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Atopic Keratoconjunctivitis: Diagnosis and Treatment. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00299-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Jang HM, Kim H, Park SY, An EJ, Sung CY, Jeong DH, Lee G. Dissolvable Microneedle Patch Increases the Therapeutic Effect of Jawoongo on DNCB-Induced Atopic Dermatitis in Mice. Complement Med Res 2022; 30:1-10. [PMID: 35728517 DOI: 10.1159/000525451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 06/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Jawoongo (JW) is a topical herbal ointment that has been used as an alternative treatment option for atopic dermatitis. Topical ointments are known to have less bioavailability because the stratum corneum allows only lipophilic and low molecular weight drugs to pass across it. This study aimed to investigate whether applying microneedle patches (MNP) increases the therapeutic effect of 2,4-dinitrochlorobenzene (DNCB)+JW for atopic dermatitis by enhancing transdermal delivery. METHODS Atopic dermatitis was induced by DNCB in BALB/c mice. The combination treatment of JW and MNP was estimated to study the effect of MNP in improving transdermal delivery. Histological analysis, quantitative real-time PCR (qPCR), and immunofluorescence were performed to verify the effect of MNP in enhancing the therapeutic effects of DNCB+JW on atopic dermatitis in mice. RESULTS Both combination treatment and DNCB+JW treatment ameliorated histological alterations and reduced skin thickness and infiltration of CD4+ T cells in atopic dermatitis-like skin lesions in DNCB-exposed BALB/c mice. However, the improvement of histological alterations was better in the combination treatment, which was almost normal. Furthermore, the combination treatment exhibited a larger decrease in mRNA levels of IL-4, IL-6, IL-13, iNOS, and TNF-α, compared to DNCB+JW only. In addition, skin thickness and infiltration of CD4+ T cells in the sensitized skin were significantly lower using the combination treatment than using DNCB+JW only. CONCLUSION Combination treatment with JW and MNP further decreased skin thickness and several inflammatory cytokines in atopic dermatitis like skin lesions compared to treatment using JW alone. These findings suggest that applying a dissolvable MNP after JW application could be useful for treating atopic dermatitis.
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Affiliation(s)
- Hye Min Jang
- College of Korean Medicine, Dongshin University, Naju-si, Republic of Korea,
| | - Haejoong Kim
- College of Korean Medicine, Dongshin University, Naju-si, Republic of Korea
| | - Soo-Yeon Park
- Department of Ophthalmology, Otolaryngology & Dermatology, College of Korean Medicine, Dongshin University, Naju-si, Republic of Korea
| | - Eun Jin An
- Raphas Co., Ltd., Seoul, Republic of Korea
| | | | | | - Gihyun Lee
- College of Korean Medicine, Dongshin University, Naju-si, Republic of Korea
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Arnon R, Rozen-Knisbacher I, Yahalomi T, Stanescu N, Niazov Y, Goldberg D, Sharabi-Nov A, Mostovoy D. When to start tacrolimus ointment for vernal keratoconjunctivitis? A proposed treatment protocol. Int Ophthalmol 2022; 42:1771-1780. [PMID: 34981294 DOI: 10.1007/s10792-021-02174-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to compare treatment regimens of tacrolimus and of topical steroids for VKC and suggest a treatment protocol according to our clinical experience. METHODS This retrospective, nonrandomized case series enrolled 85 patients with VKC. Patients were classified clinically according to severity (mild, moderate, severe) and were treated according to a suggested protocol. Analysis was made according to treatment received: tacrolimus ointment as first line treatment (tacrolimus 1st line), tacrolimus ointment after topical steroid drops treatment (tacrolimus 2nd line) and topical steroid drops or artificial tears alone (topical steroid and tears group). RESULTS Significant improvements in clinical signs and symptoms were achieved under tacrolimus treatment 14 months in the moderate group and 5 months in the severe group. The longest duration of treatment was for tacrolimus 2nd line group (p = 0.031) and the mean number of visits in the clinic was the highest. The mean number of topical treatments per day was higher in the topical steroid and tears group (2.6 times) than in the two tacrolimus groups (1.3 times for both). The mean time needed to achieve disease remission or relief did not differ between the tacrolimus 1st line and 2nd line groups. CONCLUSION Tacrolimus treatment is effective and safe for VKC. Tacrolimus as 1st line treatment may be preferred for severe cases, for faster disease remission compared to tacrolimus as 2nd line treatment; and with fewer topical treatments per day compared to topical steroids.
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Affiliation(s)
- Roee Arnon
- Assuta-Samson Medical Center, Ophthalmology Department, University/Hospital: Ben-Gurion University, Harefuah 7 Street, 7747629, Ashdod, Israel.
| | - Irit Rozen-Knisbacher
- Assuta-Samson Medical Center, Ophthalmology Department, University/Hospital: Ben-Gurion University, Harefuah 7 Street, 7747629, Ashdod, Israel.,School of Medicine, Ben Gurion University, Beer-Sheva, Israel
| | - Tal Yahalomi
- Assuta-Samson Medical Center, Ophthalmology Department, University/Hospital: Ben-Gurion University, Harefuah 7 Street, 7747629, Ashdod, Israel
| | - Nir Stanescu
- Assuta-Samson Medical Center, Ophthalmology Department, University/Hospital: Ben-Gurion University, Harefuah 7 Street, 7747629, Ashdod, Israel
| | - Yulia Niazov
- Assuta-Samson Medical Center, Ophthalmology Department, University/Hospital: Ben-Gurion University, Harefuah 7 Street, 7747629, Ashdod, Israel
| | - Dina Goldberg
- Assuta-Samson Medical Center, Ophthalmology Department, University/Hospital: Ben-Gurion University, Harefuah 7 Street, 7747629, Ashdod, Israel
| | | | - Dina Mostovoy
- Assuta-Samson Medical Center, Ophthalmology Department, University/Hospital: Ben-Gurion University, Harefuah 7 Street, 7747629, Ashdod, Israel.,School of Medicine, Ben Gurion University, Beer-Sheva, Israel
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Yazu H, Miyazaki D, Fujishima H. Experience With 0.1% Tacrolimus Eye Drop for Noninfectious, Non-necrotizing Anterior Scleritis. Eye Contact Lens 2021; 47:185-190. [PMID: 32404650 DOI: 10.1097/icl.0000000000000696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To report experience with 0.1% tacrolimus eye drops in the treatment of noninfectious, non-necrotizing anterior scleritis. METHODS This prospective, single-arm study included nine patients (4 men and 5 women; mean age=59.4 years, SD=10.5) with anterior scleritis. All patients were first treated with steroids for 1 month and then switched to tacrolimus eye drops alone. We defined baseline as the initiation of tacrolimus eye drops. Hyperemia and pain were scored before each treatment, at 1 and 2 weeks, and at 1 month after initiation of each treatment using 5 grades (0=none; 1+=mild; 2+=moderate; 3+=severe; 4+=extremely severe). Intraocular pressure (IOP) was also measured during treatment with each drug. Safety was assessed based on the severity and the incidence of adverse events. RESULTS The scores of hyperemia and pain had significantly decreased from baseline by 1 week after initiating tacrolimus eye drops (both P<0.05). No significant reduction was observed with steroid treatment throughout the 1-month period in both scores. Tacrolimus eye drops elicited statistically significant differences in mean IOP over the course of treatment (P=0.02). No additional medications were required to provide relief in any of the patients receiving tacrolimus treatment. No patient demonstrated infectious adverse events after initiation of tacrolimus treatment. CONCLUSIONS Topical tacrolimus may effectively and immediately reduce clinical signs and symptoms of noninfectious, non-necrotizing anterior scleritis in cases unresponsive to a course of topical steroid.
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Affiliation(s)
- Hiroyuki Yazu
- Department of Ophthalmology (H.Y., H.F.), Tsurumi University School of Dental Medicine, Kanagawa, Japan ; Department of Ophthalmology (H.Y.), Keio University School of Medicine, Tokyo, Japan ; and Ophthalmology and Visual Science (D.M.), Faculty of Medicine Tottori University, Tottori, Japan
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Yazu H, Fukagawa K, Shimizu E, Sato Y, Fujishima H. Long-term outcomes of 0.1% tacrolimus eye drops in eyes with severe allergic conjunctival diseases. Allergy Asthma Clin Immunol 2021; 17:11. [PMID: 33522964 PMCID: PMC7852099 DOI: 10.1186/s13223-021-00513-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/10/2021] [Indexed: 01/20/2023] Open
Abstract
Background Because atopic dermatitis does not heal completely, associated severe atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) often require long-term treatment. This study aims to evaluate the long-term outcomes of using 0.1% tacrolimus eye drops to treat these severe allergic conjunctival diseases. Methods Two-hundred-and-seventy eyes of 135 patients diagnosed with AKC or VKC from April 2004 to April 2014 were screened retrospectively. Patient demographics and objective signs were extracted from the electronic medical records. The severity of 10 objective signs, related to the palpebral and bulbar conjunctiva, limbus, and cornea, and intraocular pressure (IOP) were observed at baseline, at 2 weeks, 1, 2, 3, 6, and 12 months after starting treatment, and every 1 year thereafter (average use period: 8.4 ± 2.9 years). Safety was evaluated based on the incidence and severity of adverse events. Results 12 patients (AKC; 7 cases, VKC; 5 cases) who were treated with 0.1% tacrolimus eye drops were enrolled in this study. The total score of clinical signs significantly decreased after 2 weeks and remained effective thereafter. Tacrolimus eye drops elicited a statistically significant difference in the mean total clinical scores and IOP over the course of treatment (P < 0.001). Elevated IOP was observed in 2 cases and corneal infection in 1 case; these effects were completely controlled with medication. Conclusions Topical tacrolimus may provide effective and long-term improvement in clinical signs of severe AKC and VKC cases that refractory to standard conventional treatment. Trial registration: University Hospital Medical Information Network (UMIN) 000034460.
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Affiliation(s)
- Hiroyuki Yazu
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi Tsurumi-ku, Yokohama-shi, Kanagawa, 230-8501, Japan. .,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Kazumi Fukagawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,Ryogoku Eye Clinic, Tokyo, Japan
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Biostatistics At Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Fujishima
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi Tsurumi-ku, Yokohama-shi, Kanagawa, 230-8501, Japan.,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Zhao M, He F, Yang Y, Lin W, Qiu W, Meng Q, Zhang J, Zhou Z. Therapeutic efficacy of tacrolimus in vernal keratoconjunctivitis: a meta-analysis of randomised controlled trials. Eur J Hosp Pharm 2020; 29:129-133. [PMID: 33144336 PMCID: PMC9047954 DOI: 10.1136/ejhpharm-2020-002447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background and objective Tacrolimus has been widely used in recent years for treating allergic conjunctivitis, but there is currently no available meta-analysis 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.
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Affiliation(s)
- Min Zhao
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China.,College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Fazhong He
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Yang Yang
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Weijie Lin
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Wentao Qiu
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China.,College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Qian Meng
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
| | - Jianping Zhang
- College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Zhiling Zhou
- Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai 519000, China
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Feizi S, Javadi MA, Alemzadeh-Ansari M, Arabi A, Shahraki T, Kheirkhah A. Management of corneal complications in vernal keratoconjunctivitis: A review. Ocul Surf 2020; 19:282-289. [PMID: 33148465 DOI: 10.1016/j.jtos.2020.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/25/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022]
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, allergic conjunctivitis with episodes of acute exacerbations. Although VKC has a self-limiting course, chronic recurrent inflammation can cause long-term visual impairment due to corneal complications including shield ulcers, infectious keratitis, keratoconus, corneal opacities, and limbal stem cell deficiency. The initial step in the management of corneal involvement is medical treatment of the acute stage of VKC and prevention of recurrences. Giant papillae not responding to medical treatment can be removed surgically in the case of corneal involvement. Shield ulcer with no inflammatory plaque usually heals with appropriate medical therapy. For shield ulcer with inflammatory plaque, however, surgical debridement with or without amniotic membrane transplantation might be necessary. Keratoconus may develop in chronic and severe VKC. An annual evaluation of these patients with corneal topography and/or tomography is essential for early detection of keratoconus and its timely management that includes collagen cross-linking and intrastromal corneal ring segment implantation. Corneal transplantation may be required in the advanced stage of keratoconus. Both penetrating keratoplasty and deep anterior lamellar keratoplasty can result in excellent visual outcomes in keratoconic eyes with concomitant VKC. Appropriate management of inflammation in the perioperative period is crucial for achieving successful outcomes after corneal transplantation. Limbal stem cell deficiency, a rare complication of long-standing and severe VKC, might be treated with living-related conjunctival limbal allograft.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amir Arabi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toktam Shahraki
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA.
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Hossain IT, Sanghi P, Manzouri B. Pharmacotherapeutic management of atopic keratoconjunctivitis. Expert Opin Pharmacother 2020; 21:1761-1769. [PMID: 32602382 DOI: 10.1080/14656566.2020.1786534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Atopic keratoconjunctivitis (AKC) is a form of allergic eye disease that can have sight threating implications. Prevalence is underestimated due to scarce published data and treatment is expanding as a result of limitations of current strategies. This article aims to provide an up-to-date overview of AKC and summarize current and upcoming management. AREAS COVERED The authors provide history, immunopathogenesis, and summary of the clinical manifestations of AKC as well as presenting a review of the evidence in relation to treatment options including mast cell stabilizers, antihistamines, corticosteroids, and immunomodulatory drugs based on clinical trials. Future trends, drug targets, and novel delivery drug systems are also highlighted in this review. EXPERT OPINION Previously established treatment strategies of AKC had relied on corticosteroids, but the side effects of long-term therapy resulted in the expansion into the use of immunomodulatory drugs such as tacrolimus and ciclosporin. However, these too provide limited success due to the suboptimal structural properties of the current molecules. The ideal molecule should generate maximum permeability across the multi-layered structure of the cornea, be able to be formulated into eye drops for ease of application with minimal dosing and for maximal clinical effect.
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Affiliation(s)
- Ibtesham T Hossain
- Department of Ophthalmology, Queens Hospital, Barking Havering and Redbridge University Hospitals NHS Trust , Romford, UK
| | - Priyanka Sanghi
- Department of Ophthalmology, Queens Hospital, Barking Havering and Redbridge University Hospitals NHS Trust , Romford, UK
| | - Bita Manzouri
- Department of Ophthalmology, Queens Hospital, Barking Havering and Redbridge University Hospitals NHS Trust , Romford, UK
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Role of combined immunomodulator therapy in severe steroid intolerant vernal keratoconjunctivitis. Eye (Lond) 2020; 35:979-987. [PMID: 32518397 DOI: 10.1038/s41433-020-1013-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe the role of combined topical cyclosporine (CsA) 0.1% and tacrolimus 0.03% in cases with severe steroid intolerant vernal keratoconjunctivitis (VKC). METHODS Medical records of patients with acute exacerbation of VKC and steroid intolerance referred from glaucoma to cornea clinic were reviewed from March 2017 to December 2018. Eleven patients (22 eyes), (nine with steroid-induced glaucoma, two with steroid-induced cataract and glaucoma) were found. All were started on topical CsA 0.1% QID. Due to suboptimal response at 2 weeks, topical tacrolimus 0.03% BD was also included. RESULTS The mean total subjective score at presentation was 13 ± 1.4, which reduced to 11.2 ± 1.3 at 2 weeks of topical CsA therapy and further reduced to 5 ± 0 at 2 weeks of combination therapy (p < 0.001). The mean total objective score at presentation was 9.4 ± 1.4 that reduced to 8.0 ± 1.3 at 2 weeks of topical CsA therapy and further reduced to 4.3 ± 1.6 at 2 weeks of combination therapy (p < 0.001). Similar results were obtained in a sub-group analysis including the worse eye or right eye of the cases only. The absolute change in the total subjective and objective score was much more with combination therapy. Photophobia and conjunctival hyperemia resolved within 4 weeks of combined therapy. No recurrence was observed till 6 months follow-up. CONCLUSIONS Combined use of cyclosporine and tacrolimus may lead to rapid resolution of symptoms and reduced recurrence rate in cases with severe VKC where steroid has to be avoided.
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Beck KM, Seitzman GD, Yang EJ, Sanchez IM, Liao W. Ocular Co-Morbidities of Atopic Dermatitis. Part II: Ocular Disease Secondary to Treatments. Am J Clin Dermatol 2019; 20:807-815. [PMID: 31352589 DOI: 10.1007/s40257-019-00465-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Treatments used for managing atopic dermatitis (AD) may have adverse ocular effects that permanently affect vision. The objective of this review is to raise awareness among dermatologists regarding the potential ocular adverse effects of various AD therapies, including corticosteroids, calcineurin inhibitors, an interleukin-4 receptor α (IL-4Rα) antagonist, and phototherapy. Pertinent potential short- and long-term risks of these therapies include elevations in intraocular pressure from use of topical corticosteroids and conjunctivitis from use of dupilumab. Since some of these adverse effects may not exhibit symptomatology until permanent vision impairment occurs, it is important for dermatologists to understand these risks and proactively ensure their patients are receiving appropriate measures to prevent them.
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Affiliation(s)
- Kristen M Beck
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA.
| | - Gerami D Seitzman
- Department of Ophthalmology, Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Eric J Yang
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Isabelle M Sanchez
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
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Nahum Y, Mimouni M, Livny E, Bahar I, Hodak E, Leshem YA. Dupilumab-induced ocular surface disease (DIOSD) in patients with atopic dermatitis: clinical presentation, risk factors for development and outcomes of treatment with tacrolimus ointment. Br J Ophthalmol 2019; 104:776-779. [DOI: 10.1136/bjophthalmol-2019-315010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 11/04/2022]
Abstract
AimTo identify risk factors for the development of dupilumab-induced ocular surface disease (DIOSD) in adult patients with atopic dermatitis (AD) and describe outcomes of treatment.MethodsA retrospective institutional cohort study performed at the Rabin Medical Center, Petach Tikva, Israel. Adult patients with AD who received dupilumab from March 2018 to June 2019 were included. Demographics, AD severity scores, blood IgE levels, previous atopic keratoconjunctivitis (AKC), dermatological response to dupilumab, ophthalmological evaluation and treatment were noted. Univariate and multivariate analyses were used to identify risk factors for DIOSD.ResultsSixteen of 37 patients who were included in the study (43%) had new or exacerbated symptoms of ocular surface disease starting at 2 weeks following the first treatment. Three patients reported transient dry eye sensation which lasted 2 weeks; nine patients reported chronic dry eye sensation, and four patients (25%) had marked blepharoconjunctivitis. The presence of severe AD was the strongest predictor of DIOSD. Not a single patient with moderate AD had DIOSD. In multivariate analysis, prior AKC was a risk factor for DIOSD (R2=15.78, OR=23.28, p=0.005) while a family history of atopy was protective of DIOSD (R2=6.22, OR=0.13, p=0.05). All four patients with blepharoconjunctivitis had resolution of signs, and symptoms within days of starting periocular 0.03%–0.1% tacrolimus ointment.ConclusionsDIOSD is common in patients with AD receiving dupilumab. While most cases are mild, some patients can develop blepharoconjunctivitis which responds well to tacrolimus ointment. AD severity, and previous AKC are risk factors for DIOSD.
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Leonardi A, Silva D, Perez Formigo D, Bozkurt B, Sharma V, Allegri P, Rondon C, Calder V, Ryan D, Kowalski ML, Delgado L, Doan S, Fauquert JL. Management of ocular allergy. Allergy 2019; 74:1611-1630. [PMID: 30887530 DOI: 10.1111/all.13786] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 12/13/2022]
Abstract
The treatment and management of ocular allergy (OA) remain a major concern for different specialties, including allergists, ophthalmologists, primary care physicians, rhinologists, pediatricians, dermatologists, clinical immunologists, and pharmacists. We performed a systematic review of all relevant publications in MEDLINE, Scopus, and Web Science including systematic reviews and meta-analysis. Publications were considered relevant if they addressed treatments, or management strategies of OA. A further wider systematic literature search was performed if no evidence or good quality evidence was found. There are effective drugs for the treatment of OA; however, there is a lack an optimal treatment for the perennial and severe forms. Topical antihistamines, mast cell stabilizers, or double-action drugs are the first choice of treatment. All of them are effective in reducing signs and symptoms of OA. The safety and optimal dosing regimen of the most effective topical anti-inflammatory drugs, corticosteroids, are still a major concern. Topical calcineurin inhibitors may be used in steroid-dependent/resistant cases of severe allergic keratoconjunctivitis. Allergen-specific immunotherapy may be considered in cases of failure of first-line treatments or to modify the natural course of OA disease. Based on the current wealth of publications and on the collective experience, recommendations on management of OA have been proposed.
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Affiliation(s)
- Andrea Leonardi
- Ophthalmology Unit, Department of Neuroscience University of Padua Padua Italy
| | - Diana Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, Serviço de Imunoalergologia, Centro Hospitalar São João University of Porto, EPE – Porto Porto Portugal
| | - Daniel Perez Formigo
- Department of Ophthalmology Hospital Universitario de Torrejon Madrid Spain
- Faculty of Medicine University of Francisco de Vitoria (UFV) Pozuelo de Alarcon, Madrid Spain
| | - Banu Bozkurt
- Department of Ophthalmology, Faculty of Medicine Selcuk University Konya Turkey
| | - Vibha Sharma
- Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital Manchester University NHS Foundation Trust Manchester UK
| | - Pia Allegri
- Allergic Conjunctivitis Unit, Ocular Inflammatory Diseases Referral Center, Rapallo Hospital Ophthalmology DepartmentGenova Italy
| | - Carmen Rondon
- Allergy Unit, Regional University Hospital of Malaga, IBIMA UMA Malaga Spain
| | - Virginia Calder
- Department of Ocular Biology & Therapeutics UCL Institute of Ophthalmology London UK
| | - Dermot Ryan
- Allergy and Respiratory Research Group, Medical School, Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK
| | - Marek L. Kowalski
- Department of Immunology, Rheumatology, and Allergy Medical University of Lodz Lodz Poland
| | - Luis Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, Serviço de Imunoalergologia, Centro Hospitalar São João University of Porto, EPE – Porto Porto Portugal
| | - Serge Doan
- Service d’Ophtalmologie Hôpital Bichat and Fondation A. de Rothschild Paris France
| | - Jean L. Fauquert
- CHU Estaing Unité d’Allergologie de l’Enfant Clermont‐Ferrand Cedex1 France
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Benaim D, Tétart F, Bauvin O, Delcampe A, Joly P, Muraine M, Gueudry J. Tacrolimus pommade dans la prise en charge de la kératoconjonctivite atopique. J Fr Ophtalmol 2019; 42:435-440. [DOI: 10.1016/j.jfo.2018.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 10/27/2022]
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15
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Singhal D, Sahay P, Maharana PK, Raj N, Sharma N, Titiyal JS. Vernal Keratoconjunctivitis. Surv Ophthalmol 2019; 64:289-311. [DOI: 10.1016/j.survophthal.2018.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
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16
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Benaim D, Tétart F, Bauvin O, Delcampe A, Joly P, Muraine M, Gueudry J. Tacrolimus ointment in the management of atopic keratoconjunctivitis. J Fr Ophtalmol 2019; 42:e147-e151. [DOI: 10.1016/j.jfo.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/28/2022]
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17
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Management of advanced ocular surface disease in patients with severe atopic keratoconjunctivitis. Ocul Surf 2019; 17:303-309. [DOI: 10.1016/j.jtos.2018.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/08/2018] [Accepted: 12/03/2018] [Indexed: 12/15/2022]
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18
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Liu FY, Liu HY, Chu HS, Chen WL, Hu FR, Wang IJ. Dermatologic tacrolimus ointment on the eyelids for steroid-refractory vernal keratoconjunctivitis. Graefes Arch Clin Exp Ophthalmol 2019; 257:967-974. [DOI: 10.1007/s00417-019-04287-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/24/2019] [Accepted: 03/03/2019] [Indexed: 11/30/2022] Open
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Yazu H, Shimizu E, Aketa N, Dogru M, Okada N, Fukagawa K, Fujishima H. The efficacy of 0.1% tacrolimus ophthalmic suspension in the treatment of severe atopic keratoconjunctivitis. Ann Allergy Asthma Immunol 2019; 122:387-392.e1. [PMID: 30639466 DOI: 10.1016/j.anai.2019.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Severe atopic keratoconjunctivitis (AKC) is a relatively rare disease, and some cases are refractory to conventional steroid treatment. OBJECTIVE To examine the efficacy of 0.1% tacrolimus ophthalmic suspension in treating severe AKC during a 1-year follow-up. METHODS This was a single-center, retrospective clinical study. Sixty eyes from 30 patients with severe AKC who were treated with 0.1% tacrolimus ophthalmic suspension 4 times per day, were included. The mean age of the patients was 21.5 ± 13.7 years. The severity of objective signs was observed at baseline (before treatment), at 2 weeks, and at 1, 2, 3, 6, and 12 months after treatment initiation. Ten objective signs of palpebral conjunctiva, bulbar conjunctiva, limbus, and cornea were assessed using 4 grades (0 = normal; 1+ = mild; 2+ = moderate; 3+ = severe). Safety was assessed based on the incidence and the severity of adverse events. RESULTS The total score of the 10 clinical signs significantly decreased from baseline 2 weeks after initiating tacrolimus eye drop treatment, except at 2 months. The mean total score of clinical signs was 13.6 ± 6.6 at the beginning of treatment, and decreased to 5.4 ± 4.8 12 months after initiation. Treatment was gradually tapered, with increasing intervals between applications. Additional medications were required to provide relief in 18 patients during follow-up. No patient discontinued treatment due to adverse drug effects. Herpes keratitis was observed in 3 cases during follow-up. However, these cases were completely controlled. CONCLUSION The 0.1% tacrolimus ophthalmic suspension is effective for the treatment of severe AKC refractory to standard conventional treatments throughout a full year.
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Affiliation(s)
- Hiroyuki Yazu
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Naohiko Aketa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Murat Dogru
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Naoko Okada
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Department of Pharmaceutical Sciences, Nihon Pharmaceutical Hospital, Saitama, Japan
| | - Kazumi Fukagawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Ryogoku Eye Clinic, Tokyo, Japan
| | - Hiroshi Fujishima
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa, Japan
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Kandikattu HK, Mishra A. Immunomodulatory effects of tacrolimus (FK506) for the treatment of allergic diseases. INTERNATIONAL JOURNAL OF CELL BIOLOGY AND PHYSIOLOGY 2018; 1:5-13. [PMID: 31595270 PMCID: PMC6783126 DOI: 10.5281/zenodo.2530969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Tacrolimus has been used to prevent allograft rejection and also used in kidney, liver and heart transplantations. Various preclinical and clinical studies demonstrated that Tacrolimus possess immunomodulatory and anti-inflammatory properties. The mechanism of action of Tacrolimus in allergic diseases involves calcineurin inhibition, and downregulation of T-cell reactivity, IgE degranulation, and its actions on mast cells, dendritic cells, basophils, eosinophils and inhibition of transcription of proinflammatory cytokines. Herein we reviewed the Pharmacotherapeutic mechanism of action of Tacrolimus in the prevention of asthma, atopic dermatitis, and allergic conjunctivitis.
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Affiliation(s)
- Hemanth Kumar Kandikattu
- Department of Medicine, Section of Pulmonary Diseases, Tulane Eosinophilic DisordersCenter, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans L 70112
| | - Anil Mishra
- Department of Medicine, Section of Pulmonary Diseases, Tulane Eosinophilic DisordersCenter, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans L 70112
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21
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Li J, Luo X, Ke H, Liang L. Recalcitrant Atopic Keratoconjunctivitis in Children: A Case Report and Literature Review. Pediatrics 2018; 141:S470-S474. [PMID: 29610174 DOI: 10.1542/peds.2016-2069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 11/24/2022] Open
Abstract
Atopic keratoconjunctivitis (AKC) is the most severe type of allergic conjunctivitis and may eventually lead to blindness. Although AKC is reported to be more prevalent in adults, we report a child with AKC whose clinical characteristics were not inconsistent with those typically seen in adult patients with AKC, and who was refractory to traditional topical anti-inflammatory and immunosuppressant therapies. An 11-year-old boy presented with a 3-month history of ocular redness and itching and decreased vision for a week in both eyes. Slit-lamp examination revealed typical signs of vernal keratoconjunctivitis, including cobblestone papillae in both upper conjunctiva, superficial punctate keratopathy on the right cornea, and a sterile shield-shaped ulcer on the left cornea. Physical examination revealed eczematous lid changes and a generalized body rash, particularly on the face, neck, and flexor surfaces of the limbs. He was diagnosed to have AKC in both eyes and atopic dermatitis. The patient did not respond well to conventional topical antihistamine, mast cell stabilizers, corticosteroids, or tacrolimus, even in combination with amniotic membrane transplant. After using systemic immunosuppressants, the symptoms were relieved; the inflammation on the skin and ocular surface subsided, the cobblestone papillae disappeared, and the corneal ulcer healed gradually within 8 weeks. This case reveals that pediatric AKC should be differentiated from vernal keratoconjunctivitis because both disorders include upper cobblestone papillae, but the former is accompanied by atopic dermatitis. Pediatric AKC requires appropriate and aggressive treatment to prevent sight-threatening corneal complications. Systemic immunosuppressant should be considered when traditional topical anti-inflammatory therapies have failed.
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Affiliation(s)
- Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Ocular Surface Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Ocular Surface Center, Sun Yat-sen University, Guangzhou, China
| | - Hongmin Ke
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Ocular Surface Center, Sun Yat-sen University, Guangzhou, China
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Ocular Surface Center, Sun Yat-sen University, Guangzhou, China
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Topical Tacrolimus as Adjuvant Therapy to Corticosteroids in Acute Endothelial Graft Rejection After Penetrating Keratoplasty: A Randomized Controlled Trial. Cornea 2017; 37:307-312. [DOI: 10.1097/ico.0000000000001408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Liang L, Shi WY. The effects of FK506 combined with natamycin in the treatment of experimental fungal keratitis by suppressing NLRP3 inflammasome activation. EUR J INFLAMM 2017. [DOI: 10.1177/1721727x17740305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to investigate the mechanisms of combination treatment with FK506 and natamycin on alleviating damage of the cornea in mouse model of fungal keratitis. In this study, the mouse model of fungal keratitis was created by intrastromal injection with Fusarium solani or Aspergillus flavus. The mice received 5% natamycin eye drops 6–8 times a day, or the mice received 0.05% FK506 eye drops 2 times per day for 21 consecutive days. Corneal damage was evaluated by H&E staining. The protein expression levels of NLRP3 were detected by immunohistochemistry. Moreover, the markers of inflammasome activation including NLRP3, ASC, caspase-1, IL-1β, and IL-18 were detected by western blot. Histopathological results showed increased corneal thickening, dense inflammatory cell infiltration, and loss of epithelial continuity in the corneas after fungal infection. In addition, NLRP3 positive signals were observed to be obviously increased in the corneas after A. flavus or F. solani infection compared to the control group. Furthermore, the NLRP3 inflammasome is induced by fungal infection, as evidenced by increased protein expression levels of NLRP3, ASC, caspase-1, and downstream cytokines, such as interleukin (IL)-1β and IL-18. However, the corneal damage was alleviated and the activation of the NLRP3 inflammasome was significantly inhibited by drug treatment. Besides, the treatment outcomes were better in combined treatment group than that in single-agent treatment group. In conclusion, FK506 combined with natamycin alleviate fungi-induced corneal damage by suppressing NLRP3 inflammasome activation.
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Affiliation(s)
- Li Liang
- Shandong University, Jinan, China
- Department of Ophthalmology, Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, Anhui Province, China
| | - Wei-Yun Shi
- Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China
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Abstract
PURPOSE OF REVIEW The update reviews prevalence, classification, cause, and treatment options for allergic eye disease. RECENT FINDINGS The incidence of allergic eye disease is underreported but may affect almost all patients with allergic rhinitis. Increased rates of oculonasal symptoms have been reported in the United States resulting in significant economic expenditures. The spectrum of allergic conjunctivitis and its differential considerations include seasonal and perennial conjunctivitis, vernal and atopic keratoconjunctivitis, and giant papillary conjunctivitis. Patients with allergic conjunctivitis have classic immunoglobulin E-mediated pathophysiology and treatments directed at allergen avoidance, traditional pharmacotherapy with oral antihistamines, topical dual-acting antihistamine/mast cell stabilizer agents, and treatment of tear film dysfunction are first-line management strategies. Immunotherapy is an effective treatment option and refractory cases may require ophthalmology comanagement for consideration of topical ester-based corticosteroid therapy and consideration of topical immunomodulators. SUMMARY Ocular allergy involving specific modifiable and treatable environmental sensitizations is common and often underrecognized. It can impair quality of life to varying degrees. Some cases are quite refractory to management and may require multidisciplinary coordination of care between allergy and ophthalmology specialists. Understanding classification, triggers, and treatment options is important in designing the most appropriate patient-tailored management plans.
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Abstract
PURPOSE OF REVIEW Contact lens-induced papillary conjunctivitis (CLPC) is a common ocular allergic disease in contact lens wearers. In its more severe form, it can cause giant papillary conjunctivitis, resulting in contact lens intolerance and the need to discontinue the use of contact lenses. This review presents the pathogenesis, clinical manifestations and management guidelines of this common disorder. RECENT FINDINGS Different types of contact lenses are associated with differences in the severity of CLPC. Refitting patients with silicone hydrogel contact lenses or with daily disposable contact lenses may improve the signs and symptoms of CLPC. The recent introduction of the topical immunomodulatory agent tacrolimus in other severe allergic eye diseases may apply in suppressing the allergic inflammation in CLPC as well. SUMMARY CLPC is a common ocular disorder in contact lens wearers, with a significant impact on the quality of vision. It should be promptly recognized by healthcare practitioners and managed by modifications of the types and wearing schedules of contact lenses, as well as novel treatment options with topical immunomodulators.
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Palioura S, Kymionis G. Corneal neovascularization in childhood keratitis. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1379900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sotiria Palioura
- Athens Vision Eye Institute, Cornea Service, Athens, Greece
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - George Kymionis
- Jules Gonin Eye Hospital, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Ophthalmology, ‘Gennimatas Hospital’, National and Kapoditrian University of Athens, Athens, Greece
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Tacrolimus Eye Drops as Adjunct Therapy in Severe Corneal Endothelial Rejection Refractory to Corticosteroids. Cornea 2017; 36:1195-1199. [PMID: 28817391 DOI: 10.1097/ico.0000000000001298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of tacrolimus eye drops as adjunctive therapy in the treatment of severe corneal endothelial rejection after penetrating keratoplasty refractory to corticosteroids. METHODS In this prospective interventional case series, 11 eyes of 11 patients assessed for severe corneal endothelial rejection, with an inadequate response to topical, local, and systemic corticosteroids, were treated with either 0.01% or 0.05% tacrolimus eye drops 4 times daily. Improvement in signs of rejection, visual function, and development of complications were monitored. RESULTS The duration of steroid treatment before intervention was 8.1 ± 1.4 days (range = 7-11). Patients were subsequently administered topical tacrolimus 0.01% or 0.05% qid. The time to clinical improvement was 10.3 ± 3.4 days (range = 3-17). The time to rejection reversal was 27.8 ± 16.3 days (range = 7-52). After 3 months, 10 patients (90.8%) demonstrated clinical improvement, and complete restoration of graft clarity was achieved in 5 patients (45.4%). In responsive cases, steroid therapy was successfully tapered off after 60.2 ± 19.7 days (range = 36-93). The best spectacle-corrected visual acuity improved from 1.7 ± 0.9 to 0.8 ± 0.5 logMAR (P = 0.0016). Reported side effects included stinging on drop instillation and punctate epithelial keratopathy. CONCLUSIONS Tacrolimus eye drops may be able to play an adjunctive therapeutic role in patients with severe corneal endothelial rejection refractory to conventional steroid treatment. Controlled studies are needed to further investigate the role of tacrolimus in this setting.
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Abstract
Allergic conjunctivitis (AC), which may be acute or chronic, is associated with rhinitis in 30%-70% of affected individuals, hence the term allergic rhinoconjunctivitis (AR/C). Seasonal and perennial AC is generally milder than the more chronic and persistent atopic and vernal keratoconjunctivitis. Natural allergens like house dust mites (HDM), temperate and subtropical grass and tree pollen are important triggers that drive allergic inflammation in AC in the Asia-Pacific region. Climate change, environmental tobacco smoke, pollutants derived from fuel combustion, Asian dust storms originating from central/north Asia and phthalates may also exacerbate AR/C. The Allergies in Asia Pacific study and International Study of Asthma and Allergies in Childhood provide epidemiological data on regional differences in AR/C within the region. AC significantly impacts the quality of life of both children and adults, and these can be measured by validated quality of life questionnaires on AR/C. Management guidelines for AC involve a stepped approach depending on the severity of disease, similar to that for allergic rhinitis and asthma. Topical calcineurin inhibitors are effective in certain types of persistent AC, and sublingual immunotherapy is emerging as an effective treatment option in AR/C to grass pollen and HDM. Translational research predominantly from Japan and Korea involving animal models are important for the potential development of targeted pharmacotherapies for AC.
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Affiliation(s)
- Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Shoughy SS. Topical tacrolimus in anterior segment inflammatory disorders. EYE AND VISION 2017; 4:7. [PMID: 28286787 PMCID: PMC5343311 DOI: 10.1186/s40662-017-0072-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/01/2017] [Indexed: 11/26/2022]
Abstract
Immune mediated inflammatory anterior segment diseases are variable and their management requires intense immunosuppression. Treatment with topical steroids is associated with serious ocular side effects. In order to overcome the potentially blinding complications of topical steroids, immunomodulatory drugs are being used more frequently. Tacrolimus is a calcineurin inhibitor that induces suppression of T lymphocytes activity and reduction of ocular inflammation. Tacrolimus was recently investigated for application in various anterior segment inflammatory disorders. In this review, we will discuss the therapeutic application of topical tacrolimus as a steroid-sparing agent in treating T cell mediated anterior segment inflammation.
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Affiliation(s)
- Samir S Shoughy
- The Eye Center and the Eye Foundation for Research in Ophthalmology, PO Box 55307, Riyadh, 11534 Saudi Arabia
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30
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Al-Amri AM, Fiorentini SF, Albarry MA, Bamahfouz AY. Long-term use of 0.003% tacrolimus suspension for treatment of vernal keratoconjunctivitis. Oman J Ophthalmol 2017; 10:145-149. [PMID: 29118487 PMCID: PMC5657154 DOI: 10.4103/ojo.ojo_232_2014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE: To evaluate the safety and efficacy of 0.003% tacrolimus suspension for the treatment of refractory vernal keratoconjunctivitis (VKC). MATERIALS AND METHODS: This prospective study included 40 eyes of 20 patients with severe VKC. After discontinuing all other medications, patients were treated with varying doses of 0.003% tacrolimus suspension. All were followed for at least 24 months. Changes in signs and symptoms after treatment were evaluated; adverse events were assessed. The clinical response to the treatment was the most important measurement to achieve the conclusion. RESULTS: The mean age of the patients was 15.7 ± 1.4 years. Two patients discontinued treatment due to severe burning sensation and were excluded from the study. Significant improvements in all signs and symptoms, including itching, foreign body sensation, papillae, and Trantas dots, were seen in all patients 6 weeks after starting topical tacrolimus. Itching was the first symptom to improve. Treatment was gradually reduced, and intervals were increasing between applications. Recurrence occurred in all patients who attempted to discontinue treatment. No additional medications were required to provide relief, and no significant changes in visual acuity or refraction were seen. CONCLUSIONS: The safety and efficacy of 0.003% Tacrolimus suspension treatment for refractory VKC were achieved and it can be considered a useful option instead of steroids, despite the poor compliance in few patients due its adverse effects.
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Shoughy SS, Jaroudi MO, Tabbara KF. Efficacy and safety of low-dose topical tacrolimus in vernal keratoconjunctivitis. Clin Ophthalmol 2016; 10:643-7. [PMID: 27103784 PMCID: PMC4827889 DOI: 10.2147/opth.s99157] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to evaluate the efficacy and safety of topical low-dose tacrolimus (0.01%) solution in patients with vernal keratoconjunctivitis (VKC). Patients and methods A total of 62 consecutive patients with VKC refractory to conventional treatment were included retrospectively. Tacrolimus 0.01% ophthalmic solution was administered to patients twice daily after discontinuation of all previous topical medications. The duration of treatment ranged from 1 month to 29 months. The clinical symptoms of itching, redness, foreign body sensation, and discharge and the clinical signs of conjunctival hyperemia, conjunctival papillary hypertrophy, limbal infiltration, Trantas dots, and superficial punctate keratopathy were graded as 0 (normal), 1+ (mild), 2+ (moderate), or 3+ (severe). Assessment was carried out before initiation of therapy and on the last visit after treatment. Results There were 62 patients with VKC comprising 49 male and 13 female patients. The median age was 12 years (range: 5–47 years). The mean visual acuity improved from 20/30 to 20/25 following treatment. There was statistically significant improvement in symptoms of itching (P<0.001), redness (P<0.001), foreign body sensation (P<0.001), and discharge (P<0.001). Statistically significant improvement was also observed in clinical signs of conjunctival hyperemia (P<0.001), limbal infiltration (P<0.001), Trantas dots (P<0.001), superficial punctate keratopathy (P<0.001), and conjunctival papillary hypertrophy (P<0.001). The solution form of tacrolimus was well tolerated. None of the patients developed elevation of intraocular pressure, cataract, or infectious keratitis. Conclusion Low-dose topical tacrolimus 0.01% solution is effective and safe in the management of patients with refractory VKC.
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Affiliation(s)
- Samir S Shoughy
- The Eye Center and The Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud O Jaroudi
- The Eye Center and The Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Khalid F Tabbara
- The Eye Center and The Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia; Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Wilmer Ophthalmological Institute of the Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ackerman S, Smith LM, Gomes PJ. Ocular itch associated with allergic conjunctivitis: latest evidence and clinical management. Ther Adv Chronic Dis 2016; 7:52-67. [PMID: 26770669 DOI: 10.1177/2040622315612745] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Allergic conjunctivitis is one of the most common allergic conditions worldwide. Its incidence is increasing due to changing climate, pollution, increased pollen loads, and the subject's heightened immunological sensitivity in response to these environmental changes. The pathophysiology predominantly involves immunoglobulin E-related mast-cell activation, with release of histamine and other mediators contributing to the propagation of the response by calling in other immune cells and further inflammation. This article presents the evolution of ocular allergy treatments, from vasoconstrictors, to antihistamines and mast-cell stabilizers, to the dual-acting agents, as well as corticosteroid and immunomodulatory options. Future targets for allergy treatment are also discussed.
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Affiliation(s)
- Stacey Ackerman
- Philadelphia Eye Associates, 1113 Hospital Drive, Suite 302, Willingboro, NJ 08046, USA
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Pastor-Clerigues A, Serrano A, Milara J, Marti-Bonmati E, Lopez-Perez FJ, Garcia-Montanes S, Sanfeliu J, Saval-Victoria AC, Cortijo J. Evaluation of the Ocular Tolerance of Three Tacrolimus Topical Pharmaceutical Preparations by Bovine Corneal Opacity and Permeability Test. Curr Eye Res 2015; 41:890-6. [PMID: 26554729 DOI: 10.3109/02713683.2015.1082187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Tacrolimus ocular preparations are commonly employed in autoimmune or inflammatory ocular disorders. However, currently there are not yet approved ocular formulations. Tacrolimus ocular side effects have been reported in clinical use, so the evaluation of different pharmaceutical preparations is mandatory. In this study, the local corneal tolerance and safety profile of three common tacrolimus 0.03% pharmaceutical preparations were evaluated. MATERIAL AND METHODS Corneal irritation and permeability of tacrolimus preparations were evaluated with the bovine corneal opacity and permeability (BCOP) test. Complementary corneal hematoxylin/eosin and immunohistochemistry staining for tight junctions and adherent junctions E-cadherin, VE-cadherin and zonula occludens-1 were examined and scored to evaluate and to confirm corneal disruption and irritation scores obtained with the BCOP method. RESULTS Commercial brand ointment (Protopic®), topical compounded eye ointment (pharmacy elaboration) and tacrolimus suspension eye drops (elaborated from parenteral prograf®) were tested as potential ocular preparations to be used in clinics. Tacrolimus preparations hereby studied do not alter the opacity and permeability of the bovine cornea by more than three units, measured by the In Vitro Irritancy Score, neither affected the immunohistochemical parameters, composite score or transepithelial electrical resistance. CONCLUSIONS Tacrolimus preparations studied can be safely applied as a topical ocular treatment.
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Affiliation(s)
- Alfonso Pastor-Clerigues
- a Research Foundation of General Hospital of Valencia , Valencia , Spain.,b Hospital Pharmacy , University General Hospital Consortium , Valencia , Spain
| | - Adela Serrano
- a Research Foundation of General Hospital of Valencia , Valencia , Spain.,c CIBERES , Health Institute Carlos III , Valencia , Spain
| | - Javier Milara
- a Research Foundation of General Hospital of Valencia , Valencia , Spain.,b Hospital Pharmacy , University General Hospital Consortium , Valencia , Spain.,c CIBERES , Health Institute Carlos III , Valencia , Spain.,d Clinical Research Unit (UIC) , University General Hospital Consortium , Valencia , Spain
| | - Ezequiel Marti-Bonmati
- a Research Foundation of General Hospital of Valencia , Valencia , Spain.,b Hospital Pharmacy , University General Hospital Consortium , Valencia , Spain
| | | | | | - Joan Sanfeliu
- b Hospital Pharmacy , University General Hospital Consortium , Valencia , Spain
| | | | - Julio Cortijo
- a Research Foundation of General Hospital of Valencia , Valencia , Spain.,b Hospital Pharmacy , University General Hospital Consortium , Valencia , Spain.,c CIBERES , Health Institute Carlos III , Valencia , Spain.,d Clinical Research Unit (UIC) , University General Hospital Consortium , Valencia , Spain.,e Department of Pharmacology , Faculty of Medicine, University of Valencia , Valencia , Spain
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Eriş E, Yüksel N, Pirhan D, Karadenizli A, Aslan M, Gacar G, Erman G, Subaş C, Uzuner H, Yldz DK, Karaöz E. Evaluation of Effect of Topical Tacrolimus Treatment on Herpetic Stromal Keratitis in a Rat Model. Eye Contact Lens 2015; 42:163-70. [PMID: 25996419 DOI: 10.1097/icl.0000000000000162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the effectiveness of topical tacrolimus treatment on herpetic stromal keratitis (HSK) in a rat model. METHODS The development of HSK was monitored for 14 days after the inoculation of rats with herpes simplex type 1 virus. Rats that developed HSK were divided into four groups as follows: (1) topical antiviral treatment (control), (2) topical antiviral and 1% prednisolone acetate, (3) topical antiviral and 0.03% tacrolimus ointment, and (4) topical antiviral plus 0.1% tacrolimus ointment. After 14 days of treatment, the severity levels of HSK were scored and compared with the levels before the treatment. The expression of CD3, CD4, and CD8 was evaluated by flow cytometry. The development of the disease was evaluated clinically and histologically. RESULTS Significant improvement in vascularization was observed in the groups with the drug treatment in addition to the antiviral agent (P<0.05), but there was no obvious difference within groups 2, 3, and 4 in the vascularization severity. The regression of corneal edema was 8.05%±6% in group 1, 25.17%±14.55% in group 2 (P=0.01), 36.40%±21.69% in group 3 (P=0.03), and 46.39%±14.96% in group 4 (P=0.00). A significant decrease in the number of inflammatory cells in the groups with the drug treatment was evaluated by immunohistochemical staining and confirmed by flow cytometry analysis. CONCLUSIONS Topical tacrolimus treatment caused a significant decrease in corneal vascularization accompanied by a lower number of inflammatory cells in the experimental HSK corneal edema model. Therefore, topical tacrolimus has the potential to be used in the treatment of HSK.
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Affiliation(s)
- Erdem Eriş
- Departments of Ophthalmology (E.E., N.Y., D.P., M.A.), Medical Microbiology (A.K., H.U.), Stem Cell (G.G., G.E., C.S., E.K.), and Pathology (D.K.Y.), Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Abstract
PURPOSE OF REVIEW Allergic eye diseases comprise a spectrum of diseases, with each condition being characterized by a complex immunopathology. The more severe and chronic conditions, such as vernal keratoconjunctivitis and atopic keratoconjunctivitis, involve predominantly mast cells and eosinophils, while also being associated with a preponderance of T cells. Treatment with topical antihistamines or mast cell stabilizers is often unsatisfactory, and therapy depends on topical corticosteroids. Corticosteroids have significant side-effects with long-term use; therefore, they appear to be more appropriate for short-term pulse therapy. Immunomodulatory agents can also be used to inhibit T-cell activation and show encouraging results among patients with severe allergic eye conditions. The present review is an attempt to present a coherent picture of the recent investigations of topical immunomodulatory agents' therapy in severe allergic eye diseases, especially cyclosporine A and tacrolimus, and their mechanisms of action. RECENT FINDINGS Immunomodulatory agents are commonly indicated for the treatment of severe and prolonged allergic conjunctivitis. This article reviews the recent studies of these drugs and the development of immunomodulatory treatments for severe allergic eye diseases. SUMMARY Cyclosporine A and tacrolimus are currently available for the treatment of severe allergic conjunctivitis. These agents have led to improved therapeutic results for patients with severe and chronic allergic eye diseases.
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