Comparison of the safety and efficacy of topical Tacrolimus (0.03%) versus dexamethasone (0.05%) for subepithelial infiltrates after adenoviral conjunctivitis

Bhargava, Rahul; Kumar, Pardeep

doi:10.4103/ijo.ijo_1352_18

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…[ 24 25 26 27 ] Topical tacrolimus is a safe corticosteroid-sparing agent and with possible benefit in preventing recurrences. [ 27 28 ] In our series, the SEIs following MKC were identical to the ones seen in adenoviral corneal infection. In absence of a detailed analysis, our current observed clinical differentiation includes large size (1–1.5 mm), coin or ring shape, significant localized stromal edema, and peripheral location.…”

Section: Discussionsupporting

confidence: 73%

Sequelae of microsporidial keratoconjunctivitis and its management

Mohanty

Mitra

Mallick

et al. 2021

Indian Journal of Ophthalmology

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Purpose: To characterize the sequelae of microsporidia keratoconjunctivitis (MKC) and outline its management. Methods: Retrospective analysis of microbiologically proven MKC returned with persistent disease between January 2015 and December 2019 was done. Demographics, clinical features, management, and outcome were analyzed. Results: Sixteen patients (21 eyes) of 332 treated for MKC returned with the persisting disease. The mean age of 11 males (68.7%), and 5 females was 35.1 ± 12.2 years. Three-quarter of them did not have a known predisposing risk factor and one-quarter of them were referred for chronic conjunctivitis. Past medications included topical antivirals ( n = 8) and topical corticosteroid ( n = 6). Three predominant presentations were persistent (>3 weeks) superficial punctate keratitis (SPKs, n = 7), sub-epithelial infiltrates (SEIs, n = 13), and uveitis ( n = 2). The lesions recurred in eight eyes (SPK and SEI 4 each) after a disease-free interval of 60.4 ± 40.6 days; there were 13 episodes of recurrence. Topical low potent corticosteroids (loteprednol/fluorometholone), and tacrolimus ointment 0.03% were used in 17 (80.9%) and 8 (38%) eyes, respectively, for a mean duration of 44.8 ± 31.6 and 226.8 ± 180.5 days, respectively. At follow-up, 172.3 ± 183.6 days, visual recovery was statistically significant in persistent eyes (BCVA 0.07 ± 0.07 logMAR; P < 0.00001) but, not in recurrent eyes (BCVA 0.16 ± 0.08 logMAR; P = 0.07). Five of 21 eyes were left with residual significant scar. Conclusion: The sequelae of microsporidial keratoconjunctivitis are not uncommon. Topical 0.03% tacrolimus ointment appeared to be an effective corticosteroid-sparing agent for the treatment of SEIs and prevention of recurrence.

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Section: Discussionsupporting

confidence: 73%

Sequelae of microsporidial keratoconjunctivitis and its management

Mohanty

Mitra

Mallick

et al. 2021

Indian Journal of Ophthalmology

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“…[64][65][66][67][68][69] Additionally, corticosteroid treatment of SEIs can result in a 17.5% recurrence rate and consequential, unsuccessful drug tapering. 70 If discontinued abruptly, these viral antigens continue to attract lymphocytes, causing persistence of SEIs. 62,66 Excimer laser ablation can be helpful in such cases.…”

Section: Antiviral Therapymentioning

confidence: 99%

“…This cytokine is integral in the maintenance, differentiation, and survival of CD4 + T cells and CD8 + T cells. 70,[84][85][86] Topical tacrolimus 0.03% has ophthalmic uses, mainly in the treatment of giant papillary conjunctivitis and vernal keratoconjunctivitis. With regards to its effect on HAdV keratoconjunctivitis, tacrolimus was more effective than dexamethasone in the reduction of SEIs, and subsequently in the improvement of vision and symptomology.…”

Section: Immunotherapy and Cardiotonic Steroidsmentioning

confidence: 99%

“…Adverse effects were observed in 17.8% of patients using tacrolimus, manifesting as burning, redness, and foreign body sensation. 70 Generally, for SEIs that are resistant to tapering of corticosteroid, tacrolimus 0.03% was proven to be an effective corticosteroid-sparing agent. 87 Another promising treatment for HAdV is adoptive T cell therapy.…”

Section: Immunotherapy and Cardiotonic Steroidsmentioning

confidence: 99%

See 1 more Smart Citation

<p>Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions</p>

Labib¹,

Minhas²,

Chigbu³

2020

OPTH

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Human adenovirus (HAdV) is the most common cause of infectious conjunctivitis, accounting for up to 75% of all conjunctivitis cases and affecting people of all ages and demographics. In addition to ocular complications, it can cause systemic infections in the form of gastroenteritis, respiratory disease, and dissemination in immunocompromised individuals. HAdV causes lytic infection of the mucoepithelial cells of the conjunctiva and cornea, as well as latent infection of lymphoid and adenoid cells. Epidemic keratoconjunctivitis (EKC) is the most severe ocular manifestation of HAdV infection, in which the presence of subepithelial infiltrates (SEIs) in the cornea is a hallmark feature of corneal involvement. SEIs have the tendency to recur and may lead to long-term visual disability. HAdV persistence and dissemination are linked to sporadic outbreaks of adenoviral keratoconjunctivitis. There is no FDA-approved antiviral for treating adenoviral keratoconjunctivitis, and as such, solutions should be proffered to handle the challenges associated with viral persistence and dissemination. Several treatment modalities have been investigated, both systemically and locally, to not only mitigate symptoms but reduce the course of the infection and prevent the risk of long-term complications. These options include systemic and topical antivirals, in-office povidone-iodine irrigation (PVI), immunoglobulin-based therapy, antiinflammatory therapy, and immunotherapy. More recently, combination PVI/dexamethasone ophthalmic formulations have shown favorable outcomes and were well tolerated in clinical trials for the treatment of EKC. Possible, future treatment considerations include sialic acid analogs, cold atmospheric plasma, N-chlorotaurine, and benzalkonium chloride. Continued investigation and evaluation of treatment are warranted to reduce the economic burden and potential long-term visual debilitation in affected patients. This review will focus on how persistence and dissemination of HAdV pose a significant challenge to the management of adenoviral keratoconjunctivitis. Furthermore, current and future trends in prophylactic and therapeutic modalities for adenoviral keratoconjunctivitis will be discussed.

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“…Furthermore, steroid dependency is a frequent finding in these patients, who make them prone to steroid-induced complications including cataract, glaucoma especially in children aged less than 10 years, and infectious diseases. These complications may contribute to severe visual impairment in these young individuals (11,12). Therefore, finding the ways including high potency steroid sparing medications, which subside their chronic inflammation and decrease their dependency to steroids might potentially reduce their visual impairment and drug-induced complications (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Topical Tacrolimus 0.05% Suspension in Steroid-Resistant and Steroid-Dependent Vernal Keratoconjunctivitis

Akbari¹

2021

PJMHS

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Objective: The purpose of this study was to investigate the safety and effectiveness of topical tacrolimus 0.05% suspension in the management of prolonged steroid-dependent and -resistant vernal keratoconjunctivitis (VKC). Materials and methods: The present interventional prospective case series were conducted on the research units suffering from refractory VKC between 2017, April and 2020, December. Despite routine drug treatment, consisting of topical steroids (steroid-resistant group), all subjects exhibited active symptomatic illness or were dependent on topical steroids (steroid-dependent group). After discontinuation of all medications for at least 1 week, the patients received eye drop (topical tacrolimus 0.05%) minimally for six months. Objective and subjective signs and symptoms were examined for alterations after one week, and one and six months of treatment. Analyses were continued for probable systemic and ocular adverse effects. Results: The study included 28 eyes of 14 participants (including 4 females and 10 males), with the mean age of 22 ± 8 years (between 11 and 38 years), and the mean VKC duration of 12 ± 6 years (between 5 and 23 years), as well as follow up period of 10±2 months (between 6 and 12 months). The results showed an improvement (P<0.001) in the symptoms such as mucus discharge, foreign body sensation, photosensitivity, redness, burning and itching. The initial sign was conjunctival hyperemia, which improved one week after treatment. Other objective signs including, conjunctival and limbal papillary hypertrophy, corneal pannus and corneal punctate epithelial erosions improved at least one month after treatment. No changes were observed in corneal opacity during follow-up (p> 0.05). There were no systemic or ocular adverse effects. Conclusion: This is the first time that tacrolimus suspension drops 0.05%, are used in these cases. Topical tacrolimus 0.05% was shown to be an effectiveness and safe agent to treat the refractory VKC. This drug is recommended to be prescribed prior to the appearance of side effects such as corneal opacity, irreversible deficiency in limbal stem cell, and steroid side effects. Keywords: Vernal keratoconjunctivitis, Tacrolimus eye drop, Refractory

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Comparison of the safety and efficacy of topical Tacrolimus (0.03%) versus dexamethasone (0.05%) for subepithelial infiltrates after adenoviral conjunctivitis

Cited by 14 publications

References 21 publications

Sequelae of microsporidial keratoconjunctivitis and its management

Sequelae of microsporidial keratoconjunctivitis and its management

<p>Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions</p>

Efficacy of Topical Tacrolimus 0.05% Suspension in Steroid-Resistant and Steroid-Dependent Vernal Keratoconjunctivitis

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