension with topical cyclosporine and tacrolimus for managing vernal keratoconjunctivitis (VKC) Methods In this prospective, interventional study, 38 patients with moderate to severe VKC were allocated to receive either 2% rebamipide in one eye and 0.03% tacrolimus ointment in the contralateral eye (n = 19) or 2% rebamipide in one eye and 0.05% cyclosporine in the contralateral eye (n = 19) for 12 weeks. Ten ocular signs and 7 symptoms were graded on a scale of 0-3 each for each eye at every visit. Results Total sign and symptom scores reduced significantly in all 4 subgroups (all p’s <0.05) at 12 weeks. Reduction of mean sign scores between rebamipide and tacrolimus (- 4.67 ± 4.63 and - 2.80 ± 3.18 respectively) and between rebamipide and cyclosporine (-6.00 ± 3.74 and -5.42 ± 3.68 respectively) was comparable. Reduction in symptom scores was also comparable between subgroups. Conclusion Our findings suggest that efficacy of topical rebamipide is comparable to topical cyclosporine and tacrolimus for managing moderate to severe VKC and it merits further evaluation as a novel steroid sparing alternative for this disorder.

Controversy of indomethacin eye drops in the treatment of rheumatoid arthritis-induced corneal ulceration: a case report

BackgroundPerforation of the cornea is a rare finding in patients with rheumatoid arthritis (RA). Addressing a perforated cornea associated with RA is challenging, since its pathogenesis is not fully elucidated. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) were developed to prevent cystoid macular edema following cataract surgery in patients at risk. Their prescription in inflammation of the anterior segment of the eye may induce negative effects on the ocular surface. We bring into focus a corneal perforation in a patient with RA who used indomethacin eye drops to treat corneal ulceration, but responded promptly to drug discontinuation and initiation of topical cyclosporine 0.1%. Our aim is to emphasize two issues: the contraindication of topical indomethacin in corneal defects, and the immediate positive impact of topical cyclosporine 0.1% on corneal healing.Case presentationA 73-year-old Caucasian woman with a 13-year history of RA was treated for corneal ulceration in her oculus sinister (OS) with topical indomethacin and gentamicin. The patient was being treated with systemic immunosuppression and NSAIDs for the underlying RA and artificial tears in both eyes. No bandage contact lens was used. After 3 weeks of treatment, perforation of the left cornea occurred and the patient was referred to our hospital. Upon admission, visual acuity (VA) in the OS was 20/630. Slit lamp examination of the OS revealed paracentral corneal perforation, iris plugging the perforation site, shallow anterior chamber, clear aqueous humor, and clear lens. Anterior segment optical coherence tomography showed the inclavated iris in the perforation site and minimum corneal thickness of 101 µm. Topical NSAIDs were discontinued and topical treatment was initiated with tobramycin, tropicamide 1%, phenylephrine 10%, and artificial tears five times a day, and occlusive patch. For 5 days, there was no improvement, so topical cyclosporine 0.1% was started, one drop every evening. Within 7 days, the cornea had healed, the iris was liberated from the perforation site, the minimum corneal thickness increased to 250 µm, VA improved to 20/25, and the patient was free of symptoms.ConclusionsThe main “takeaway” lessons from this case are that topical indomethacin should not be prescribed in cases of inflammation of the anterior segment of the eye, and that topical cyclosporine was efficacious in healing corneal perforation in our patient.

Short-Term Therapeutic Effects of Topical Corticosteroids on Refractory Dry Eye Disease: Clinical Usefulness of Matrix Metalloproteinase 9 Testing as a Response Prediction Marker.

PurposeTo compare the short-term therapeutic effects of topical corticosteroids in patients with refractory dry eye disease (DED) according to the tear matrix metalloproteinase 9 (MMP-9) point-of-care positivity.MethodsThis study was conducted on 137 patients who were referred from other eye clinics, complaining of irresponsive DED or acute DED flares despite routine treatment with topical cyclosporin or diquafosol. The patients received treatment with topical corticosteroids for 1 month. DED was evaluated by SANDE (Symptom Assessment in Dry Eye) questionnaire, tear film breakup time, ocular surface staining score, and meibomian gland dysfunction stage. The InflammaDry MMP-9 immunoassay was conducted in more symptomatic eyes of all patients. The changes in the subjective symptoms were additionally surveyed as symptom improvement score.ResultsThe mean age of the patients was 57.8±13.4 years, and the tear MMP-9 positivity was 73.0%. Topical corticosteroids treatment showed significant improvement of symptoms and signs in the patients with refractory DED irrespective of the positivity of MMP-9 (each p<0.001). The changes in SANDE score and OSS, and symptom improvement score were higher in the MMP-9 positive group than in the MMP-9 negative group (p=0.002/0.010/0.011). The overall rates of subjective symptoms improvement and SANDE reduction were 73.0% and 90.6% after topical corticosteroids treatment, respectively.ConclusionShort-term topical corticosteroids had excellent therapeutic effects in patients with refractory DED or acute DED flares, irrespective of the tear MMP-9 level. Tear MMP-9 positivity may serve as a reliable response predictor of topical corticosteroids treatment in DED.

Topical cyclosporine a (0.05%) treatment in dry eye patients: a comparison study of Sjogren's syndrome versus non-Sjogren's syndrome.

To evaluate the clinical effect of topical cyclosporine A (CsA) (0.05%) on dry eye patients with Sjogren's syndrome (SS) and non-Sjogren's syndrome (NSS). This retrospective comparative study includes the dry eye (DE) patients who were treated with topical CsA. DE patients were divided into two groups as follows: DE with Sjogren's syndrome (DE-SS) and DE with Non-Sjogren's syndrome (DE-NSS). Dry eye parameters were recorded at baseline and each visit. Schirmer's test 1 scores were 2.7 ± 0.5mm at baseline and 3.5 ± 0.7mm at 12th month in DE-SS, 2.9 ± 0.7mm at baseline and 9.5 ± 0.7mm in DE-NSS groups at 12th month. Mean ST score was higher in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (both p = 0.001). Tear break-up time score showed a significant improvement in DE-NSS group, and it was lower in DE-NSS group than DE-SS group group at sixth and 12th months of the treatment (p = 0.044 and 0.027, respectively). Mean OSDI score was lower in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (p = 0.030 and 0.032, respectively). Topical CsA seems to be more effective in the treatment of the DE-NSS.

Clinical efficacy and safety of omalizumab in conventional treatment-resistant vernal keratoconjunctivitis: Our experience and literature review.

Clinical efficacy and safety of omalizumab in conventional treatment-resistant vernal keratoconjunctivitis: Our experience and literature review.

Comparing the efficacy of 2% topical rebamipide and 0.1% topical sodium hyaluronate with or without 0.05% topical cyclosporine in patients with dry eye disease

Background: Dry Eye Disease (DED) is a multifactorial and complex disease of the ocular surface, with a high prevalence in adults. Aims and Objectives: To compare the efficacy of 2% topical Rebamipide and 0.1% topical Sodium hyaluronate with or without 0.05% topical cyclosporine in patients with dry eye disease (DED). Materials and Methods: This prospective, randomised, comparative, interventional study was conducted at a tertiary level academic centre on 240 eyes of 120 patients having DED, with Schirmer's test (without anesthesia) value less than or equal to 10mm and tear film breakup time (TBUT) less than or equal to 10 secs. After detailed ophthalmic examination, patients were randomly allocated in 4 different groups (A B C D). Group A were given 2% topical Rebamipide, group B received 2% topical Rebamipide with 0.05% topical Cyclosporine, group C were started on 0.1% topical Sodium Hyaluronate and group D were given 0.1% topical Sodium Hyaluronate with 0.05% cyclosporine. Each of these drops was given for 4 times a day for a period of 12 weeks. All patients were followed up after 2 weeks, 4 weeks and 12 weeks. Results: Out of 120 patients, 79 (65.83%) were female and 41 (34.16%) were male. The change in the mean schirmer's score and mean TBUT score was statistically significant in all four groups from baseline to 12 weeks (p<0.05). On comparing with each other, no significance difference was noted in any group. Conclusion: According to our study, 3 months of treatment with either 2% topical Rebamipide or 0.1% sodium hyaluronate is equally effective for DED and addition of 0.05% cyclosporine have no adjunctive role.

Thygeson's superficial punctate keratopathy: A review and case series.

Thygeson‘s superficial punctate keratitis (TSPK) is a chronic disorder with episodes of exacerbations and remissions which span over years to decades. Typical features of the disease include multiple, grayish white, intraepithelial corneal lesions with minimal or no conjunctival involvement. The exact etiopathogenesis of this entity is unknown. However, it may have a genetic association with HLA-DR3, an antigen proved to be associated with immunogenic responses. Treatment of the disease consists of artificial tears, topical corticosteroids, topical cyclosporine, topical tacrolimus, or usage of soft contact lenses. TSPK should be considered as a diagnosis of exclusion in cases of bilateral superficial punctate keratopathy of long duration. Thirteen patients of TSPK were examined during the last 6 years (2014–2019) at our Institute. Visual acuity was 20/20 to 20/30 in majority cases. All patients required lubricants.

Topical cyclosporine A for the treatment of dry eye: a randomized clinical study

Aim The aim of this study was to determine the efficacy and safety of topical cyclosporine A (CsA) in treatment of moderate-to-severe dry eye. Setting and design This is a prospective randomized comparative clinical study that was carried out at Alexandria Main University Hospital, Alexandria, Egypt. Patients and methods The study included 80 eyes of 40 patients with moderate-to-severe dry eye. Patients were divided into two groups: group I received topical CsA 0.05%, and group II were controls. Patients were assessed at weeks 1, 4, and 12 during and after the treatment phase for changes from the baseline using Schirmer’s test, tear break-up time (TBUT), fluorescein staining, and Ocular Surface Disease Index (OSDI). Results There were greater improvements in group I than in group II in Schirmer’s test results (P=0.002), TBUT (P=0.001), and OSDI scores (P=0.009) at week 4. At week 12 posttreatment phase, the improvement in group I kept on more slowly toward stability for Schirmer’s test (P=0.004) and TBUT (P=0.002), whereas the improvement in fluorescein staining and OSDI scores was not significant (P=0.706 and 0.065, respectively). Conclusion CsA ophthalmic oily solution 0.05% was demonstrated to be effective. It decreased the manifestations of dry-eye disease. Additionally, its effect continued to occur significantly within the treatment periods and the improvement of the ocular condition kept on, actually, more slowly toward stability, although the drug was already discontinued.

Efficacy of topical cyclosporine 0.05% and osmoprotective lubricating eye drops in treating dry eye disease and inflammation.

Purpose:To evaluate the effect of topical cyclosporine 0.05% and osmoprotective lubricating eye drops on patients with dry eye disease (DED) with inflammation as measured by raised tear matrix metalloproteinases (MMP-9).Methods:This prospective study included 106 eyes of 53 patients diagnosed with DED based on any of the following DED criteria (Ocular Surface Disease Index [OSDI] score >12, tear film breakup time [TBUT] <10 s, Schirmer’s I test result <10 mm/5 min, ocular surface staining). Ocular surface inflammation was assessed by assessing MMP-9 positivity from tears of the patients in the study (Inflammadry kit Quidel corporation). Patients were prescribed osmoprotective lubricating eye drops (Osmodrops, Cipla Ltd) four times a day and cyclosporine A 0.05% eye drops (Imudrops, Cipla Ltd) twice a day for 6 months. Efficacy of the formulations was evaluated by OSDI scores, Schirmer’s test, TBUT change, reduction in ocular surface staining, and reduction in MMP-9 levels after 6 months of usage. Check P value and add from resultsResults:After 6 months of topical therapy, improvement was observed in OSDI scores (mean pretreatment: 25.7 ± 12.8, and mean posttreatment: 15.2 ± 8.4), P < 0.001. There was also reduction number of patients who were MMP-9 positive. Out of 75 eyes that tested MMP-9 positive, 70.66% showed reduction in MMP-9 levels P < 0.0001). Ocular surface staining also improved.Conclusion:Topical osmoprotective lubricating eye drops and cyclosporine A 0.05% reduce inflammation in cases of DED, which correlates with improvement in OSDI scores, ocular surface staining, and reduction in inflammation as measured by levels of tear MMP-9.

The Effect of Topical 0.05% Cyclosporine in the Prevention of Recurrence Following Pterygium Surgery.

Objectives:To evaluate the effect of topical cyclosporine A (CsA) (Restasis, Abbvie, Lake Bluff, IL, USA) on recurrence rates and tear metrics after pterygium excision and limbal-conjunctival autografting (LCUA) technique in patients with primary pterygium.Methods:A total of 60 eyes of 60 patients with primary pterygium who underwent pterygium excision and the LCUA technique were evaluated prospectively. Among them, 30 eyes of 30 patients were treated with topical CsA (Restasis) for 6 months postoperatively (Group 1). The remainder of the patients were assigned to Group 2. The follow-up period was 12 months for each group. The primary outcome measures were a comparison of Schirmer I test and fluorescein tear break-up time (FTBUT) results, the recurrence rate, and postoperative complications.Results:There were no significant differences in age (mean age of Group 1 and 2 was 55.0±9.7 years and 56.3±8.9 years, respectively) or sex between groups (p>0.05). Farmers were the largest group of patients (40.0%). Recurrence of pterygium was observed in 5 (16.6%) eyes in Group 1 and 8 (26.6%) eyes in Group 2. The recurrence rate was not statistically significant between groups (p=0.35). The complication rate was significantly lower in Group 1 compared with that of Group 2 (p=0.02). The average increase in Schirmer I and FTBUT values was significantly higher in Group 1 than in Group 2 (p<0.05).Conclusion:The use of topical CsA did not demonstrate any significant improvement in the recurrence rate of pterygium following LCUA surgery.

Kuru Göz Sendromlu Hastaların Tedavisinde %0.05 Siklosporin A’nın Etkinliği

Dry eye is one of the most common ocular diseases in the elderly population and has increasing importance. Aging, decreased hormones and systemic autoimmunity are among the common causes of dry eye disease. Although the etiology of dry eye can change, it is known that the main cause is the inflammation in both lacrimal glands and ocular surfaces. To evaluate the effectiveness of topical cyclosporine A (CsA) 0.05% which is an immune-modulatory agent in the treatment of dry eyes, total of 51 patients with dry eye syndrome were included in our study. Forty-six of the patients were female while 5 patients were male. The mean duration of medication use of the patients was 8.72 ± 3.59 months (6-16 months). There was a statistically significant difference between the pre-treatment Schirmer scores and Schirmer scores found in 1st, 6 th and last month controls of Sjögren and Non-Sjögren groups (p&amp;lt;0.05) while there was no statistically significant difference between Sjögren and Non-Sjögren groups (p&amp;gt;0.05). In conclusion, it was found that there was a significant increase in Schirmer and fluorescein TBUT scores and tear meniscus height of both Sjögren and and Non- Sjögren groups.

Topical Cyclosporine in Severe Steroid-Dependent Phlyctenular Keratoconjunctivitis associated with Ocular Rosacea

Introduction: Phlyctenular keratoconjunctivitis is an uncommon and often misdiagnosed ocular immunological disorder, secondary to ocular or systemic illness, that usually responds well to topical steroids. In a few cases, it can be refractory or steroid dependent, hindering treatment. Case Report: A healthy 12-year-old dark skin female without prior ocular or systemic disease presented in our department with a corneal ulcer and centripetal corneal neovascularization in the left eye and phlyctenules in both eyes, without blepharitis. Testing for different possible inciting agents, such as chlamydia and tuberculosis, was negative. During the follow-up, the patient presented episodes of chalazia and facial pustules and the diagnosis of bilateral phlyctenular keratoconjunctivitis secondary to recurrent ocular rosacea was presumed. As soon as the corneal ulcer was completely healed, the patient started topical corticosteroid treatment with clinical improvement. After several failed attempts of steroids tapering, topical cyclosporine was added to therapy, enabling corticosteroid discontinuation. Discussion: Phlyctenular keratoconjunctivitis is frequently caused by a hypersensitivity reaction to microorganisms, such as staphylococcus species and mycobacterium tuberculosis, but it can be also associated with ocular rosacea without evidence of other inciting agents. The progression of phlyctenulosis to severe complications, as corneal scarring or even perforation, can compromise visual acuity at an early age and for that reason it is important to find and treat any inciting agent for the successful management of this disease. Even with adequate treatment for ocular rosacea with steroids, side effects of long-term therapy to control recurrent ocular inflammation grants topical cyclosporine an important role in disease management.

First reported case of safe and efficacious use of tocilizumab for treatment of hyperinflammatory syndrome associated with COVID‐19 in an allogeneic stem cell transplant patient

First reported case of safe and efficacious use of tocilizumab for treatment of hyperinflammatory syndrome associated with COVID‐19 in an allogeneic stem cell transplant patient