Topical Tacrolimus 0.03% for Maintenance Therapy in Steroid-Dependent, Recurrent Phlyctenular Keratoconjunctivitis

Yoon, Chang Ho; Kim, Mee Kum; Oh, Joo Youn

doi:10.1097/ico.0000000000001440

Cited by 8 publications

(6 citation statements)

References 19 publications

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“…TAC is mainly used clinically for treating various chronic allergic conjunctivitis conditions, including VKC, AKC, and giant papillary conjunctivitis 19. Several studies have shown that TAC plays an important role in the treatment of chronic allergic conjunctivitis, based on TAC’s effect in substantially reducing the symptom score by approximately 50% 20–26. In addition, the safety of long-term TAC application in the treatment of allergic conjunctivitis has also been verified.…”

Section: Discussionmentioning

confidence: 99%

“…19 Several studies have shown that TAC plays an important role in the treatment of chronic allergic conjunctivitis, based on TAC's effect in substantially reducing the symptom score by approximately 50%. [20][21][22][23][24][25][26] In addition, the safety of long-term TAC application in the treatment of allergic conjunctivitis has also been verified. A study by Al-Amri et al, 27 using 0.1% topically applied TAC for treatment of AKC over 48 months, demonstrated the control and remission of the disease in the absence of other medications.…”

Section: Systematic Reviewmentioning

confidence: 92%

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

Zhao

Yang

et al. 2020

Eur J Hosp Pharm

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Background and objective Tacrolimus has been widely used in recent years for treating allergic conjunctivitis, but there is currently no available metaanalysis regarding its therapeutic efficacy. This study systematically evaluated the effectiveness of tacrolimus in the treatment of allergic conjunctivitis. Methods Data obtained from literature searches of the PubMed, Cochrane Library, Embase, CNKI, and Wanfang databases were retrieved by combining medical subject words and free words. Literature was selected on the basis of established inclusion and exclusion criteria, and the extracted data were evaluated for risk of bias using RevMan 5.3 for meta-analysis. Results A total of 177 articles were retrieved, of which 5 articles were eventually selected, all of which involved tacrolimus treatment for vernal keratoconjunctivitis. A total of 203 samples were analysed. Results of the meta-analysis showed that the tacrolimus treatment group had significantly lower ocular objective sign scores (SMD −1.39, 95% CI −2.50 to −0.27; p<0.05) and had a significantly lower subjective symptom evaluation score (SMD −0.92, 95% CI −1.59 to −0.24; p<0.05) than the control group. Conclusion Current evidence shows that tacrolimus is effective in treating vernal keratoconjunctivitis. RESEARCH METHODS This meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. 11

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Section: Discussionmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 92%

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

Zhao

Yang

et al. 2020

Eur J Hosp Pharm

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“…46 However, doxycycline and other tetracyclines should still not be used for PKC because a prolonged course of these agents is typically needed. Adjuvant steroid-sparing topical agents such as cyclosporine 17,22,42 or tacrolimus 43,47 may also be beneficial in some cases to control disease and reduce cumulative corticosteroid burden. The treatment of PKC principally should also address the underlying cause.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Phlyctenular Keratoconjunctivitis at a Tertiary Care Center in the United States

Kaufman

Chhadva

Bontu

et al. 2022

Cornea

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Purpose:The aim of this study was to evaluate characteristics and outcomes of pediatric phlyctenulosis at a tertiary care center in the United States.Methods:A retrospective cohort study of phlyctenulosis diagnosis in patients younger than 18 years was conducted. Demographics, presenting features, treatment regimens, and outcomes were analyzed.Results:Seventy patients (95 eyes) with phlyctenulosis were identified. Fifty-four patients (77.1%) were Hispanic, which was greater than the center's proportion of pediatric patients identifying as Hispanic (53.8%, P < 0.0001). Common comorbidities included adjacent external/lid disease (82.9%), allergic/atopic disease (18.6%), and viral infections (8.6%). Nine patients had tuberculosis testing which was negative in all cases. Five patients had vitamin A testing which revealed deficiency in 1 patient. Treatment regimens were diverse and included varying combinations of topical and systemic medications. Complications included corneal scarring (27.4%), corneal neovascularization (40.0%), amblyopia (16.8%), corneal perforation (3.2%), and severe limbal stem-cell deficiency (1.1%). 26.3% of affected eyes had final visual acuity worse than 20/40. Differences in rates of corneal complications between Hispanic and non-Hispanic patients were not statistically significant, although severe corneal complications including perforation occurred only in the Hispanic group.Conclusions:This study presents a modern cohort of phlyctenulosis at a tertiary center in the United States and includes a larger proportion of Hispanic patients than expected. Phlyctenulosis carries high corneal morbidity and may frequently result in reduced visual acuity. Similar rates of corneal complications were seen in Hispanic versus non-Hispanic patients, but severe corneal complications were seen only in the Hispanic group.

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“…6 BKC treatments include topical and/or systemic medications targeting the clearance of meibomian gland secretion, 4,6,7 correction of ocular surface dysbiosis, 1,5,15,16 and reduction of ocular surface inflammation. 1,5,6,[17][18][19][20][21][22][23] Despite treatment, BKC is recurrent and chronic in nature, rendering pediatric patients vulnerable to detrimental and permanent visual impairment. Thus, long-term observation and management are critical to ensure full visual development in pediatric patients with BKC.…”

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confidence: 99%

Clinical Characteristics and Therapeutic Outcomes of Pediatric Blepharokeratoconjunctivitis

Moon

Lee

Kim

et al. 2022

Cornea

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Purpose:The purpose of this study was to determine the clinical characteristics, disease course, therapeutic outcomes, and prognostic factors for pediatric patients with blepharokeratoconjunctivitis (BKC).Methods:A retrospective medical chart review was performed for patients aged 15 years or younger who had been diagnosed with BKC between 2004 and 2020 at 2 tertiary hospitals in Korea. The following data were collected: demographics, medical history, ocular findings, geometric profiling of corneal lesion, medical management, and outcomes.Results:A total of 137 patients (90 female and 47 male) were included. The patients’ mean age was 8.3 ± 3.8 years at disease onset. Both eyes were involved in 57.7% of cases. The most common corneal lesion was corneal neovascularization (77.4%), followed by clinically visible corneal infiltration (51.8%) and stromal scarring (43.1%). Most of the corneal lesions involved a single quadrant, most commonly the inferior quadrant. After treatment, disease remission was achieved in 95% of patients, and visual acuities improved from 0.2 ± 0.3 logarithm of minimal angle of resolution at disease presentation to 0.1 ± 0.3 logarithm of minimal angle of resolution at final follow-up (P = 0.001). Recurrence occurred in 52.6% of patients. Cylinder power was significantly higher in patients with recurrence than in those without. The number of cases of recurrence was positively associated with final cylinder power.Conclusions:Although the treatment induced disease remission in 95% of children with BKC, recurrence occurred in 52.6% of those cases. Because recurrence resulted in significant astigmatism, careful observation for recurrence and prompt management are warranted for preservation of vision in pediatric patients with BKC.

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Topical Tacrolimus 0.03% for Maintenance Therapy in Steroid-Dependent, Recurrent Phlyctenular Keratoconjunctivitis

Abstract: Topical tacrolimus 0.03% was effective in maintaining long-term remission in patients with recurrent, steroid-dependent PKC.

Cited by 8 publications

References 19 publications

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

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

Pediatric Phlyctenular Keratoconjunctivitis at a Tertiary Care Center in the United States

Clinical Characteristics and Therapeutic Outcomes of Pediatric Blepharokeratoconjunctivitis

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