Therapeutic efficacy of tacrolimus in vernal keratoconjunctivitis: a meta-analysis of randomised controlled trials

Zhao, Min; He, Fazhong; Yang, Yang; Lin, Weijie; Qiu, Wentao; Meng, Qian; Zhang, Jianping; Zhou, Zhi‐Ling

doi:10.1136/ejhpharm-2020-002447

Cited by 15 publications

(10 citation statements)

References 25 publications

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“…Nevertheless, they should not be considered as the first line agents due to adverse effects such as steroid-induced glaucoma and cataract (6). Topical tacrolimus has been shown to markedly improve VKC and may reduce or replace topical steroid use (6,8,11,(14)(15)(16). Early medical treatment with topical tacrolimus can also prevent the development of serious ocular complications of VKC, such as shield ulcers or limbal stem cell deficiency (17).…”

Section: Discussionmentioning

confidence: 99%

Combination of 0.05% Azelastine and 0.1% Tacrolimus Eye Drops in Children With Vernal Keratoconjunctivitis: A Prospective Study

Chen

Wei

et al. 2021

Front. Med.

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Aims: To compare the efficacy of the combination of 0. 05% azelastine and 0.1% tacrolimus eye drops with 0.1% tacrolimus monotherapy in pediatric patients with vernal keratoconjunctivitis (VKC).Methods: Prospective study. Seventy-six patients with VKC were randomized 1:1 into monotherapy group with 0.1% tacrolimus or combination therapy group with 0.1% tacrolimus and 0.05% azelastine. The Ocular Surface Disease Index (OSDI) scores and the signs of conjunctival hyperemia, corneal involvement, and palpebral conjunctiva papillae were assessed at baseline and at 1, 2, and 6 weeks after treatment.Results: Two groups were comparable in age, sex, duration of VKC, OSDI, and clinical signs of VKC at baseline. Significant improvements in OSDI score and clinical signs were observed in both groups at all follow-up visits (all p < 0.001), compared with baseline. The combination therapy group showed a larger decrease in OSDI score from baseline (10.30 ± 0.9) compared with monotherapy group (7.30 ± 0.7, p =0.0085) at 1 week. Greater improvements in conjunctival hyperemia and conjunctival papillae were identified in the combination therapy group, compared with in the monotherapy group, at all follow-up visits (all p < 0.05). The corneal involvement scores in the combination group is significantly lower than the monotherapy group at 2 weeks after the treatment (p = 0.0488). No severe adverse effect was found in either group during the study.Conclusions: Compared with a monotherapy of 0.1% tacrolimus, the combination of 0.05% azelastine and 0.1% tacrolimus eye drops lead to faster and greater improvements in clinical signs and symptoms of vernal keratoconjunctivitis in pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Combination of 0.05% Azelastine and 0.1% Tacrolimus Eye Drops in Children With Vernal Keratoconjunctivitis: A Prospective Study

Chen

Wei

et al. 2021

Front. Med.

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“…Case series and small RCTs of various concentrations demonstrate good efficacy and safety, but a commercial product is currently only available in Japan. 1,6…”

Section: Where Is the E Viden Ce Supp Orting The Us E Of Topi C Al C Alcineurin Inhib Itor S In Akc/ Vkc ?mentioning

confidence: 99%

“…Case series and small RCTs of various concentrations demonstrate good efficacy and safety, but a commercial product is currently only available in Japan. 1,6 cases with sight-threatening corneal complications to control inflammation, similar to the approach used in acute asthma flareups. 7 Montelukast is effective in seasonal allergic conjunctivitis, but RCT evidence in AKC/VKC is lacking although anecdotally it can be helpful.…”

Section: Where Is the E Viden Ce Supp Orting The Us E Of Topi C Al C Alcineurin Inhib Itor S In Akc/ Vkc ?mentioning

confidence: 99%

“…In countries where CSA eye drops are not available, tacrolimus ointment is widely used off‐licence in the treatment of severe allergic eye disease, with application to the inner aspect of the lower eyelid. Case series and small RCTs of various concentrations demonstrate good efficacy and safety, but a commercial product is currently only available in Japan 1,6 …”

Section: Where Is the Evidence Supporting The Use Of Topical Calcineurin Inhibitors In Akc/vkc?mentioning

confidence: 99%

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Severe allergic eye disease: What to do and when?

Dahlmann‐Noor

Muthusamy

Hingorani

2021

Clin Experimental Allergy

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“…Unfortunately, the long-term use of topical corticosteroids is frequently complicated by cataract and glaucoma. Therefore, patients need topical immunosuppressant therapy like cyclosporine A or tacrolimus eye drops (11) to reduce ocular in ammation and prevent long-term ocular damage (12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Impact of Screen Exposure on Pediatric Vernal Keratoconjunctivitis: a Survey During the COVID-19 Pandemic in Italy

Masini

Brindisi

Giovannini

et al. 2021

Preprint

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Background SARS-CoV-2 outbreak pushed the Italian government to start a strict lockdown, replacing school attendance with long-distance learning. This caused reduced exposure to sunlight but increased exposure to screens. Vernal keratoconjunctivitis (VKC) is a chronic inflammatory ocular condition in which exposure to light plays a cardinal role. We conducted an online survey to evaluate the impact of screen exposure in children with VKC during the lockdown. Methods We performed a survey-based observational study, asking patients followed at the Allergology of Meyer Children’s University Hospital in Florence and of Policlinico Umberto I in Rome to provide grading on 6 subjective ocular clinical manifestations presented during the lockdown and to give an estimate of the hours/day of screen exposure. Results Mean scores of signs and symptoms increased homogeneously when studying patients exposed to longer screen time. When comparing scores collected in 2019 versus 2020, there was not a significant reduction in clinical manifestations, although the situation differed between the two centres due to geographical differences in sunlight exposure. Conclusion During the lockdown, there was a reduction of sunlight exposure but conversely an increase in the time spent in front of screens that correlated with the worsening of VKC signs symptoms in direct proportion to the hours/day of screen exposure. Our results also showed a statistically significant difference in the relative impact of long-distance learning on VKC clinical manifestations in the different Italian regions.

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Therapeutic efficacy of tacrolimus in vernal keratoconjunctivitis: a meta-analysis of randomised controlled trials

Cited by 15 publications

References 25 publications

Combination of 0.05% Azelastine and 0.1% Tacrolimus Eye Drops in Children With Vernal Keratoconjunctivitis: A Prospective Study

Combination of 0.05% Azelastine and 0.1% Tacrolimus Eye Drops in Children With Vernal Keratoconjunctivitis: A Prospective Study

Severe allergic eye disease: What to do and when?

Impact of Screen Exposure on Pediatric Vernal Keratoconjunctivitis: a Survey During the COVID-19 Pandemic in Italy

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