Therapeutic effects of topical 0.03% Tacrolimus ointment in children with refractory vernal keratoconjunctivitis in Middle East

Abstract

Objective The purpose of this paper is to review the efficacy and safety profile in children treated with topical 0.03% Tacrolimus ointment for vernal keratoconjunctivitis in Middle East and to propose a treatment posology. According to recent studies, a complex non-IgE dependent mechanism plays a relevant role in the pathogenesis of vernal keratoconjunctivitis. Numerous cells and mediators have been found in the serum, conjunctiva and tears of patients with Vernal keratoconjunctivitis. Design This case series included 10 patients from a single centre, pediatric department of a tertiary hospital with active symptomatic vernal keratoconjunctivitis. All the patients had proliferative lesions and corneal involvement despite conventional medications, including topical steroids. All other medications, systemic and topical: steroids, antihistamines and cyclosporine, were unsuccessful. Patients were treated with topical 0.03% Tacrolimus ointment twice daily for 8 weeks and then once a day for the next two month followed by thrice a week for two months. The changes in symptoms and signs after treatment were evaluated, also the development of possible complications was assessed. Results The results showed a significant reduction in signs and symptoms after 4 weeks of the treatment. Clinical resolution of giant papillae and corneal lesions were seen within eight weeks and no additional drug was required during that period, except tear substitutes. Treatment was continued for period of two months and then slowly reduced. Conclusion The use of 0.03% Tacrolimus ointment is safe and effective in children refractory to conventional treatment of vernal keratoconjunctivitis even in high temperature climate as Middle East. Due to the effectiveness of the treatment, the dosage used may be proposed for conventional use.

Is Interferon α-2b 1 MillionIU/mL Truly Better Than Tacrolimus 0.03% for Steroid-Resistant VKC ?: Our 2-Year Experience at a Tertiary Health-Care Centre

“… 16 , 17 In 2019, Fiorentini et al showed that tacrolimus eye ointment 0.03% can be used as a safe and effective agent for the treatment of refractory VKC in children. 18 IFN α-2b is a cytokine with anti-proliferative, anti-inflammatory and immunomodulator effects, which inhibits arachidonic acid metabolism, stabilises mast cells and inhibits IgE-mediated release of histamine. The role of IFN α-2b has been established in allergic asthma, atopic dermatitis and in conjunctival neoplasias.…”

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

“…TAC is a non-steroidal immune-modulator capable of blocking the calcineurin, thereby suppressing the synthesis of different cytokines through active T cells. TAC ointment is extensively effective to treat atopic dermatitis (21). The topical TAC in doses of 0.02-0.1% are reportedly useful to treat multiple refractory inflammatory diseases of the eye surface, such as VKC and atopic keratoconjunctivitis (AKC) (28).…”

“…These two medications belong to calcineurin inhibitors capable of deactivating the T cells and relevant produced cytokines contributing to develop the VKC. The inhibitory activity of cyclosporin on the T cells is approximately 100 times less than that of TAC, thus the preparation of ophthalmic TAC can be stronger against the severe form of VKC (21)(22)(23)(24)(25). The present research aimed to investigate the safety and effectiveness of TAC suspension 0.05% on treatment of long standing refractory VKC patients.…”

Biochemical and molecular alterations and potential clinical applications of biomarkers in keratoconus

“…Apart from the routinely used mast cell inhibitor eye drops such as olopatadine or cromolyn sodium, resistant cases of ocular allergy have been shown to benefit from short-term topical steroids and long-term topical cyclosporine 0.5% or tacrolimus 0.03%, as these are involved in blocking the IgE-mediated cellular (T-cell) activation. [ 74 95 96 ] Controlling IgE levels are also considered important in the management of KC. For patients with high IgE, Ahuja et al .…”