Cyclosporine a 0.05% eye drops for the treatment of subepithelial infiltrates after epidemic keratoconjunctivitis

Abstract

BackgroundTo evaluate the treatment with topical 0.05% cyclosporine A (CsA) in patients with subepithelial corneal infiltrates (SEI).MethodsWe reviewed 16 patients (22 eyes) before and after the treatment with 0.05% CsA eye drops. All patients had been treated previously with topical corticosteroids without any improvement and also they had to stop the medication secondary to intraocular pressure elevation. The objective data recorded included best-corrected visual acuity (BCVA), evaluation of corneal subepithelial infiltrate scores (CSIS), intraocular pressure (IOP) prior to treatment and the last follow-up visit.ResultsSix males (37.5%) and 10 females (62.5%), mean age of 35.2 ± 16.6 years, were included. The patients’ average topical CsA use duration was 5.1 ± 3.5 months (1 – 13 months). The average follow up time of the patients was 9.2 ± 4.7 months (4 – 22 months). One patient, although he didn’t have a 0 scale of SCIS, did not show up for follow up examinations after six months. The mean BCVA (logarithm of the minimum angle of resolution) before and after the treatment were 0.15 ± 0.15 and 0.07 ± 0.07 respectively, CSIS 1.68 ± 0.89 and 0.23 ± 0.53 respectively, IOP 18.50 ± 3.82 and 16.86 ± 2.76 mmHg respectively. There were statistically significant improvements in BCVA (p = 0.002), reduction of CSIS (p = 0.002) and reduction of IOP (p < 0.001) prior to treatment and the last follow-up visit. 18 eyes (81.9%) showed clinical improvement and 4 (18.1%) had decreased SEI which did not fully disappear during the treatment period. The eyes which reached CSIS score 0 (18 eyes) were treated with CsA for 1 – 13 months; while the eyes which had clinical improvement but had not CSIS score 0 (4 eyes) were decided to discontinue of CsA treatment in last follow-up visit. There were recurrences in 2 eyes 3 months after the treatment. Patients reported reduction in the severity of symptoms after the treatment. Most of the patients reported no foreign body sensation, glare, or other side effects with topical CsA treatment. Overall, patients noted an improvement in vision and satisfaction with topical 0.05% CsA treatment.ConclusionsTopical 0.05% CsA is a safe and effective alternative treatment in patients with SEI who do not respond to other treatment modalities or have undesired side effects from topical steroids.

Evaluation of Clinical and Demographic Characteristics of Cases with Adenoviral Conjunctivitis

“…3 Topikal steroid ya da siklosporin A tedavisinin etkili olduğunu gösteren çalış-malar bulunmaktadır. 3,[19][20][21][22] Tedaviye yanıtsız, görme azalmasına neden olan durumlarda "excimer laser" tercih edilebilmektedir. 23,24 Bir çalışmada, adenoviral vakalarda %13-33,3 oranında kornea tutulumunun izlendiği bildirilmiştir.…”

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

“…2,63 While chronic corticosteroid treatment has been proven to reduce these findings, a significant challenge to this mode of treatment is the risk of complications of long-term use, including glaucoma and cataract formation. [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.…”

“…Topical cyclosporine (both 1% and 2% concentrations) is an alternative option which, if used in the acute phase of adenoviral keratoconjunctivitis, is successful in both reducing the risk of developing corneal findings as well as the chronic treatment of persistent SEIs, with most cases resolving over a course of 3-4 weeks. 64,66,69,78 Okumus et al studied the efficacy of 0.05% cyclosporine (Restasis ® , Allergan, Irvine, California, USA) once per day or once every other day, in treatment of SEIs secondary to adenoviral epidemic keratoconjunctivitis in cases persisting for more than three months. Patients in this study had also initially been treated with topical corticosteroids for several months with no regression, or who had to discontinue due to subsequent, elevated IOP.…”

Comparison of clinical outcome with different treatment regimens in acute adenoviral keratoconjunctivitis

“…9 It has also been used in varying concentrations between 0.5 and 2% for eradicating the symptoms and minimising the recurrences of corneal subepithelial infiltrates in acute adenoviral keratoconjunctivitis. [10][11][12][13] Virustatic agents such as trifluridine, vidarabine, ganciclovir, and cidofovir have been found to be only mildly effective or entirely ineffective against adenoviral diseases, whether in vitro, in vivo, or in human clinical trials. [14][15][16] Povidone-iodine is a non-causally-directed treatment option for AAK with a virucidal effect on adenoviruses.…”