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Gagrani M, Conner EA, Scanga H, Hiasat JG, Tripi KS, Pihlblad MS, Jhanji V, Nischal KK. Thygeson's superficial punctate keratitis in children. Eye (Lond) 2023; 37:3455-3460. [PMID: 37085721 PMCID: PMC10630495 DOI: 10.1038/s41433-023-02533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/07/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE To describe the first paediatric case series of Thygesons' superficial punctate keratitis (TSPK) with management outcomes. METHODS A retrospective chart review was done for all children either diagnosed at initial presentation or referred with TSPK from 01/2012 to 08/2021 at a tertiary children's hospital. Records were assessed for signs, symptoms, diagnosis, steroid and cyclosporine 0.05% use. The main outcome measures were visual acuity, treatment response and total steroid exposure. RESULTS Fifteen children (7 females), mean age at presentation 8 ± 4 years were included. All had bilateral disease and a BCVA of >20/40 in the better eye. All patients received topical fluorometholone 0.1%, (FML) initially. 80% had a good response to FML. Corneal scraping was done to exclude infectious causes in four cases due to poor initial response or clinical suspicion. All 4 needed EUA for scraping and anterior segment OCT, after which 2 had molecularly confirmed TGFBI-related stromal dystrophy. For the rest, slow steroid taper was done every 4-6 weeks and recurrences were treated by increasing steroid frequency. Cyclosporine 0.05% was started in nine patients (69%), 8 ± 6 months after initial presentation. The decrease in total steroid exposure per week after starting cyclosporine was statistically significant (p < 0.05). CONCLUSION Children with TSPK respond quickly to steroids, however, recurrences are common, necessitating a slow taper. Non-response to steroid needs careful reconsideration of the diagnosis and may necessitate the use of an EUA. Using cyclosporine 0.05% reduces the total steroid exposure in TSPK.
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Affiliation(s)
- Meghal Gagrani
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth A Conner
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hannah Scanga
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamila G Hiasat
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly Schooping Tripi
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Matthew S Pihlblad
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vishal Jhanji
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Thygeson’s superficial punctate keratitis. Graefes Arch Clin Exp Ophthalmol 2022; 260:1837-1841. [DOI: 10.1007/s00417-022-05617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/04/2022] Open
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Bernales A, Berger O, Hamada S. Topical tacrolimus for the treatment of external eye inflammation in children. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2039628] [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: 10/19/2022]
Affiliation(s)
| | - Osvaldo Berger
- Corneoplastic department. Queen Victoria Hospital. East Grinstead. United Kingdom
| | - Samer Hamada
- Corneoplastic department. Queen Victoria Hospital. East Grinstead. United Kingdom
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Priyadarshini SR, Roy A, Das S. Thygeson's superficial punctate keratopathy: A review and case series. Indian J Ophthalmol 2021; 69:806-811. [PMID: 33727439 PMCID: PMC8012948 DOI: 10.4103/ijo.ijo_1624_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thygeson's superficial punctate keratitis (TSPK) is a chronic disorder with episodes of exacerbations and remissions which span over years to decades. Typical features of the disease include multiple, grayish white, intraepithelial corneal lesions with minimal or no conjunctival involvement. The exact etiopathogenesis of this entity is unknown. However, it may have a genetic association with HLA-DR3, an antigen proved to be associated with immunogenic responses. Treatment of the disease consists of artificial tears, topical corticosteroids, topical cyclosporine, topical tacrolimus, or usage of soft contact lenses. TSPK should be considered as a diagnosis of exclusion in cases of bilateral superficial punctate keratopathy of long duration. Thirteen patients of TSPK were examined during the last 6 years (2014-2019) at our Institute. Visual acuity was 20/20 to 20/30 in majority cases. All patients required lubricants.
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Affiliation(s)
| | - Aravind Roy
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sujata Das
- Cornea & Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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Abstract
PURPOSE To evaluate the efficacy of topical tacrolimus 0.02% eye drops in the treatment of patients with Thygeson superficial punctate keratitis. METHODS Ten consecutive patients with Thygeson superficial punctate keratitis were included retrospectively. Seven patients were unresponsive to topical steroids and/or lubricants. Diagnosis was made based on the history and clinical findings. All patients were treated with topical tacrolimus 0.02% solution twice daily. Outcome measures included improvement in symptoms of tearing and photophobia, whereas improvement in signs included decrease in the number of the lesions, resolution of the lesions, flattening of the lesions, and decrease in stain of the lesions. RESULTS There were 3 male and 7 female patients with an age range of 3 to 51 years (mean 17 years). All patients had bilateral ocular involvement. Duration of treatment ranged from 1 to 42 weeks (mean 10 weeks). All patients had subjective improvement in symptoms of tearing and photophobia and resolution of the superficial punctate keratitis. The response to treatment was noted 72 hours after initiation of therapy in all patients. Topical tacrolimus was well tolerated in all patients. CONCLUSIONS Topical tacrolimus 0.02% is safe and effective in reducing ocular surface inflammation in patients with Thygeson superficial punctate keratitis who are not responsive to conventional therapy. Tacrolimus is helpful as a steroid-sparing agent to avoid vision-threatening complications.
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Saad R, Saad S, Haigh O, Molinari D, Labetoulle M, Rousseau A. Using pre-existing social networks to determine the burden of disease and real-life needs in rare diseases: the example of Thygeson's superficial punctate keratitis. Orphanet J Rare Dis 2021; 16:55. [PMID: 33516254 PMCID: PMC7847580 DOI: 10.1186/s13023-021-01707-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Thygeson’s superficial punctate keratitis (TSPK) is a rare and still poorly understood disease of the ocular surface, responsible for recurrent episodes of photophobia and eye pain. While TSPK is considered as a benign condition, a subset of patients has frequent recurrences or even chronic disease, two situations in which there are currently no therapeutic guidelines. We used a preexisting Facebook TSPK patient support group to assess the clinical journey and the burden of disease of TSPK. Results An online survey was sent to the patient support group. The first part of the questionnaire gathered information on demographics and the patient’s clinical journey [diagnostic modalities, symptoms, duration and frequency of recurrent episodes (RE), efficacy and tolerance to treatments]. The second part focused on quality of life (QoL) using the Ocular Surface Disease-QoL (OSD-QoL) questionnaire. Seventy-two patients out of 595 members of the support group completed the questionnaire during the 3-months study period. Eighty percent of patients developed symptoms before 30 years old, and 47% reported a delay in the diagnosis above 1 year. Sixty percent of patients reported over 5 RE yearly, and 18% of RE lasted more than 3 months. Forty percent of all patients used cyclosporine eyedrops (50% of those with > 5 episodes/year) and it was perceived as effective by 72% of these patients. The impact on daily life activities was judged as severe by 22% of patients, while 38% reported reduced professional activity and 80% were deeply saddened by their eye condition. Conclusion TSPK patients may present with frequent recurrences and/or chronic disease, that result in a severe impact on QoL, and an off-label use of topical immunomodulatory eye drops, suggesting the urgent need for controlled studies. The utility of using social networks for rare ophthalmic disease research includes, faster data collection, data from patients across the globe, and also raises relevant questions about their real needs.
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Affiliation(s)
- Rana Saad
- Service d'Ophtalmologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, Centre de Référence Maladies Rares en Ophtalmologie (OPHTARA), 78, rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Sami Saad
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Oscar Haigh
- CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses, Le Kremlin-Bicêtre, France
| | - Domitille Molinari
- Unité de Recherche Clinique Paris-Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Marc Labetoulle
- Service d'Ophtalmologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, Centre de Référence Maladies Rares en Ophtalmologie (OPHTARA), 78, rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.,CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses, Le Kremlin-Bicêtre, France
| | - Antoine Rousseau
- Service d'Ophtalmologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, Centre de Référence Maladies Rares en Ophtalmologie (OPHTARA), 78, rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. .,CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses, Le Kremlin-Bicêtre, France.
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Tang XJ, Liu Q, Pi LH, Chen XK, Chen L. Thygeson's superficial punctate keratitis (TSPK): a paediatric case report and review of the literature. BMC Ophthalmol 2021; 21:64. [PMID: 33514353 PMCID: PMC7845125 DOI: 10.1186/s12886-020-01790-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Thygeson's superficial punctate keratitis (TSPK) is reportedly a rare disease with an insidious onset, numerous remissions and exacerbations, and a long duration. The corneal lesions are elevated, whitish-grey in colour, and granular in the intraepithelium. A few reported cases of TSPK exist, and paediatric experience is limited. Due to the unknown aetiology and controversial treatment strategies for TSPK, we performed a literature review to summarize the criteria for the diagnosis, treatment and prognosis of TSPK to provide a basis for the treatment of TSPK in paediatric patients. CASE PRESENTATION The clinical course of a boy with TSPK who repeatedly presented with episodes of tearing, photophobia and foreign body sensation in both eyes is described. Irritation was uncontrollable with antiviral and antibiotic medications, and it was managed by corticosteroids. No recurrence was reported at the 1-year follow-up after corticosteroid replacement and tapering. CONCLUSIONS The clinical features, treatment and prognosis between adult and paediatric TSPK patients have many similarities. The diagnosis of TSPK in children is more difficult, leading to missed diagnosis. TSPK needs to be carefully differentiated from other types of keratitis, especially intraepithelial secondary and other infectious ocular surface diseases.
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Affiliation(s)
- Xiao-Jiao Tang
- Department of Ophthalmology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136, Zhongshan 2nd RD, Yuzhong District, 400014, Chongqing, China
| | - Qing Liu
- Department of Ophthalmology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136, Zhongshan 2nd RD, Yuzhong District, 400014, Chongqing, China
| | - Lian-Hong Pi
- Department of Ophthalmology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136, Zhongshan 2nd RD, Yuzhong District, 400014, Chongqing, China
| | - Xin-Ke Chen
- Department of Ophthalmology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136, Zhongshan 2nd RD, Yuzhong District, 400014, Chongqing, China
| | - Lin Chen
- Department of Ophthalmology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136, Zhongshan 2nd RD, Yuzhong District, 400014, Chongqing, China.
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