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Ghiglioni DG, Bruschi G, Chiappini E, Consales A, Allegri P, Aragona P, Bonini S, Caputo R, Cardinale F, Landi M, Leonardi A, Marseglia GL, Mori F, Nebbioso M, Nucci P, Osnaghi S, Procoli U, Villani E, Zicari AM, Miraglia Del Giudice M. Seeing eye to eye: a modified Delphi method-based multidisciplinary expert consensus on the diagnosis and treatment of vernal keratoconjunctivitis. Eur J Pediatr 2024; 183:5053-5061. [PMID: 39325215 DOI: 10.1007/s00431-024-05776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 09/05/2024] [Accepted: 09/11/2024] [Indexed: 09/27/2024]
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, inflammatory disease that affects both eyes, often with asymmetric severity, potentially causing major visual complications. The seasonal management of VKC can be challenging, especially when specialists with different diagnostic and therapeutic approaches need to be consulted. The aim of this expert panel was to reach a national consensus among pediatric allergologists and ophthalmologists on the diagnosis and treatment of VKC. This consensus was developed by an expert panel of 17 Italian pediatric allergologists and ophthalmologists with over a decade of experience. Ten statements on VKC diagnosis and treatment formulated after a thorough review of current literature were evaluated by the panelists. The level of agreement was quantitatively assessed using a 5-point Likert scale. Consensus was reached if ≥ 75.0% of panelists agreed to any given statement. The consensus emphasizes the importance of evaluation by multispecialty reference centers or experienced specialists for accurate diagnosis. Prompt diagnosis, especially during active phases, is crucial and should occur before corticosteroid therapy. The Bonini score from 2007 is the preferred tool for VKC assessment, although future revisions may be considered. Short cycles of topical corticosteroids should be preferred over prolonged use, even during immunomodulatory therapy. When cyclosporine fails, tacrolimus should be considered. CONCLUSION This is the first consensus on the management of VKC that has gathered the expert opinions of both pediatricians and ophthalmologists. The outcome of this multidisciplinary effort provides a uniform approach to VKC diagnosis and treatment, thereby facilitating patient management across the country. WHAT IS KNOWN • Vernal keratoconjunctivitis (VKC) is a chronic recurrent ocular disease particularly prevalent in the pediatric population. • Despite its relevance, there is a lack of standardized approaches shared between pediatricians and ophthalmologists, leading to notable variations in clinical practice. WHAT IS NEW • This expert panel, comprising 17 pediatric allergologists and ophthalmologists, has reached a national consensus to provide standardized guidance for VKC management. • The consensus emphasizes the importance of a multidisciplinary approach to managing VKC, ensuring consistent and effective patient care.
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Affiliation(s)
- Daniele Giovanni Ghiglioni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Pediatria Pneumoinfettivologia, Milan, Italy
| | - Gaia Bruschi
- Department of Clinical Sciences and Community Health, Dipartimento Di Eccellenza 2023-2027, University of Milan, Milan, Italy
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, Florence, Italy
- Pediatric Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Alessandra Consales
- Department of Clinical Sciences and Community Health, Dipartimento Di Eccellenza 2023-2027, University of Milan, Milan, Italy.
| | - Pia Allegri
- Ocular Inflammatory Diseases Referral Center Head, Rapallo Hospital, Genova, Italy
| | - Pasquale Aragona
- Department of Biomedical Sciences, University of Messina, Messina, Italy
| | - Stefano Bonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Roberto Caputo
- Pediatric Ophthalmology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Fabio Cardinale
- Pediatric Department, Pediatric Hospital Giovanni XXIII, Azienda Ospedaliero-Universitaria Policlinic of Bari, Bari, Italy
| | - Massimo Landi
- Department of Medical Sciences-Graduate School of Allergology and Clinical Immunology, University of Turin, Turin, Italy
| | - Andrea Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Marcella Nebbioso
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Silvia Osnaghi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Pediatria Pneumoinfettivologia, Milan, Italy
| | - Ugo Procoli
- Ophthalmology Complex Operative Unit, Children's Hospital Giovanni XXIII Azienda Ospedaliero-Universitaria "Consorziale Policlinico", Bari, Italy
| | - Edoardo Villani
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Maria Zicari
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, Rome, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman and Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
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Koca DS, Dietrich-Ntoukas T. Frequency of Topical Immunomodulatory and Immunosuppressive Therapies for Ocular Chronic Graft-versus-Host Disease. J Clin Med 2024; 13:4728. [PMID: 39200870 PMCID: PMC11355837 DOI: 10.3390/jcm13164728] [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: 06/24/2024] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Introduction: The purpose of the study was to evaluate the frequency of topical immunomodulatory and immunosuppressive therapies in patients with ocular chronic graft-versus-host disease (cGVHD) in consideration of inflammatory activity and systemic immunosuppressive therapies in a tertiary care university hospital setting. Methods: We included 95 adult patients (48 male, 47 female) with ocular chronic graft-versus-host disease (cGVHD) after alloHSCT (median age 49.5 years). Clinical ophthalmological findings and the grade of ocular cGVHD according to the NIH eye score and the German-Austrian-Swiss Consensus (GAS) Grading were analyzed. Systemic GVHD manifestations as well as the prevalence of topical and systemic (immunomodulatory) therapies were assessed. Results: A total of 74 of 95 patients (77.8%) had manifestations of systemic chronic graft-versus-host disease other than ocular GVHD. 68.42% (65/95) of patients were under systemic immunosuppressive therapy with at least one immunosuppressive medication. All patients (95/95) received lid-margin hygiene and phosphate- and preservative-free lubricating eye drops. Twenty-five percent of the cohort (24/95) were treated with autologous serum eye drops (ASEDs). In total, 80% (76/95) of patients required topical steroid therapy to treat acute exacerbation of inflammation at least once; continuous topical steroid therapy was only necessary for a minor part (12%) with refractory chronic inflammation. A total of 92.63% (88/95) were primarily treated with ciclosporin A 0.1% as Ikervis®, of whom at least one third did not continue the therapy because of intolerable side effects during follow-up and received alternative topical formulations. Conclusions: Our data show that patients with ocular cGVHD mostly need topical therapy including anti-inflammatory agents despite systemic immunosuppressive therapy. In our cohort, 80% of patients received topical steroids, and more than 90% received topical ciclosporin A eye drops, which were tolerated by only two thirds of patients due to side effects.
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Affiliation(s)
| | - Tina Dietrich-Ntoukas
- Department of Ophthalmology, Charité—University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany;
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Agarwal S, Doan S, Srinivasan B, Iyer G, Leonardi A. Unraveling the complexity - Insights and interventions of refractory vernal keratoconjunctivitis. Ocul Surf 2024; 34:173-182. [PMID: 39103015 DOI: 10.1016/j.jtos.2024.07.009] [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: 03/17/2024] [Revised: 07/13/2024] [Accepted: 07/26/2024] [Indexed: 08/07/2024]
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic severe ocular allergic inflammation mostly observed in children and young adults. The ocular manifestations are the expression of multifactorial immune mechanisms that generally have a good prognosis, however long-term inflammation may remarkably reduce the visual function due to complications and poor therapeutic responses. Lack of responsiveness to a drug or treatment is relatively common in VKC and it is not only due to corneal involvement, which is considered the main sign of severity. The concept of refractory may be relative to multiple factors including the clinical condition, systemic co-morbidities, previous or concomitant drugs or regiments, compliance, patient's psychological condition or expectations, type of exposome and environmental conditions, doctor's experience and expectations, or timing of clinical evaluation. In this narrative review, the authors propose a definition of refractory VKC based on revised literature and clinical experience and consider potential new treatments for refractory patients and surgical management in case of complications.
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Affiliation(s)
- Shweta Agarwal
- CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, 600006, Tamil Nadu, India.
| | - Serge Doan
- Bichat Hospital and Foundation A. de Rothschild, Paris, France
| | - Bhaskar Srinivasan
- CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, 600006, Tamil Nadu, India
| | - Geetha Iyer
- CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, 600006, Tamil Nadu, India
| | - Andrea Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padova, Padova, Italy.
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Bisen AC, Srivastava S, Mishra A, Sanap SN, Biswas A, Choudhury AD, Dubey A, Gupta NM, Yadav KS, Mugale MN, Bhatta RS. Pharmaceutical Emulsions: A Viable Approach for Ocular Drug Delivery. J Ocul Pharmacol Ther 2024; 40:261-280. [PMID: 38654153 DOI: 10.1089/jop.2023.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Affiliation(s)
- Amol Chhatrapati Bisen
- Pharmaceutics and Pharmacokinetics Division, Lucknow, Uttar Pradesh, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Saurabh Srivastava
- Pharmaceutics and Pharmacokinetics Division, Lucknow, Uttar Pradesh, India
| | - Anjali Mishra
- Pharmaceutics and Pharmacokinetics Division, Lucknow, Uttar Pradesh, India
| | - Sachin Nashik Sanap
- Pharmaceutics and Pharmacokinetics Division, Lucknow, Uttar Pradesh, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Arpon Biswas
- Pharmaceutics and Pharmacokinetics Division, Lucknow, Uttar Pradesh, India
| | | | - Ayush Dubey
- Pharmaceutics and Pharmacokinetics Division, Lucknow, Uttar Pradesh, India
| | - Neeraj Mohan Gupta
- Department of Chemistry, Government P. G. College, Guna, Madhya Pradesh, India
| | - Karan Singh Yadav
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
- Division of Toxicology and Experimental Medicine; CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Madhav Nilakanth Mugale
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
- Division of Toxicology and Experimental Medicine; CSIR-Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Rabi Sankar Bhatta
- Pharmaceutics and Pharmacokinetics Division, Lucknow, Uttar Pradesh, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
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Erdinest N, Noyman DBE, London N, Lavy I, Levinger N, Landau D, Solomon A, Morad Y, Naroo SA. Applications of topical immunomodulators enhance clinical signs of vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC): a meta-analysis. Int Ophthalmol 2024; 44:157. [PMID: 38522059 DOI: 10.1007/s10792-024-03097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE This meta-analysis aimed to review the safety and efficacy of topical cyclosporine A (CsA) and topical tacrolimus in allergic eye disease. METHODS A systematic search identified thirteen studies and a total of 445 patients for inclusion, making this the largest meta-analysis published on the subject. The current review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS Thirteen randomized control trials were included in the meta-analysis. Eleven studies used CsA as the treatment, and two used Tacrolimus. In total, 445 participants were included, of whom 76.6% were male. The mean age of participants across the included studies was 14 years. All studies reported clinical signs as evaluated by an examining clinician. Signs were usually assessed by anatomical region, with the most common regions being the conjunctiva and the cornea, and the most common signs assessed were hyperemia and papillae. Three studies accounted for more than 50% of the meta-analysis's weight. Effect size (d) ranged from - 2.37 to - 0.03, negative values favoring immunomodulators. Fixed Effect Meta-Analysis returned an SMD of - 0.81 (95% CI [- 0.98, - 0.65]). However, there was significant heterogeneity (I2 = 61%, Qw = 30.76) in the outcome measure (P = 0.0021); therefore, a random-effect meta-analysis was also completed in which the pooled SMD was - 0.98 (95% CI [- 1.26, - 0.69], τ2 = 0.16). CONCLUSIONS This study affirms the current scientific community's stance that immunomodulators effectively treat clinical signs, including blepharitis, conjunctival hyperemia, edema, papillae, and corneal damage in severe ocular allergic disease.
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | - Itay Lavy
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nadav Levinger
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Ophthalmology, Enaim Refractive Surgery Center, Jerusalem, Israel
| | - David Landau
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Abraham Solomon
- Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Morad
- Department of Ophthalmology, Asaf Harofeh Medical Center, Béer Yáakov, Israel
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
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6
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Kassumeh S, Brunner BS, Priglinger SG, Messmer EM. [New and future treatment approaches for allergic conjunctivitis]. DIE OPHTHALMOLOGIE 2024; 121:180-186. [PMID: 38363381 DOI: 10.1007/s00347-024-01996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND In severe and recurrent ocular allergies conventional ophthalmic drugs can reach their limits, especially in chronic forms. The first novel immunomodulators and biologicals are already in clinical use and could provide relief. OBJECTIVE Based on the immunopathophysiological mechanisms of ocular allergies, possible targets for innovative treatment approaches are presented. An overview of promising new and future immunomodulators and biologicals and their modes of action is also given. MATERIAL AND METHODS Current reviews on ocular allergies and the treatment of systemic allergic diseases were screened. Case reports on the treatment of ocular allergy using immunomodulators and biologicals were analyzed. The clinical relevance and possible applications are presented. RESULTS In chronic forms of ocular allergies, complex ocular surface inflammatory responses mediated via immunoglobulin E (IgE), mast cells, CD4-positive type 2 T‑helper cells and eosinophilic granulocytes are predominant. Cyclosporine A 0.1% eyedrops have been approved in Europe since 2018 for children aged 4 years and older with severe vernal keratoconjunctivitis (VKC). In addition, case reports present promising data on the systemic off-label use of biologicals, such as dupilumab or omalizumab, in refractory VKC or atopic keratoconjunctivitis (AKC). CONCLUSION A profound understanding of the immunopathophysiology of ocular allergies is necessary to detect further targets for future immunomodulators and biologicals. Currently, immunomodulatory therapy remains limited to cyclosporine A eyedrops. Other immunomodulatory agents, such as tacrolimus and biologicals can only be used off-label. Further studies on the controlled clinical use of these substances in the treatment of VKC or AKC are underway.
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Affiliation(s)
- Stefan Kassumeh
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland.
| | - Barbara S Brunner
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Siegfried G Priglinger
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Elisabeth M Messmer
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
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7
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Caputo R, Di Grande L, de Libero C, Marziali E, Mori F, Masini M. Efficacy of a Cationic Emulsion of Cyclosporine in Moderate Vernal Keratoconjunctivitis. Cornea 2024; 43:228-232. [PMID: 37747690 DOI: 10.1097/ico.0000000000003368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/06/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE The aim of this study was to demonstrate the efficacy of cyclosporine A 0.1% cationic emulsion (CsA CE) eye drops 4 times a day in pediatric patients affected by a moderate form of vernal keratoconjunctivitis (VKC). METHODS This was a prospective study of pediatric patients, aged 5-16 years, with an active moderate form of VKC who were poor responders to topical antihistamines treatment and were treated 4 times a day with CsA CE. The clinical signs were graded for analysis as follows: hyperemia, tarsal papillae, and limbal papillae. RESULTS Twenty-eight patients (22 males and 6 females) with a minimum follow-up period of 3 months were included in the analysis. Statistical analysis excluded tarsal papillae because of the very low baseline value. The clinical score of hyperemia and limbal papillae improved from the first evaluation and was maintained over the follow-up. No side effects were noted. CONCLUSION CsA CE has been proposed as a treatment for severe forms of VKC. This study has shown that administration 4 times a day is also effective in the treatment of moderate forms of VKC in children.
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Affiliation(s)
- Roberto Caputo
- Ophthalmology Unit, Meyer Children's Hospital, Florence, Italy; and
| | - Laura Di Grande
- Pediatric Allergy Unit, Meyer Children's Hospital, Florence, Italy
| | - Cinzia de Libero
- Ophthalmology Unit, Meyer Children's Hospital, Florence, Italy; and
| | - Elisa Marziali
- Ophthalmology Unit, Meyer Children's Hospital, Florence, Italy; and
| | - Francesca Mori
- Pediatric Allergy Unit, Meyer Children's Hospital, Florence, Italy
| | - Marzio Masini
- Pediatric Allergy Unit, Meyer Children's Hospital, Florence, Italy
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Leonardi A, Pisella PJ, Benítez-Del-Castillo JM, Amrane M, Ismail D, Doan S, Bremond-Gignac D. NOVATIVE: A Phase II/III, Multicenter, Double-masked, Randomized Study of Cyclosporine A 0.05% and 0.1% Ophthalmic Cationic Emulsion Versus Vehicle in Patients with Vernal Keratoconjunctivitis. Clin Ther 2023; 45:1284-1288. [PMID: 37872059 DOI: 10.1016/j.clinthera.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE This study evaluates the efficacy and tolerability of cyclosporine A cationic emulsion (CsA-CE) in patients ≥4 years of age with moderate-to-severe vernal keratoconjunctivitis (VKC). METHODS This Phase II/III, multicenter, double-masked, dose-ranging study had 2 treatment periods: a 4-week, randomized, vehicle-controlled period in which patients received 0.05% CsA-CE, 0.1% CsA-CE, or vehicle eye drops 4 times daily (period 1) and a 3-month period in which patients received 0.05% CsA-CE or 0.1% CsA-CE 2 or 4 times daily (period 2). The primary efficacy end point was rating of subjective symptoms at day 28 in period 1 per the BenEzra scale. FINDINGS All groups showed improvement in subjective VKC symptoms at day 28, without a statistically significant difference between 0.05% or 0.1% CsA-CE vs vehicle. Both CsA-CE doses produced statistically significant improvements in corneal fluorescein staining scores vs vehicle at day 28; improvements were evident as early as week 1 and continued through month 1. Progressive reduction in subjective itching was evident after week 1 and continued through month 1. Treatment for an additional 3 months further improved subjective symptoms and objective signs of VKC in both CsA-CE groups. Improvement was most notable with 0.1% CsA-CE in patients with severe keratitis. The safety and tolerability profile is favorable. IMPLICATIONS Although treatment with 0.05% and 0.1% CsA-CE showed clinical efficacy in alleviating keratitis and itching as early as week 1, with sustained benefit through 1 month, the primary efficacy end point was not met. These findings informed the design of the Phase III trial of 0.1% CsA-CE (Vernal Keratoconjunctivitis Study). CLINICALTRIALS gov identifier: NCT00328653.
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Affiliation(s)
- Andrea Leonardi
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Pierre-Jean Pisella
- Department of Ophthalmology, Tours University Hospital, Université François Rabelais, Hôpital Bretonneau, Tours, France
| | - José Manuel Benítez-Del-Castillo
- Department of Ophthalmology, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clinico San-Carlos (IdISSC), Madrid, Spain; Clínica Rementería, Madrid, Spain
| | | | | | - Serge Doan
- Department of Ophthalmology, Fondation A de Rothchild, Paris, France
| | - Dominique Bremond-Gignac
- University Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Rare Eye Disease Center (OPHTARA), Paris Cite University, Paris, France.
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Salami E, Righetti G, Cavarzeran F, Leonardi A. Efficacy and Satisfaction of Cyclosporine 0.1% in Patients with Vernal Keratoconjunctivitis. Ocul Immunol Inflamm 2023; 31:1870-1872. [PMID: 35914313 DOI: 10.1080/09273948.2022.2103833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
Vernal keratoconjunctivitis (VKC) is a severe form of ocular allergy that compromises the quality of life of affected patients. Topical cyclosporine 0.1% cationic emulsion (CsA-CE) has been recently authorized for the treatment of severe VKC. We treated 29 VKC patients with on-label CsA-CE and recorded signs and symptoms, subjective patient's treatment satisfaction and the additional use of topical corticosteroids in case of exacerbations. CsA-CE was effective in reducing signs and symptoms in daily clinical practice. The overall subjective improvement of symptoms, efficacy of the treatment, tolerability to the drug and compliance reached a high level of subjective satisfaction score.55% of treated patients required the additional use of a 3-day course of topical dexamethasone with 1.13 ± 0.81 mean courses/month. In conclusions, VKC patients reported an overall high satisfaction with used the on-label topical CsA-CE with a limited use of additional topical corticosteroid treatment.
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Affiliation(s)
- Elena Salami
- Department of Neuroscience, Ophthalmology Unit, University of Padova, Padova, Italy
| | - Giuseppe Righetti
- Department of Neuroscience, Ophthalmology Unit, University of Padova, Padova, Italy
| | - Fabiano Cavarzeran
- Department of Neuroscience, Ophthalmology Unit, University of Padova, Padova, Italy
| | - Andrea Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padova, Padova, Italy
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Ali A, Bielory L, Dotchin S, Hamel P, Strube YNJ, Koo EB. Management of vernal keratoconjunctivitis: Navigating a changing treatment landscape. Surv Ophthalmol 2023:S0039-6257(23)00138-8. [PMID: 37890678 DOI: 10.1016/j.survophthal.2023.10.008] [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: 06/27/2022] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic, progressive, and potentially sight-threatening form of ocular inflammatory disease that primarily affects children and young adults. Prevalence varies by region, ranging from <2 per 10,000 in the United States to as high as 1,100 per 10,000 in parts of Africa. The rarity of VKC in developed countries can make differential diagnosis challenging, and treatment is often delayed until the disease is advanced, and symptoms are significantly impacting patients' quality of life. Although once viewed primarily as an immunoglobulin E-mediated condition, approximately 50% of patients with VKC do not exhibit allergic sensitization. It is now recognized that the immunopathology of VKC involves multiple inflammatory pathways that lead to the signs, symptoms, and conjunctival eosinophilic and fibroproliferative lesions that are a hallmark of the disease. We examine the evolution of our understanding of the immunopathology of VKC, the expanding VKC treatment armamentarium, the clinical implications of emerging treatment approaches, and future directions for VKC research and practice.
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Affiliation(s)
- Asim Ali
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Leonard Bielory
- Departments of Medicine, Allergy, Immunology and Ophthalmology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Stephanie Dotchin
- Department of Surgery, Section of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Hamel
- CHU Ste-Justine, Université de Montréal and McGill University Health Center, Montréal, Québec, Canada
| | - Yi Ning J Strube
- Department of Ophthalmology, Queen's University/Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Euna B Koo
- Stanford Byers Eye Institute, Palo Alto, California, USA
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11
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Labetoulle M, Leonardi A, Pisella PJ, Baudouin C. Ciclosporin A Cationic Emulsion 0.1% for the Management of Dry Eye Disease: Facts That Matter for Eye-Care Providers. Ocul Immunol Inflamm 2023; 31:1707-1715. [PMID: 35766874 DOI: 10.1080/09273948.2022.2088566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
Dry eye disease (DED) is a chronic inflammatory disease of the ocular surface requiring long-term therapy. Severe forms of DED generally do not respond to tear substitutes alone or combined, and often require treatment with topical anti-inflammatory agents to break the vicious circle of inflammation. This review summarises data from randomised controlled trials and real-world evidence on the efficacy and safety of ciclosporin A 0.1% cationic emulsion (Ikervis®) for the management of DED. Improvements in clinical signs and symptoms were reported from as early as 4 weeks after treatment initiation, although it can take a few months to reach the full benefits. Treatment periods of up to 12 months provide sustained benefit to patients. In the most responsive patients, treatment discontinuation is possible with no further substantial relapse over 12 months in over 65% of patients. Transient local ocular effects are the most commonly reported adverse events.
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Affiliation(s)
- Marc Labetoulle
- Department of Ophthalmology, Paris-Sud University, Paris, France
| | - Andrea Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
| | | | - Christophe Baudouin
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital and Vision Institute, IHU FOReSIGHT, Paris, France
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Coco G, Ambrosini G, Poletti S, Meliante LA, Taloni A, Scorcia V, Giannaccare G. Recent advances in drug treatments for dry eye disease. Expert Opin Pharmacother 2023; 24:2059-2079. [PMID: 37804227 DOI: 10.1080/14656566.2023.2269090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/06/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Dry eye disease (DED) is a common ocular condition with a significant impact on patients' quality of life. Conventional treatments include behavioral changes, tear substitutes, and anti-inflammatory agents; however, recent advances in the understanding of DED pathogenesis have opened the way to the development of novel treatment strategies able to target several pathways involved in the onset and persistence of DED. AREAS COVERED Literature search was conducted on PubMed and Scopus around the term 'dry eye disease' and others involving its pathophysiology and therapeutic strategy. The primary focus was on recent drugs approved by FDA or under investigation in phase 3 clinical trials. Google and ClinicalTrials.gov were used for obtaining information about the status of FDA approval and ongoing clinical trials. EXPERT OPINION Due to its multifaced pathogenesis, DED management is often challenging, and patients' needs are frequently unmet. Recently, several novel treatments have been either FDA-approved or studied in late-phase trials. These novel drugs target-specific biological components of the ocular surface and reduce inflammation and ocular pain. Additionally, new drug delivery systems allow for increased bioavailability, improve effective dosing, and minimize ocular side effects. These advances in drug therapies show real promise for better management of DED patients.
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Affiliation(s)
- Giulia Coco
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giacomo Ambrosini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Poletti
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Laura Antonia Meliante
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Taloni
- Department of Ophthalmology, University of Magna Græcia, Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University of Magna Græcia, Catanzaro, Italy
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Leonardi A, Doan S, Aragona P, Amrane M, Ismail D, Montero J, Németh J, Bremond-Gignac D. Topical cyclosporine A cationic ophthalmic emulsion in paediatric vernal keratoconjunctivitis: pooled analysis of randomised NOVATIVE and VEKTIS trials. Eye (Lond) 2023; 37:2320-2326. [PMID: 36564576 PMCID: PMC10366270 DOI: 10.1038/s41433-022-02342-6] [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: 07/01/2022] [Revised: 10/28/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/OBJECTIVES Cyclosporine A cationic ophthalmic emulsion (CsA CE) was evaluated in paediatric and adolescent patients with vernal keratoconjunctivitis (VKC) in the NOVATIVE (NCT00328653) and VEKTIS (NCT01751126) trials. The similarity of these studies permitted pooled assessment of the effect of CsA CE on corneal damage as well as safety and tolerability. SUBJECTS/METHODS Pooled outcomes were assessed for the first 28 days of treatment. In NOVATIVE, 118 patients were randomised to 4 times daily (QID) CsA CE 0.05%, 0.1%, or vehicle eye drops. In VEKTIS, 169 patients were randomised to CsA CE 0.1% QID or twice daily (BID) or vehicle. For these analyses, treatment groups comprised: (1) pooled CsA CE 0.1% QID arms (high-dose; n = 96); (2) pooled CsA CE 0.05% QID arm from NOVATIVE and CsA CE 0.1% BID data from VEKTIS (low-dose; n = 93); and (3) pooled vehicle QID arms (vehicle; n = 98). RESULTS Changes from baseline to day 28 (mean ± standard deviation) in corneal fluorescein staining (CFS) scores for CsA CE high-dose, low-dose, and vehicle groups were -1.6 ± 1.47 (95% CI: -0.9, -0.1; p = 0.0124 vs vehicle), -1.7 ± 1.39 (95% CI: -1.1, -0.3; p = 0.0015 vs vehicle), and -1.0 ± 1.55, respectively. Adverse events (AEs) of any type were reported in 37.5%, 34.4%, and 37.8% of the high-dose, low-dose, and vehicle groups, respectively. Most were mild or moderate in severity. CONCLUSIONS CsA CE significantly decreased corneal damage and was safe and well tolerated in patients with VKC. These data support CSA CE as a treatment option for the management of VKC.
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Affiliation(s)
- Andrea Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy.
| | - Serge Doan
- Bichat Hospital and Foundation A. de Rothschild, Paris, France
| | - Pasquale Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | | | | | | | - János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Dominique Bremond-Gignac
- Department of Ophthalmology, University Hospital Necker Enfants Malades, APHP, Paris, France
- INSERM Unit 1138, T17 Paris Cité University, Paris, France
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Bruschi G, Ghiglioni DG, Cozzi L, Osnaghi S, Viola F, Marchisio P. Vernal Keratoconjunctivitis: A Systematic Review. Clin Rev Allergy Immunol 2023; 65:277-329. [PMID: 37658939 PMCID: PMC10567967 DOI: 10.1007/s12016-023-08970-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023]
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic, bilateral corneal and conjunctival problem which typically presents in young individuals. VKC is characterized by itching, photophobia, white mucous discharge, lacrimation, foreign body sensation, and pain due to corneal involvement of shield ulcers. Vernal keratoconjunctivitis is categorized within ocular diseases. The diagnosis is clinical, as no sure biomarkers pathognomonic of the disease have yet been identified. The VKC therapy relies on different types of drugs, from antihistamines and topical steroids to cyclosporine or tacrolimus eye drops. In extremely rare cases, there is also the need for surgical treatment for the debridement of ulcers, as well as for advanced glaucoma and cataracts, caused by excessive prolonged use of steroid eye drops. We performed a systematic review of the literature, according to PRISMA guideline recommendations. We searched the PubMed database from January 2016 to June 2023. Search terms were Vernal, Vernal keratoconjunctivitis, and VKC. We initially identified 211 articles. After the screening process, 168 studies were eligible according to our criteria and were included in the review. In this study, we performed a systematic literature review to provide a comprehensive overview of currently available diagnostic methods, management of VKC, and its treatments.
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Affiliation(s)
| | - Daniele Giovanni Ghiglioni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 9, 20122, Milan, Italy.
| | - Laura Cozzi
- Università degli Studi di Milano, Milan, Italy
| | - Silvia Osnaghi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 9, 20122, Milan, Italy
| | - Francesco Viola
- Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 9, 20122, Milan, Italy
| | - Paola Marchisio
- Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 9, 20122, Milan, Italy
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Giannaccare G, Rossi C, Borselli M, Bonzano C, Carnovale Scalzo G, Nicolò M, Scorcia V, Traverso CE, Vagge A. Clinical Outcomes of Topical 0.1% Ciclosporin Cationic Emulsion Used on Label in Children with Vernal Keratoconjunctivitis. Ophthalmol Ther 2023; 12:1787-1793. [PMID: 37043141 PMCID: PMC10164196 DOI: 10.1007/s40123-023-00707-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/22/2023] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION The purpose of this short article is to report the clinical outcomes of topical 0.1% ciclosporin cationic emulsion (CsA-CE) used on label in children with vernal keratoconjunctivitis (VKC). METHODS In this prospective, non-comparative, observational study children affected by active severe VKC were treated for at least 12 months with topical 0.1% CsA-CE. The drug was instilled in both eyes 4 times daily. Data collected from medical charts for the baseline visit (T0) and 1-year follow-up visit (T1) included symptomatic score (0-15), clinical score (0-15), side effects, rescue therapy (need and total number of courses with 0.1% dexamethasone 4 times daily for 5 days), ocular complications and tolerability (visual analog scale [0-100]). RESULTS Data from 25 children (20 boys, 5 girls; mean [± standard deviation] age 8.40 ± 2.54 years) were included in the study. Of the 25 patients, 23 (92%) used 0.1% CsA-CE eye drops as per label recommendations, including four patients who had prematurely stopped using topical galenic CsA due to side effects. Symptomatic and clinical scores decreased significantly after treatment, with the mean symptomatic score decreasing from 9.76 ± 1.27 at T0 to 3.80 ± 1.08 at T1, and the mean clinical score decreasing from 9.20 ± 1.32 at T0 to 3.44 ± 1.00 at T1; both P < 0.0001). Five patients (20%) required at least one course of rescue medication (mean 3.4 ± 4.8 courses/year). No patients experienced ocular complications during the study, and treatment tolerability was very high (mean score 89.40 ± 5.46). CONCLUSION Our findings confirm that topical CsA-CE is an effective on-label option for children with VKC in the real-life setting. In our pediatric patient population, CsA-CE provided good clinical outcomes with a limited need for rescue medication, and it was well tolerated by almost all patients, including those who were intolerant to galenic formulations.
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Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy.
| | - Costanza Rossi
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Massimiliano Borselli
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Chiara Bonzano
- IRCCS Polyclinic Hospital San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | | | - Massimo Nicolò
- IRCCS Polyclinic Hospital San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Carlo Enrico Traverso
- IRCCS Polyclinic Hospital San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Aldo Vagge
- IRCCS Polyclinic Hospital San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
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Novel Insights in the Management of Vernal Keratoconjunctivitis (VKC): European Expert Consensus Using a Modified Nominal Group Technique. Ophthalmol Ther 2023; 12:1207-1222. [PMID: 36790673 PMCID: PMC10011216 DOI: 10.1007/s40123-023-00665-5] [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: 11/18/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Vernal keratoconjunctivitis (VKC) is a rare, severe allergic ocular disease, typically occurring in children and adolescents, that can have a significant impact on quality of life and lead to visual impairment. Long-term treatment may be necessary to tackle chronic inflammation and topical corticosteroid dependency must be minimised due to the risk of complications. There is a need for unified clinical guidance to aid the assessment, diagnosis and management of VKC across Europe. The aim of this expert panel (the EUR-VKC Group) was to provide clear guidance for primary care physicians and general ophthalmologists involved in the diagnosis and management of VKC. METHODS An expert group of seven European ophthalmologists was convened and a modified nominal group technique used to develop key recommendations on VKC management. The recommendations were subject to up to two rounds of voting using a 5-point Likert scale to ascertain consensus and the strength of each recommendation. Consensus was set at a predetermined threshold of ≥ 75.0% of experts selecting 'Strongly agree' or 'Agree'. RESULTS A total of 47 recommendations were developed relating to the assessment of key of VKC, guidance on who and when to refer, as well as treatment-escalation pathways, long-term follow-up, and supportive care and education. All recommendations reached consensus after two rounds. The group emphasise how timely diagnosis and treatment initiation that is appropriate to disease severity are crucial to benefit patients with VKC. Patients with signs ('red flags') indicating severe VKC, or persistent mild-to-moderate VKC that is non-responsive following 2-4 weeks of treatment, should be referred to a sub-specialist. CONCLUSION The EUR-VKC Group provides recommendations on the assessment, diagnosis, management, referral and follow-up of patients with VKC. It also provides a framework to facilitate collaboration between primary care physicians, general ophthalmologists and sub-specialists to improve the outcomes for patients with VKC.
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Wu KY, Ashkar S, Jain S, Marchand M, Tran SD. Breaking Barriers in Eye Treatment: Polymeric Nano-Based Drug-Delivery System for Anterior Segment Diseases and Glaucoma. Polymers (Basel) 2023; 15:polym15061373. [PMID: 36987154 PMCID: PMC10054733 DOI: 10.3390/polym15061373] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/25/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
The eye has anatomical structures that function as robust static and dynamic barriers, limiting the penetration, residence time, and bioavailability of medications administered topically. The development of polymeric nano-based drug-delivery systems (DDS) could be the solution to these challenges: it can pass through ocular barriers, offering higher bioavailability of administered drugs to targeted tissues that are otherwise inaccessible; it can stay in ocular tissues for longer periods of time, requiring fewer drug administrations; and it can be made up of polymers that are biodegradable and nano-sized, minimizing the undesirable effects of the administered molecules. Therefore, therapeutic innovations in polymeric nano-based DDS have been widely explored for ophthalmic drug-delivery applications. In this review, we will give a comprehensive overview of polymeric nano-based drug-delivery systems (DDS) used in the treatment of ocular diseases. We will then examine the current therapeutic challenges of various ocular diseases and analyze how different types of biopolymers can potentially enhance our therapeutic options. A literature review of the preclinical and clinical studies published between 2017 and 2022 was conducted. Thanks to the advances in polymer science, the ocular DDS has rapidly evolved, showing great promise to help clinicians better manage patients.
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Affiliation(s)
- Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Said Ashkar
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Shrieda Jain
- Department of Experimental Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Michael Marchand
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
- Correspondence:
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Ren X, Wang Y, Wu T, Jing D, Li X. Binocular dynamic visual acuity in dry eye disease patients. Front Neurosci 2023; 17:1108549. [PMID: 36968505 PMCID: PMC10030492 DOI: 10.3389/fnins.2023.1108549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/17/2023] [Indexed: 03/10/2023] Open
Abstract
PurposeTo investigate binocular dynamic visual acuity (DVA) for patients with dry eye disease (DED).MethodsThe prospective study included DED patients. The binocular DVA at 40 and 80 degrees per second (dps), Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear film break-up time first (TBUTF), corneal fluorescein staining (CFS), eyelid margin abnormalities and meibomian gland (MG) abnormalities morphology and function were evaluated. A deep learning model was applied to quantify the MG area proportion. The correlation between DVA and DED parameters was analyzed.ResultsA total of 73 DED patients were enrolled. The age, OSDI, CFS, MG expressibility, secretion quality, and eyelid margin abnormalities were significantly positively correlated with the DVA for 40 and 80 dps (all P < 0.05). The MG area proportion in the upper eyelid was negatively correlated with DVA at 40 dps (R = −0.293, P < 0.001) and at 80 dps (R = −0.304, P < 0.001). Subgroup analysis by MG grade demonstrated that the DVA of patients with severe MG dropout (<25% of the total area) was significantly worse than other mild and moderate groups, both in 40 and 80 dps (all P < 0.05). The patients with CFS showed worse 40 (P < 0.001) and 80 dps (P < 0.001) DVA than the patients without CFS.ConclusionBinocular DVA is significantly associated with DED symptoms and signs. The DED patients with CFS and severe MG dropout and dysfunction have worse DVA.
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Han H, Li S, Xu M, Zhong Y, Fan W, Xu J, Zhou T, Ji J, Ye J, Yao K. Polymer- and lipid-based nanocarriers for ocular drug delivery: Current status and future perspectives. Adv Drug Deliv Rev 2023; 196:114770. [PMID: 36894134 DOI: 10.1016/j.addr.2023.114770] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
Ocular diseases seriously affect patients' vision and life quality, with a global morbidity of over 43 million blindness. However, efficient drug delivery to treat ocular diseases, particularly intraocular disorders, remains a huge challenge due to multiple ocular barriers that significantly affect the ultimate therapeutic efficacy of drugs. Recent advances in nanocarrier technology offer a promising opportunity to overcome these barriers by providing enhanced penetration, increased retention, improved solubility, reduced toxicity, prolonged release, and targeted delivery of the loaded drug to the eyes. This review primarily provides an overview of the progress and contemporary applications of nanocarriers, mainly polymer- and lipid-based nanocarriers, in treating various eye diseases, highlighting their value in achieving efficient ocular drug delivery. Additionally, the review covers the ocular barriers and administration routes, as well as the prospective future developments and challenges in the field of nanocarriers for treating ocular diseases.
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Affiliation(s)
- Haijie Han
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Su Li
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Mingyu Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Yueyang Zhong
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Wenjie Fan
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Jingwei Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Tinglian Zhou
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China
| | - Jian Ji
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China.
| | - Ke Yao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China; Zhejiang Provincial Key Lab of Ophthalmology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, People's Republic of China.
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Dahlmann-Noor AH, Roberts C, Muthusamy K, Calder V, Hingorani M. Topical cyclosporine A 1 mg/ml for atopic keratoconjunctivitis: Five-year case series of 99 children and young people. Acta Ophthalmol 2023; 101:e197-e204. [PMID: 36151755 DOI: 10.1111/aos.15251] [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: 03/18/2022] [Revised: 05/20/2022] [Accepted: 09/03/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To explore the effects of cyclosporine A (CsA) in the management of atopic keratoconjunctivitis (AKC). METHODS Open single-group interventional consecutive cohort study (case series) at a single eye care facility in the UK. We reviewed the electronic patient records of 99 children and young people (CYP) aged 3.4-18 years with AKC treated with topical CsA 1 mg/ml. Main outcome measures were number of prescriptions and hospital clinic visits over 12 months before and after the start of CsA and the proportion of CYP affected by adverse effects. RESULTS The median number of inflammatory episodes requiring treatment with topical corticosteroids (tCS) fell from 3 (interquartile range IQR 1-4) during the 12 months prior to CsA to 1 (IQR 0-3) during the 12 months after, excluding tCS prescriptions with the first CsA prescription (Wilcoxon signed ranks test, 2 tailed, p < 0.01). In the 12-month period following initiation of CsA 1 mg/ml with concomitant prescription of tCS (n = 66), daily dosage of steroids was reduced in 62 CYP (93.9%), and they were discontinued in 43 (65.2%). The median number of hospital visits fell from 4 (IQR 3-6) to 3 (IQR 2-5; Wilcoxon p < 0.01). Adverse events leading to discontinuation of CsA were stinging (instillation site pain; 9/99, 9%) and a transient skin rash (1/99, 1%). CONCLUSIONS Off-label use of commercial preparations of CsA 1 mg/ml significantly reduces the need for concomitant topical corticosteroids and hospital clinic visits in CYP with AKC. Stinging and skin rash can lead to discontinuation.
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Affiliation(s)
- Annegret H Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, London, UK.,Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Clare Roberts
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | | | - Melanie Hingorani
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Corneal Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Ghauri AJ, Biswas S, Manzouri B, Barua A, Sharma V, Hoole J, Dahlmann-Noor A. Management of Vernal Keratoconjunctivitis in Children in the United Kingdom: A Review of the Literature and Current Best Practice Across Six Large United Kingdom Centers. J Pediatr Ophthalmol Strabismus 2023; 60:6-17. [PMID: 35611818 DOI: 10.3928/01913913-20220328-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Vernal keratoconjunctivitis (VKC) is a form of ocular allergy primarily affecting children. Considered a rare disease in Europe, its prevalence varies by geographic region and is poorly studied in the United Kingdom. There is considerable national variation in the management of VKC within the United Kingdom, risking misdiagnosis and delays to treatment for some children. This can significantly impact their quality of life, with the potential for lasting negative consequences. Based on discussions between experienced clinicians from six large centers across the United Kingdom, this article describes best practice recommendations for United Kingdom settings, including principles for diagnosis, referral, initial and long-term management, and supportive care. Recommendations include guidance on referral timing, which should depend on VKC severity, and a stepwise approach to treatment. Joint management by primary care and secondary care is recommended and the importance of supportive care, including emotional support and outreach to schools, is highlighted. Because frequent flareups are common in VKC, it is essential that families have access to the information they need to manage the disease and routes to access rapid care if needed. A thorough understanding of the nature of VKC, its triggers, and how best to manage it, by both patients and their families, is critical to ensuring appropriate management and to improving patient outcomes. [J Pediatr Ophthalmol Strabismus. 2023;60(1):6-17.].
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22
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Dahlmann-Noor AH, Roberts C, Muthusamy K, Calder V, Hingorani M. Steroid-sparing effect of ciclosporin A 1 mg/mL: 5-year case series of 107 children and young people with vernal keratoconjunctivitis. BMJ Open Ophthalmol 2022; 7:e001040. [PMCID: PMC9756209 DOI: 10.1136/bmjophth-2022-001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background/aims To explore the steroid-sparing and other therapeutic effects of ciclosporin A (CsA) 1 mg/mL in the management of vernal keratoconjunctivitis (VKC). Methods Open retrospective single-group interventional consecutive cohort study (case series) of 107 children and young people (CYP) age 4.4–18 years with severe and/or recurrent VKC who were prescribed CsA 1 mg/mL between November 2015 and May 2021 at one institution. Review of electronic patient records, noting clinical indication for prescribing CsA 1 mg/mL, dosage prescribed at initiation and follow-up, impact on steroid usage before and after commencing CsA as well as adverse events and indications for discontinuation of treatment. Results The median number of inflammatory episodes requiring treatment with topical corticosteroids fell from 3 (IQR 2–4) during the 12 months prior to CsA 1 mg/mL to 1 (IQR 0–3) during the 12 months after, excluding steroid prescriptions with the first CsA 1 mg/mL prescription (Wilcoxon signed ranks test, two tailed, p<0.01). In the 12-month period following initiation of CsA 1 mg/mL with concomitant prescription of topical corticosteroids (n=82), daily dosage of steroids was reduced in 79 (96.3%) and discontinued in 67 (81.7%). The median number of hospital clinic visits fell from 4 (IQR 3–5) to 3 (IQR 2–5) (Wilcoxon p<0.01). Adverse events leading to discontinuation of CsA 1 mg/mL within 12 months of starting included stinging (instillation site pain) (6/107, 5.6%) and skinrash (1/107, 0.9%). Conclusion Commercial preparations of CsA 1 mg/mL, licensed for severe VKC in CYP, significantly reduce the need for concomitant topical corticosteroids and hospital clinic visits. Adverse events which may lead to discontinuation are stinging and skin rash.
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Affiliation(s)
- Annegret Hella Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, London, UK,Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Clare Roberts
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Kirithika Muthusamy
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Melanie Hingorani
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Dogan CU, Tuzer C, Turker IC, Alkan AA, Culha D, Demir S. Topical cyclosporine versus allergen specific immunotherapy in perennial allergic conjunctivitis. Int Ophthalmol 2022:10.1007/s10792-022-02612-y. [PMID: 36513916 PMCID: PMC9747541 DOI: 10.1007/s10792-022-02612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Symptom control in the long-term with less side effects is important in perennial allergic conjunctivitis, since would improve quality of life. This study aimed to assess the clinical efficacies of topical cyclosporin A and subcutaneous allergen immunotherapy (SCIT) in terms of sign control in perennial allergic conjunctivitis. METHODS This retrospective study included 20 adult patients with perennial allergic conjunctivitis and confirmed sensitization to house dust mites with skin prick test. Patients were assigned to either topical cyclosporine A treatment or SCIT. The participants were followed for 6 months, and signs scores were recorded at 1, 3 and 6 months. RESULTS Overall, both cyclosporine and immunotherapy groups showed significant improvements in papillary reaction (p = 0.011 and 0.003, respectively), limbal involvement (p = 0.031 and 0.001), and conjunctival hyperemia (p = 0.001 and p < 0.001) scores during the 6-month follow-up. However, only cyclosporine group showed a significant improvement in corneal involvement scores (p = 0.015) during the study period. When scores at different time points were compared, significant improvement in conjunctival hyperemia was evident at 6 months in both groups when compared to baseline (cyclosporine group, 0.7 ± 0.68 vs. 2.4 ± 0.84, 70.8% decrease, p = 0.01; immunotherapy group, 0.3 ± 0.48 vs. 2.3 ± 0.95, 87.0% decrease, p = 0.004), whereas for limbal involvement such an improvement was only evident in the immunotherapy group (0.1 ± 0.32 vs. 1.3 ± 0.95, 92.3% decrease, p = 0.01). CONCLUSIONS Allergen immunotherapy and cyclosporin A treatment may provide effective sign relief in perennial allergic conjunctivitis. It may represent an encouraging treatment option particularly for cases with perennial allergic conjunctivitis refractive to other treatments and positive skin prick test to a specific allergen (house dust in the present study). Long-term relief by SCIT would reduce the side effects of polypharmacotherapy. Larger studies with longer follow-up are warranted to confirm our findings.
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Affiliation(s)
- Ceylan Uslu Dogan
- Department of Ophthalmology, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Sciences, Cumhuriyet and Demokrasi Avenue, No:1, Istanbul, Turkey
| | - Can Tuzer
- Division of Allergy and Immunology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ibrahim Cagri Turker
- Department of Ophthalmology, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Sciences, Cumhuriyet and Demokrasi Avenue, No:1, Istanbul, Turkey
| | | | - Damla Culha
- Lotus Eye Aesthetics & Strabismus Clinic, Halaskargazi Street, Sisli/Istanbul, Turkey
| | - Semra Demir
- Division of Allergy and Immunology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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24
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Fukuda K, Kishimoto T, Sumi T, Yamashiro K, Ebihara N. Biologics for allergy: therapeutic potential for ocular allergic diseases and adverse effects on the eye. Allergol Int 2022; 72:234-244. [PMID: 36333219 DOI: 10.1016/j.alit.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
Biologics applying antibodies against IgE, IL-5, IL-5 receptor α, IL-4 receptor α, and IL-13 have dramatically improved recent treatment outcomes in allergic diseases including asthma, rhinitis, and atopic dermatitis. However, these drugs have not been approved for ocular allergic diseases such as allergic conjunctivitis, vernal keratoconjunctivitis, and atopic keratoconjunctivitis. Although the putative mechanisms suggest that these drugs should have beneficial effects in patients with ocular allergies and some studies have reported such beneficial effects, various adverse ocular symptoms have also been observed in clinical trials and off-label use studies. Since ocular allergic diseases have distinct pathogeneses, each biologic drug must be examined regarding specific effects on each ocular allergy. For example, IgE-mediated type 1 hypersensitivity plays a critical role in allergic conjunctivitis. By contrast, T cells and eosinophilic and non-IgE-mediated type 2 inflammation play important roles in vernal keratoconjunctivitis. Allergists must fully understand the effects of each drug on the eye. This review outlines both potential therapeutic and adverse effects of various biologics on allergic diseases of the eye.
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Affiliation(s)
- Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan.
| | - Tatsuma Kishimoto
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tamaki Sumi
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology and Visual Science, Juntendo University Urayasu Hospital, Tokyo, Japan
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25
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Bourcier T, Dory A, Dormegny L, Alcazar J, Gaucher D, Sauer A. Efficacy and Safety of 0.1% Cyclosporine versus 2% Cyclosporine in the Treatment of Severe Vernal Keratoconjunctivitis in Children. Clin Ophthalmol 2022; 16:3589-3596. [PMID: 36304991 PMCID: PMC9596278 DOI: 10.2147/opth.s370414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Vernal keratoconjunctivitis (VKC) is an inflammatory condition in children that can cause severe eye complications. Treatment is based on corticosteroid therapy during flare-ups, then antihistamines and cyclosporine in calmer periods. The dosage and posology of cyclosporine are subject to debate. METHODS The aim of the study is to compare the evolution in symptomatic and clinical scores, and need for topical corticosteroid treatment in a population of children with severe VKC treated with two dosages of cyclosporine treatment (0.1% and 2%). Data were compiled on inclusion then every three months from March, with a total follow-up duration of 12 months. Data concerning patient evolutions and complications were collected for the two treatment groups. RESULTS The mean age of the 46 children was 8.8 ±2.4 years with age at onset of symptoms of 5.1 ± 0.9 years. The cohort was predominantly (65%) male. Corticosteroid dependence on inclusion was present in 52% of the children included. A significant improvement in the various symptomatic and clinical scores was observed following treatment with cyclosporine (0.1% and 2%). Use of topical corticosteroid treatment reduced from 19 drops per month on inclusion to 4 drops per month at 12 months. Safety was comparable for the two groups. CONCLUSION Treatments with cyclosporine 0.1% and 2% lead to a favourable evolution in clinical and symptomatic scores and reduced corticosteroid use. Cyclosporine 0.1% is an interesting alternative to the 2% dosage, particularly due to its availability and ease of handling.
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Affiliation(s)
- Tristan Bourcier
- Department of Ophthalmology, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Anne Dory
- Pharmacy, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Lea Dormegny
- Department of Ophthalmology, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Joffrey Alcazar
- Department of Ophthalmology, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, Strasbourg University Hospital, University of Strasbourg, Strasbourg, France,Correspondence: Arnaud Sauer, Department of Ophthalmology, Nouvel Hôpital Civil, Strasbourg University Hospital, BP426, Strasbourg, 67091, France, Email
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26
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Zhang C, Yin Y, Zhao J, Li Y, Wang Y, Zhang Z, Niu L, Zheng Y. An Update on Novel Ocular Nanosystems with Possible Benefits in the Treatment of Corneal Neovascularization. Int J Nanomedicine 2022; 17:4911-4931. [PMID: 36267540 PMCID: PMC9578304 DOI: 10.2147/ijn.s375570] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
Corneal neovascularization (CNV) is an ocular pathological change that results from an imbalance between angiogenic factors and antiangiogenic factors as a result of various ocular insults, including infection, inflammation, hypoxia, trauma, corneal degeneration, and corneal transplantation. Current clinical strategies for the treatment of CNV include pharmacological treatment and surgical intervention. Despite some degree of success, the current treatment strategies are restricted by limited efficacy, adverse effects, and a short duration of action. Recently, gene-based antiangiogenic therapy has become an emerging strategy that has attracted considerable interest. However, potential complications with the use of viral vectors, such as potential genotoxicity resulting from long-term expression and nonspecific targeting, cannot be ignored. The use of ocular nanosystems (ONS) based on nanotechnology has emerged as a great advantage in ocular disease treatment during the last two decades. The potential functions of ONS range from nanocarriers, which deliver drugs and genes to target sites in the eye, to therapeutic agents themselves. Various preclinical studies conducted to date have demonstrated promising results of the use of ONS in the treatment of CNV. In this review, we provide an overview of CNV and its current therapeutic strategies and summarize the properties and applications of various ONS related to the treatment of CNV reported to date. Our goal is to provide a comprehensive review of these considerable advances in ONS in the field of CNV therapy over the past two decades to fill the gaps in previous related reports. Finally, we discuss existing challenges and future perspectives of the use of ONS in CNV therapy, with the goal of providing a theoretical contribution to facilitate future practical growth in the area.
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Affiliation(s)
- Chenchen Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yuan Yin
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Jing Zhao
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yanxia Li
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yuanping Wang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Zhaoying Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Lingzhi Niu
- Department of Ophthalmology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People’s Republic of China
| | - Yajuan Zheng
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, People’s Republic of China,Correspondence: Yajuan Zheng, Email
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27
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Daull P, Baudouin C, Liang H, Feraille L, Barabino S, Garrigue JS. Review of Preclinical Outcomes of a Topical Cationic Emulsion of Cyclosporine A for the Treatment of Ocular Surface Diseases. Ocul Immunol Inflamm 2022; 30:1945-1955. [PMID: 34348575 DOI: 10.1080/09273948.2021.1957124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cyclosporine A (CsA) has been used as a topical treatment for various ocular surface diseases including dry eye disease (DED). Several CsA formulations are available as solutions or emulsions. PURPOSE This review describes the development and the preclinical testing of a cationic oil-in-water emulsion of CsA (CE-CsA) in terms of pharmacodynamics, pharmacokinetics, and ocular tolerance. Due to the cationic charge, CE electrostatically interacts with the negatively-charged ocular surface, improving its residence time. Compared to other CsA formulations, CE-CsA and CE itself were found to reduce the signs and symptoms of DED, by restoring tear film stability and properties, and inhibiting the expression and secretion of pro-inflammatory factors. No delay in wound healing nor ocular toxicity were observed using CE formulations. CONCLUSION these findings indicate that the type of vehicle can significantly affect the performance of eye drops and play an ancillary role in DED treatment. CE appears as a promising strategy to deliver drugs to the ocular surface while maintaining its homeostasis.
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Affiliation(s)
| | - Christophe Baudouin
- CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, Paris, France.,Sorbonne Universités, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Hong Liang
- CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, Paris, France.,Sorbonne Universités, INSERM, CNRS, Institut de la Vision, Paris, France
| | | | - Stefano Barabino
- Ocular Surface and Dry Eye Center, Ospedale L. Sacco, University of Milan, Milan, Italy
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28
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Executive summary: Japanese guidelines for allergic conjunctival diseases 2021. Allergol Int 2022; 71:459-471. [PMID: 36096976 DOI: 10.1016/j.alit.2022.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Allergic conjunctival disease (ACD) is an inflammatory disease of the conjunctiva that is mainly caused by type I hypersensitivity response to allergens and accompanied by subjective symptoms and other findings induced by antigens. ACD is classified as allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. This article summarizes the third edition of the Japanese guidelines for allergic conjunctival diseases published in 2021 and outlines the diagnosis, pathogenesis, and treatment of ACD. Since the introduction of immunosuppressive eye drops, the treatment strategies for severe ACDs have significantly changed. To clarify the recommended standard treatment protocols for ACD, the advantages and disadvantages of these treatments were assessed using clinical questions, with a focus on the use of steroids and immunosuppressive drugs. This knowledge will assist healthcare providers and patients in taking an active role in medical decision making.
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29
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Mehta JS, Chen WL, Cheng ACK, Cung LX, Dualan IJ, Kekunnaya R, Khaliddin N, Kim TI, Lam DK, Leo SW, Manurung F, Tesavibul N, Bremond-Gignac D. Diagnosis, Management, and Treatment of Vernal Keratoconjunctivitis in Asia: Recommendations From the Management of Vernal Keratoconjunctivitis in Asia Expert Working Group. Front Med (Lausanne) 2022; 9:882240. [PMID: 35979210 PMCID: PMC9376221 DOI: 10.3389/fmed.2022.882240] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC) is an underdiagnosed and underrecognized ocular surface disease with limited epidemiological data in Asia. It is more prevalent in warm, dry, and windy climates, and often has a substantial impact on a patient's quality of life. In rare cases, VKC can be associated with vision loss, either through corticosteroid overuse or inadequate treatment of persistent inflammation. As a potentially severe and complex disease, there is variability with how VKC is managed across Asia and among the various allergic eye diseases. Diagnosis and treatment of patients with VKC is a challenge for many ophthalmologists, since no precise diagnostic criteria have been established, the pathogenesis of the disease is unclear, and anti-allergic treatments are often ineffective in patients with moderate or severe disease. In addition, the choice of treatment and management strategies used for patients varies greatly from country to country and physician to physician. This may be because of a lack of well-defined, standardized guidelines. In response, the Management of Vernal Keratoconjunctivitis in Asia (MOVIA) Expert Working Group (13 experts) completed a consensus program to evaluate, review, and develop best-practice recommendations for the assessment, diagnosis, and management of VKC in Asia. The expert-led recommendations are summarized in this article and based on the currently available evidence alongside the clinical expertise of ophthalmologists from across Asia with specialism and interest in the ocular surface, VKC, and pediatric ophthalmology.
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Affiliation(s)
- Jodhbir S. Mehta
- Corneal & External Eye Disease Department, Singapore National Eye Centre, Singapore, Singapore
| | - Wei-Li Chen
- Department of Ophthalmology and Advanced Ocular Surface and Corneal Nerve Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Arthur C. K. Cheng
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong, Hong Kong SAR, China
| | | | - Ivo J. Dualan
- Department of Ophthalmology and Visual Sciences, University of the Philippines, Quezon City, Philippines
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma Children’s Eye Care Center, LV Prasad Eye Institute, Hyderabad, India
| | - Nurliza Khaliddin
- Department of Ophthalmology, University Malaya Eye Research Center, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Tae-Im Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Douglas K. Lam
- The Hong Kong Ophthalmic Associates, Hong Kong, Hong Kong SAR, China
| | - Seo Wei Leo
- Dr Leo Adult & Paediatric Eye Specialist Pte Ltd; Mount Elizabeth Hospital, Singapore, Singapore
| | | | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Dominique Bremond-Gignac
- Department of Ophthalmology, University Hospital Necker-Enfants Malades, APHP, OPHTARA, Paris, France; INSERM Unit UMRS1138, Team 17, Paris University, Paris, France
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30
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Chen M, Ke B, Zou J, Gong L, Wang Y, Zhang C, Xu J, Wei A, Hong J. Combination Therapy of 0.1% Fluorometholone and 0.05% Azelastine in Eyes with Severe Allergic Conjunctival Diseases: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11133877. [PMID: 35807160 PMCID: PMC9267215 DOI: 10.3390/jcm11133877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023] Open
Abstract
This study sought to evaluate the efficacy of the isolated use of fluorometholone compared with the combined use of azelastine and fluorometholone for the treatment of severe allergic conjunctival disease (ACD). One hundred and eleven patients with severe ACD were randomized into two groups: one treated with topical 0.1% fluorometholone combined with 0.05% azelastine and the other with 0.1% fluorometholone alone. The Ocular Surface Disease Index (OSDI) and the signs of keratopathy, palpebral conjunctiva papillae and conjunctival congestion were scored before and at one, two and six weeks after treatment and compared between the groups. The intra-ocular pressure (IOP) was also monitored. There were no significant differences between the groups in the baseline mean scores of signs and OSDI scores, which gradually improved at all visits after therapy in both groups. Although the time effect was significant for all the parameters (all p < 0.001), the reduction in corneal involvement scores from week 2 to week 6 was insignificant in both groups (p = 0.460 for the steroids group and p = 0.074 for the combination group). All signs and symptoms were significantly more improved in the combination group than in the isolated group at each control visit. IOP remained stable at all visits (all p < 0.001), except one patient in each group had elevated IOP over 21 mmHg. While both the isolated use of fluorometholone and combined use of azelastine and fluorometholone are effective in alleviating the signs and symptoms of severe ACD, optimal response can be achieved with adjunctive treatment including azelastine.
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Affiliation(s)
- Minjie Chen
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
| | - Bilian Ke
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China;
| | - Jun Zou
- Department of Ophthalmology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China;
| | - Lan Gong
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
| | - Yan Wang
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
| | - Chaoran Zhang
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
| | - Jianjiang Xu
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
| | - Anji Wei
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Myopia Laboratory of National Health Commission of China, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Science, 83 Fenyang Road, Shanghai 200031, China
- Correspondence: (A.W.); (J.H.); Tel.: +86-21-64377134 (A.W. & J.H.); Fax: +86-21-64318258 (A.W. & J.H.)
| | - Jiaxu Hong
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; (M.C.); (L.G.); (Y.W.); (C.Z.); (J.X.)
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, 28 Guiyi Road, Guiyang 550031, China
- Correspondence: (A.W.); (J.H.); Tel.: +86-21-64377134 (A.W. & J.H.); Fax: +86-21-64318258 (A.W. & J.H.)
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Ghiglioni DG, Bruschi G, Centonze S, Calcinai E, Cozzi L, Osnaghi S, Viola F, Marchisio PG. Cyclosporine A 0.1% Cationic Emulsion in Vernal Keratoconjunctivitis. J Pediatr Ophthalmol Strabismus 2022; 59:279. [PMID: 35856429 DOI: 10.3928/01913913-20220420-03] [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: 11/20/2022]
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Hardas A, Singh N, Mohanty A, Sahu SK. Efficacy of montelukast in preventing seasonal recurrence of vernal keratoconjunctivitis in children. Eye (Lond) 2022; 36:978-984. [PMID: 33947979 PMCID: PMC9046287 DOI: 10.1038/s41433-021-01484-3] [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: 06/06/2020] [Revised: 01/29/2021] [Accepted: 02/19/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Vernal keratoconjunctivitis is a chronic, seasonally exacerbated, allergic inflammation of the eye. The study aims to evaluate the efficacy and safety of oral montelukast in treating vernal keratoconjunctivitis in pediatric patients. METHODS This is a 26-week, prospective, randomized, open-label study. Fifty-eight patients were randomly assigned to two groups-the treatment (montelukast) and control groups. At the beginning of the study, both the groups received topical loteprednol etabonate (0.1%) in tapering doses for a month, and topical olopatadine (0.1%) for the first 3 months. Symptoms and signs observed before and after treatment and assigned scores were studied. The primary efficacy endpoint was change in the mean score on the visual analog scale (VAS) for each subjective symptom. The secondary efficacy endpoint was change in the total score of objective signs. RESULTS The montelukast group showed clinically relevant improvements in the signs and symptoms of vernal keratoconjunctivitis, compared to the control group. There was considerable improvement in clinical signs. Individual symptoms such as redness, itching, foreign body sensation, and tearing showed significant improvement at 6 months follow-up. The gradual improvement in symptoms until the last visit was statistically more significant within montelukast group. Mean VAS score showed statistically significant improvement in itching (p < 0.001) and redness (p < 0.008) in montelukast group even at 3 months. No adverse events were reported in either group. CONCLUSIONS Montelukast was found to be safe and effective as a long-term therapy to prevent relapse in moderate to severe vernal keratoconjunctivitis.
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Affiliation(s)
- Apurva Hardas
- grid.414133.00000 0004 1767 9806Cornea Unit, M & J Western Regional Institute of Ophthalmology, Ahmedabad, India
| | - Neera Singh
- grid.412122.60000 0004 1808 2016Pro Cyto Labs Pvt. Ltd., KIIT-TBI, Campus 11, KIIT University, Bhubaneswar, India
| | - Amrita Mohanty
- grid.417748.90000 0004 1767 1636Cornea and Anterior Segment Services, MTC Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Srikant Kumar Sahu
- grid.417748.90000 0004 1767 1636Cornea and Anterior Segment Services, MTC Campus, LV Prasad Eye Institute, Bhubaneswar, India
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Therapeutic Targets in Allergic Conjunctivitis. Pharmaceuticals (Basel) 2022; 15:ph15050547. [PMID: 35631374 PMCID: PMC9147625 DOI: 10.3390/ph15050547] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 02/02/2023] Open
Abstract
Allergic conjunctivitis (AC) is a common condition resulting from exposure to allergens such as pollen, animal dander, or mold. It is typically mediated by allergen-induced crosslinking of immunoglobulin E attached to receptors on primed conjunctival mast cells, which results in mast cell degranulation and histamine release, as well as the release of lipid mediators, cytokines, and chemokines. The clinical result is conjunctival hyperemia, tearing, intense itching, and chemosis. Refractory and chronic cases can result in ocular surface complications that may be vision threatening. Patients who experience even mild forms of this disease report an impact on their quality of life. Current treatment options range from non-pharmacologic therapies to ocular and systemic options. However, to adequately control AC, the use of multiple agents is often required. As such, a precise understanding of the immune mechanisms responsible for this ocular surface inflammation is needed to support ongoing research for potential therapeutic targets such as chemokine receptors, cytokine receptors, non-receptor tyrosine kinases, and integrins. This review utilized several published articles regarding the current therapeutic options to treat AC, as well as the pathological and immune mechanisms relevant to AC. This review will also focus on cellular and molecular targets in AC, with particular emphasis on potential therapeutic agents that can attenuate the pathology and immune mechanisms driven by cells, receptors, and molecules that participate in the immunopathogenesis and immunopathology of AC.
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Rasmussen MLR, Schou MG, Bach‐Holm D, Heegaard S, Jørgensen CAB, Kessel L, Wiencke AK, Subhi Y. Comparative efficacy of medical treatments for vernal keratoconjunctivitis in children and young adults: a systematic review with network meta-analyses. Acta Ophthalmol 2022; 100:35-44. [PMID: 33779061 DOI: 10.1111/aos.14858] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To systematically review the literature on the treatment of vernal keratoconjunctivitis (VKC) in children and young adults and conduct comparative efficacy analysis on clinical signs and symptoms using network meta-analyses. METHODS We systematically searched the databases PubMed/MEDLINE, EMBASE, Cochrane Central and Web of Science on 21 October 2019 for randomized controlled trials (RCT). Studies considered had patients with VKC < 20 years of age randomized into either intervention (any medical intervention) or comparator (active treatment, placebo treatment or non-treatment control), where pre-defined outcomes (data from ≥2 weeks and as close as possible to 2 months) of symptoms (itching, tearing, photophobia and foreign body sensation) and signs (hyperaemia, punctate keratitis, Horner-Trantas dots and macropapillae) were reported. Risk of bias within studies was evaluated using the Cochrane risk of bias tool. Comparisons were made using network meta-analyses. RESULTS We identified 39 studies with data on 2046 individuals. Twenty-three studies were eligible for quantitative analyses. None were systemic therapy. Temporal trend analysis showed that an initial focus on topical mast cell stabilizers turned to a focus on calcineurin inhibitors and a more diverse variety of pharmacological strategies. Studies varied in population, treatment duration and quality. The quantitative analysis revealed that efficacy of different therapies differed substantially across important clinical signs and symptoms, but there was a general trend of superior efficacy when using topical corticosteroids with stronger efficacy of the more potent corticosteroids. CONCLUSION We provide an overview of RCTs comparing the efficacy of treatments for VKC in children and young adults, which we find differs across symptoms and signs. Overall, we saw a general trend of superior efficacy with topical corticosteroids. However, our findings highlight the need for better studies, consensus on core outcomes and potential for individualized therapy.
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Affiliation(s)
| | - Marianne Guldager Schou
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Daniella Bach‐Holm
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Steffen Heegaard
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | | - Line Kessel
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Anne Katrine Wiencke
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Yousif Subhi
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
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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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36
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Biermann J, Bosche F, Eter N, Beisse F. Treating Severe Pediatric Keratoconjunctivitis with Topical Cyclosporine A. Klin Monbl Augenheilkd 2021; 239:1374-1380. [PMID: 34731901 DOI: 10.1055/a-1556-1182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The incidence of chronic keratoconjunctivitis, which potentially causes long-term loss of visual acuity due to corneal opacity, is considerably less common in children than in adults. It is therefore in danger of being overlooked. In children the appropriate treatment is therefore often introduced too late, or to an insufficient extent. In this article we would like to raise awareness about the diagnosis of chronic keratoconjunctivitis in children, and to present an effective treatment plan for severe stages of the disease. There are two forms of chronic keratoconjunctivitis that occur most frequently in children: hyperergic blepharokeratoconjunctivitis (hBKC) and vernal keratoconjunctivitis (VKC). With hBKC, the patient often has a history of recurring hordeolum and also presents with blepharitis; it is characterized by the marked presence of corneal neovascularization in the lower circumference of the cornea. VKC is typically characterized by changes under the upper eyelid, with marked changes to the superior limbus. If there is a risk of complications involving the cornea, or in the presence of such complications, a consistent long-term topical immunosuppressive and anti-inflammatory treatment is required. Both of these properties are combined in the active ingredient cyclosporine A. Other advantages of topical CSA treatment are its steroid-sparing effect and the long-term reduction of exacerbations. Parents need to be informed about the chronic nature of these two diseases and their tendency to recur; because of these characteristics, treatment, in most cases, should be envisaged for at least one year in order to effectively disrupt the complex immunologic processes. This safeguards the child's visual development and prevents amblyopia caused by scarring and astigmatism. We hope that the data presented will lower the barriers related to prescribing CSA for topical eye application in children.
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Affiliation(s)
- Julia Biermann
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
| | - Friederike Bosche
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
| | - Flemming Beisse
- Klinik für Augenheilkunde, Universitätsklinikum Heidelberg, Deutschland
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Leonardi A, Salami E, Feuerman OM, Cavarzeran F. The effects of the COVID-19 pandemic on the treatment of allergic eye diseases. Curr Opin Allergy Clin Immunol 2021; 21:500-506. [PMID: 34269742 PMCID: PMC9914169 DOI: 10.1097/aci.0000000000000766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To analyze if recommendations given before and during the COVID-19 pandemic are still a valid option for patients suffering of ocular allergy (OA). RECENT FINDINGS During the last year many doctors and patients requested suggestions for the treatment of OA patients in COVID-19 time. Most of them were given by phone calls and emails following the recommendations given by Scientific Societies. SUMMARY Considering the current multiple problems related to the COVID-19 pandemic, OA has not been considered a priority, even though patients need treatments. Topical antiallergic drugs are still the first option to treat all kind of OA, with the addition of topical corticosteroids in the severe forms of vernal and atopic keratoconjunctivitis (VKC and AKC) even in patients at risk of COVID-19. Topical immunomodulation is still recommended in severe forms of VKC and AKC unless the patient is infected. The number of patients treated with these drugs in our Center was similar than previous years. The risk to have a VKC patient affected by COVID-19 is similar to the general pediatric population but with a lower OR. In 2021, still in COVID-time, the management of OA should follow the previous recommendations with an update due to the risk of infection.
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Affiliation(s)
- Andrea Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua
| | - Elena Salami
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua
| | - Oren Mark Feuerman
- Department of Ophthalmology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Fabiano Cavarzeran
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua
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38
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Artesani MC, Esposito M, Sacchetti M, Sansone A, Romanzo A, Buzzonetti L, Fiocchi AG, Mennini M. Health-related quality of life in children at the diagnosis of Vernal Keratoconjunctivitis. Pediatr Allergy Immunol 2021; 32:1271-1277. [PMID: 33877712 DOI: 10.1111/pai.13520] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vernal keratoconjunctivitis (VKC) is a bilateral, chronic, allergic condition mostly affecting children. Clinical evaluations may not necessarily reflect the impact of the disease on the patients' health-related quality of life (HRQoL). We aimed to evaluate HRQoL in children at VKC diagnosis and to analyze correlations between HRQoL and clinical and laboratory variables. METHODS We studied 5- to 12-year-old patients with VKC. Data on clinical history, instrumental eye evaluations, blood examinations, and visual analog scale (VAS) for the subjective symptoms were collected. HRQoL was assessed through a disease-specific validated Quality of Life in Children with Vernal Keratoconjunctivitis (QUICK) questionnaire. RESULTS Seventy subjects were included in the analysis (female/male: 10/60; tarsal/mixed VKC form: 36/34). Clinical severity of VKC according to the Bonini scale was as follows: 14, mild; 36, moderate; and 20, severe. No significant difference was found concerning the distribution of patient age, gender, and history of allergic manifestations between tarsal and mixed VKC. A significant positive correlation was found between all QUICK scores and VAS scores, including different VAS subscale, while no significant correlation was found between QUICK scores and total sign scores, Schirmer's test, and corneal thickness. The presence of active severe VKC was not associated with worse HRQoL. CONCLUSIONS Our evidence shows that VKC patients experience impairment of HRQoL, especially in relation to the perception of symptoms independently of the ophthalmologic changes found, and that the QUICK questionnaire could be a useful tool to evaluate HRQoL in children with VKC, which may improve patients' classification and management.
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Affiliation(s)
- Maria Cristina Artesani
- Translational Specialized Pediatrics Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Marta Sacchetti
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Antonino Romanzo
- Ophthalmology Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Luca Buzzonetti
- Ophthalmology Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Giovanni Fiocchi
- Translational Specialized Pediatrics Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Maurizio Mennini
- Translational Specialized Pediatrics Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Dahlmann-Noor A, Muthusamy K, Hingorani M. Severe allergic eye disease: What to do and when? Clin Exp Allergy 2021; 51:989-991. [PMID: 34337807 DOI: 10.1111/cea.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Annegret Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, London, UK.,Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Melanie Hingorani
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Corneal Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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40
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Chigbu DI, Labib BA. Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives. Pharmaceuticals (Basel) 2021; 14:ph14070658. [PMID: 34358085 PMCID: PMC8308551 DOI: 10.3390/ph14070658] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 12/27/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC) is a complex and chronic, multifactorial Th2 cell-mediated chronic ocular surface inflammatory condition that typically affects predominantly male children in hot or warm climates. The primary symptom is intense ocular pruritus, often significant enough to affect activities of daily living. Clinical features differ from simple forms of allergic conjunctivitis in that they are more-or-less confined to the superior tarsus and limbus. There is also a risk of corneal involvement, which leads to irreversible vision loss in approximately 6% of patients. Right now, there is no standardized treatment protocol, and many of the currently available options are not effective in severe and recurrent cases. As such, it is imperative to understand this complex allergic immune response in order to identify future therapeutic targets. This review will focus on potential drug targets in VKC, with particular emphasis on immunomodulators and immunobiologic agents.
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Abstract
The red eye is one of the most common cause encountered in ophthalmic practice but a red eye is not always related to eye diseases, instead, it may be a clinical sign of several systemic diseases which may the alarmin signal of sight-threatening or life-threatening condition. Frequently, GPs, pediatricians, immunologists, and rheumatologists are the first landing of patients with a "red eye." This paper is addressed to non-ophthalmic specialists who may be faced with patients having a red eye. Inspection of the external eye under standard office lighting or with a bright light can be easily and accurately made by a general practitioner. Three major caveats should alert the GPs to promptly refer the patient to the ophthalmologist: the presence of pain; the loss of the natural corneal transparency and specular reflex; and any patient-described reduction of visual acuity. In most cases, a red eye is due to occasional and mild ocular surface reaction as consequence of exposure of the external eye to irritants and naturally occurring environmental agents. In these cases washing the eye with a tear lubricant may help in relief of symptoms. If this treatment fails within a few days, a consultation with an ophthalmologist is suggested. The role of the general physician is crucial in the decision making to judge the severity of the ocular condition. Managing a red eye often requires the support of other specialists. Our goal is not only to preserve vision but to globally cure the patient health.
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Affiliation(s)
- Stefano Bonini
- Department of Ophthalmology, University of Rome Campus BioMedico, Rome, Italy
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42
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Ghiglioni DG, Zicari AM, Parisi GF, Marchese G, Indolfi C, Diaferio L, Brindisi G, Ciprandi G, Marseglia GL, Miraglia Del Giudice M. Vernal keratoconjunctivitis: An update. Eur J Ophthalmol 2021; 31:2828-2842. [PMID: 34058899 DOI: 10.1177/11206721211022153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) are potentially severe and complex disease in its management among the various allergic eye diseases. In this regard, studies clarified the etiopathogenetic mechanisms. The workup should be multidisciplinary. The treatment includes topical and systemic medications with anti-inflammatory and immunosuppressant activity. However, a definition of nationally- and internationally-shared diagnostic protocols would also be needed and validated access to therapeutic options of proven safety and efficacy to avoid the use of galenic preparations, up to now still essential in the management of moderate-severe VKC. Finally, recognizing VKC and AKC, among rare diseases, at a national and international level would be an essential step to allow the management of VKC with adequate timings and settings within the National Health System.
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Affiliation(s)
- Daniele Giovanni Ghiglioni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - UOSD Pediatria Alta Intensità di Cura - Ambulatorio Allergologia Pediatrica, Milan, Italy
| | - Anna Maria Zicari
- UOS Allergologia Pediatrica, "Sapienza" Università di Roma, Rome, Italy
| | - Giuseppe Fabio Parisi
- UOC Broncopneumologia Pediatrica, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Catania, Catania, Italy
| | - Giuseppe Marchese
- Pediatra di libera scelta, Valcamonica, ATS della Montagna, Brescia, Italy
| | - Cristiana Indolfi
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Lucia Diaferio
- UOC Pediatria Generale e Pronto Soccorso, Azienda Ospedaliero-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Giulia Brindisi
- UOS Allergologia Pediatrica, "Sapienza" Università di Roma, Rome, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Michele Miraglia Del Giudice
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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Long-Term Safety and Efficacy of Tacrolimus 0.1% in Severe Pediatric Vernal Keratoconjunctivitis. Cornea 2021; 40:1395-1401. [PMID: 34029239 DOI: 10.1097/ico.0000000000002751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the safety and efficacy of tacrolimus 0.1% eye drops in a large population of pediatric patients affected by a severe form of vernal keratoconjunctivitis (VKC) who responded poorly to cyclosporine eye drops. METHODS This is a retrospective study based on standardized clinical charts and data collection of consecutive patients affected by severe VKC who responded poorly to cyclosporine eye drops topical treatment but treated with tacrolimus 0.1% eye drops with a follow-up of 18 months. Four clinical signs were graded for analysis: hyperemia, tarsal papillae, giant papillae, and limbal papillae. The blood tests for kidney and liver function and the tacrolimus level were studied. Visits were scheduled at baseline and at 3, 6, 12, and 18 months. Patients received tacrolimus 0.1% eye drops in both eyes 2 times daily. RESULTS Four hundred thirty-one patients were included. Three hundred twenty-five patients were affected by a seasonal form, whereas the remaining 106 by a perennial form. Statistical analysis on each single score showed a positive relevance (P < 0.001) from baseline to all other visits. No local or systemic complications were recorded. CONCLUSIONS Tacrolimus has been proposed as a treatment for severe forms of VKC. This study has confirmed the safety and efficacy of tacrolimus 0.1% eye drops in a large pediatric population of patients affected by a severe form of VKC who responded poorly to cyclosporine eye drops.
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Singh RB, Liu L, Yung A, Anchouche S, Mittal SK, Blanco T, Dohlman TH, Yin J, Dana R. Ocular redness - II: Progress in development of therapeutics for the management of conjunctival hyperemia. Ocul Surf 2021; 21:66-77. [PMID: 34000363 DOI: 10.1016/j.jtos.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
Conjunctival hyperemia is one of the most common causes for visits to primary care physicians, optometrists, ophthalmologists, and emergency rooms. Despite its high incidence, the treatment options for patients with conjunctival hyperemia are restricted to over-the-counter drugs that provide symptomatic relief due to short duration of action, tachyphylaxis and rebound redness. As our understanding of the immunopathological pathways causing conjunctival hyperemia expands, newer therapeutic targets are being discovered. These insights have also contributed to the development of animal models for mimicking the pathogenic changes in microvasculature causing hyperemia. Furthermore, this progress has catalyzed the development of novel therapeutics that provide efficacious, long-term relief from conjunctival hyperemia with minimal adverse effects.
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Affiliation(s)
- Rohan Bir Singh
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Lingjia Liu
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Ann Yung
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sonia Anchouche
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sharad K Mittal
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Tomas Blanco
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Thomas H Dohlman
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jia Yin
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Reza Dana
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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45
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Roumeau I, Coutu A, Navel V, Pereira B, Baker JS, Chiambaretta F, Bremond-Gignac D, Dutheil F. Efficacy of medical treatments for vernal keratoconjunctivitis: A systematic review and meta-analysis. J Allergy Clin Immunol 2021; 148:822-834. [PMID: 33819510 DOI: 10.1016/j.jaci.2021.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/16/2021] [Accepted: 03/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vernal keratoconjunctivitis (VKC) is a severe type of allergic conjunctivitis for which treatment strategies are still under debate. OBJECTIVES This study sought to conduct a systematic review and meta-analysis to evaluate the efficacy of medical treatments for VKC. METHODS The PubMed, Cochrane Library, Embase, and ScienceDirect databases were searched to assess the efficacy of treatments for VKC. Random-effect meta-analyses on changes in clinical scores of symptoms and signs between baseline and after treatment, stratified on treatment classes, were computed. Meta-regressions were searched for potential influencing parameters. RESULTS Included were 45 studies (27 randomized controlled trials and 18 prospective cohort studies), 1749 patients (78% were men; mean age, 11.2 years), and 12 different treatment classes. Mast cell stabilizers (MCSs; usually considered as first-line therapy), cyclosporine, and tacrolimus were the most studied drugs (in three-quarters of studies). Overall, all clinical scores improved. Total symptom and sign score decreased for MCSs (effect size, -3.19; 95% CI, -4.26 to -2.13), cyclosporine (effect size, -2.06; 95% CI, -2.72 to -1.40), and tacrolimus (effect size, -2.39; 95% CI, -3.36 to -1.43). No significant differences were shown depending on treatment classes, concentration, age, sex, baseline activity scores, and atopy. Sensitivity analyses demonstrated similar results. CONCLUSIONS This study confirms the efficacy of MCSs in the treatment of VKC. Efficacy of cyclosporine and tacrolimus did not differ, suggesting that tacrolimus is a good alternative to cyclosporine for severe cases of VKC. Further studies are needed to compare other drugs and their precise place in treatment strategy.
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Affiliation(s)
- Inès Roumeau
- Ophthalmology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Adrien Coutu
- Ophthalmology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Valentin Navel
- Ophthalmology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France; Translational Approach to Epithelial Injury and Repair Department, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Génétique Reproduction et Développement, Clermont-Ferrand, France.
| | - Bruno Pereira
- Biostatistics Unit, Clinical Research and Innovation Direction, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Julien S Baker
- Hong Kong Baptist University, Centre for Health and Exercise Science Research, Physical Education and Health, Kowlon Tong, Hong Kong
| | - Frédéric Chiambaretta
- Ophthalmology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France; Translational Approach to Epithelial Injury and Repair Department, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Génétique Reproduction et Développement, Clermont-Ferrand, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department, University Hospital Necker Enfants Malades, Paris, France; Sorbonne Paris Cité University, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Cordeliers Search Centre, Paris, France
| | - Frédéric Dutheil
- Physiological and Psychosocial Stress Department, Laboratoire de Psychologie Sociale et Cognitive, Centre National de la Recherche Scientifique, Université Clermont Auvergne, Clermont-Ferrand, France; Preventive and Occupational Medicine Department, WittyFit, Centre Hospitalier Universitaire Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Faculty of Health, School of Exercise Science, Australian Catholic University, Melbourne, Australia
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46
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Deshmukh R, Ting DSJ, Elsahn A, Mohammed I, Said DG, Dua HS. Real-world experience of using ciclosporin-A 0.1% (Ikervis) in the management of ocular surface inflammatory diseases. Br J Ophthalmol 2021; 106:1087-1092. [PMID: 33687999 PMCID: PMC9340021 DOI: 10.1136/bjophthalmol-2020-317907] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To report the real-world experience of using topical ciclosporin, Ikervis, in the management of ocular surface inflammatory diseases (OSIDs). METHODS This was a retrospective study of patients treated with Ikervis for OSIDs at the Queen's Medical Centre, Nottingham, between 2016 and 2019. Relevant data, including demographics, indications, clinical parameters, outcomes and adverse events, were collected and analysed for patients who had completed at least 6 months follow-up. For analytic purpose, clinical outcome was categorised as 'successful' (resolved or stable disease), 'active disease' and 'drug intolerance'. RESULTS 463 patients were included; mean age was 51.1±21.6 years, with a 59.0% female predominance. Mean follow-up was 14.6±9.2 months. The most common diagnosis was dry eye disease (DED; 322, 69.5%), followed by allergic eye disease (AED; 53, 11.4%) and ocular mucous membrane pemphigoid/Steven-Johnson syndrome (OMMP/SJS; 38, 8.2%). Successful treatment was achieved in 343 (74.1%) patients, with 44 (9.5%) requiring additional treatment and 76 (16.4%) reporting drug intolerance. The efficacy of Ikervis was highest in DED (264, 82.0%), followed by OMMP/SJS (25, 65.8%) and post-keratoplasty (7, 50.0%; p<0.001). Logistic regression analysis demonstrated age <70 years (p=0.007), AED (p=0.002) and OMMP/SJS (p=0.001) as significant predictive factors for Ikervis intolerance. AED and post-keratoplasty were 8.16 times (95% CI, 2.78 to 23.99) and 13.98 times (95% CI, 4.22 to 46.28), respectively, more likely to require additional treatment compared with DED. CONCLUSIONS Ikervis is a useful steroid-sparing topical treatment for managing OSIDs in the real-world setting. Preparations with improved tolerability are needed to benefit a larger number of patients.
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Affiliation(s)
- Rashmi Deshmukh
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK
| | - Darren Shu Jeng Ting
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK.,Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Ahmad Elsahn
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK.,Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Imran Mohammed
- Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Dalia G Said
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK.,Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Harminder Singh Dua
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK .,Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, Nottinghamshire, UK
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Shin J, Rho CR, Hyon JY, Chung TY, Yoon KC, Joo CK. A Randomized, Placebo-Controlled Phase II Clinical Trial of 0.01% or 0.02% Cyclosporin A with 3% Trehalose in Patients with Dry Eye Disease. J Ocul Pharmacol Ther 2021; 37:4-11. [PMID: 33449860 DOI: 10.1089/jop.2020.0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: To compare the efficacy and safety of HU00701 (0.01% cyclosporin A + 3% trehalose), HU007 (0.02% cyclosporin A + 3% trehalose) (all w/v), and placebo in patients with moderate to severe dry eye disease (DED). Methods: This was a multicenter, randomized, double-masked, parallel, placebo-controlled phase II study. In total, 114 patients were randomly assigned to the HU00701, HU007, placebo, or reference group. There was a 2-week run-in period before the 12-week intervention. Efficacy and safety were evaluated every 4 weeks. Results: The primary endpoint, change in corneal staining score from baseline to week 12, did not differ significantly among the control, HU00701, and HU007 groups in the full analysis. Of the secondary endpoints, only the tear film breakup time differed significantly at week 12 between the placebo and HU00701 groups. Twenty adverse events were reported by 15 patients, but the rate did not differ significantly among the 4 groups. The laboratory test, vital signs, and physical examination data showed no significant changes during the study. Conclusions: HU00701 and HU007 are safe, and HU007 effectively reduces the corneal staining score in patients with moderate-to-severe DED (NCT02917512).
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Affiliation(s)
- Jeongah Shin
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Seoul, Republic of Korea
| | - Chang Rae Rho
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Seoul, Republic of Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University, Chonnam National University Hospital, Gwangju, Korea
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48
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Elsürer Ç, Bozkurt B, Aksoy Md C, Bozkurt MK. Evaluation of Olfactory Function in Children With Vernal Keratoconjunctivitis. Am J Rhinol Allergy 2020; 35:535-540. [PMID: 33225727 DOI: 10.1177/1945892420975650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vernal keratoconjunctivitis (VKC) is a chronic, severe allergic disease of the conjunctiva, which mostly affects young males in early to mid-childhood. There is a high incidence of asthma, allergic rhinitis (AR) and eczema among patients with VKC. It is unknown if VKC patients have abnormal olfactory dysfunction, and if so, whether this is related to AR. OBJECTIVE Our aim was to evaluate olfactory function in children with VKC, with and without comorbid AR, in comparison to healthy children without VKC. MATERIALS AND METHODS Thirty-nine VKC patients and 32 healthy children were included in the study. After eye and ear, nose and throat (ENT) examination, acoustic rhinometry and modified Connecticut Chemosensory Clinical Research Center (CCCRC) tests were performed and the test results were compared between VKC and control groups and between VKC children with or without AR. A p value <0.05 was regarded as statistically significant. RESULTS The VKC group included 25 males (64.1%) with a mean age of 11.13 ± 3.22 years, while the control group included 26 males (81.3%) with a mean age of 12.50 ± 2.13 years (p > 0.05 for both age and gender). Fourteen VKC patients (35.9%) had either positive prick test or elevated serum specific IgE levels against house dust mites and pollens. Mean odor thresholds did not differ between the two groups (p = 0.084), while mean odor identification and CCCRC score were statistically significantly lower in VKC group (6.00 ± 1.02 and 6.81 ± 0.75, respectively) compared to control group (7.06 ± 0.77 and 7.5 ± 0.41, respectively) (p < 0.05, both). Thirteen VKC patients had co-associated AR (33.3%). In VKC patients with AR, mean odor threshold and identification scores were even lower (5.31 ± 0.95 and 6.23 ± 0.78, respectively) (p < 0.05, both). CONCLUSION Olfactory function was found to be mildly impaired in children with VKC, especially when co-associated with AR. Therefore, loss of smell should be asked as an extraocular symptom.
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Affiliation(s)
- Çağdaş Elsürer
- Department of Otolaryngology, Selcuk University School of Medicine, Konya, Turkey
| | - Banu Bozkurt
- Department of Ophthalmology, Selcuk University School of Medicine, Konya, Turkey
| | - Ceren Aksoy Md
- Department of Otolaryngology, Selcuk University School of Medicine, Konya, Turkey
| | - Mete K Bozkurt
- Department of Otolaryngology, Selcuk University School of Medicine, Konya, Turkey
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49
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Zicari AM, Brindisi G, De Castro G, Lollobrigida V, Nebbioso M, Duse M. Is oxidative stress involved in vernal keratoconjunctivitis? Results from a pilot study in children. Pediatr Allergy Immunol 2020; 31 Suppl 26:52-56. [PMID: 33236421 DOI: 10.1111/pai.13382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vernal keratoconjunctivitis (VKC) is a rare chronic conjunctivitis characterized by a predominantly eosinophil-mediated inflammatory disorder that could develop critical complications such as blindness. Oxidative stress plays a pivotal role in the pathogenesis of several allergic diseases. The role of oxidative stress has been hypothesized in VKC, but no study explored this issue. Furthermore, cyclosporine A (CsA) exerts an anti-inflammatory and antioxidant action on the conjunctiva. This study aimed to assess the oxidative stress in VKC patients and controls and to study the effect of CsA on oxidative stress in these subjects. METHODS Thirty-six consecutive children, including 12 VKC (nine males, 75%; mean age 10.17; SD ± 2.48) patients without treatment, 12 VKC patients treated with CsA (nine males, 75%; mean age 9.08; SD ± 2.75), and 12 controls (CT) (seven males, 58%; mean age 8.58; SD ± 1.78), were recruited. A cross-sectional study was performed to compare H2 O2 in the serum with that in the tears of these children. RESULTS Compared with CT and VKC children treated with CsA, VKC untreated children had significantly higher values of hydrogen peroxide (H2 O2 ) in the serum and the tears. No significant differences were observed between CT and VKC treated with CsA. A significant correlation was found at the linear regression analysis between serum and tear H2 O2 levels. CONCLUSION This study provides the first report attesting that patients with VKC have high oxidative stress; furthermore, it suggests that CsA could have an anti-inflammatory and antioxidant action that could be useful to prevent the poor VKC outcome.
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Affiliation(s)
| | - Giulia Brindisi
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | | | | | - Marcella Nebbioso
- Department of Sense Organs, Sapienza" University of Rome, Rome, Italy
| | - Marzia Duse
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
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50
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Liu YC, Lin MTY, Ng AHC, Wong TT, Mehta JS. Nanotechnology for the Treatment of Allergic Conjunctival Diseases. Pharmaceuticals (Basel) 2020; 13:E351. [PMID: 33138064 PMCID: PMC7694068 DOI: 10.3390/ph13110351] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Allergic conjunctivitis is one of the most common external eye diseases and the prevalence has been increasing. The mainstay of treatment is topical eye drops. However, low bioavailability, low ocular drug penetration, transient resident time on the ocular surface due to tear turnover, frequent topical applications and dependence on patient compliance, are the main drawbacks associated with topical administration. Nanotechnology-based medicine has emerged to circumvent these limitations, by encapsulating the drugs and preventing them from degradation and therefore providing sustained and controlled release. Using a nanotechnology-based approach to load the drug is particularly useful for the delivery of hydrophobic drugs such as immunomodulatory agents, which are commonly used in allergic conjunctival diseases. In this review, different nanotechnology-based drug delivery systems, including nanoemulsions, liposomes, nanomicelles, nanosuspension, polymeric and lipid nanoparticles, and their potential ophthalmic applications, as well as advantages and disadvantages, are discussed. We also summarize the results of present studies on the loading of immunomodulators or nonsteroidal anti-inflammatory drugs to nano-scaled drug delivery systems. For future potential clinical use, research should focus on the optimization of drug delivery designs that provide adequate and effective doses with safe and satisfactory pharmacokinetic and pharmaco-toxic profiles.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.-C.L.); (M.T.-Y.L.)
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore 168751, Singapore;
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Molly Tzu-Yu Lin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.-C.L.); (M.T.-Y.L.)
| | - Anthony Herr Cheun Ng
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798, Singapore;
| | - Tina T. Wong
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore 168751, Singapore;
- Ocular Therapeutics and Drug Delivery Group, Singapore Eye Research Institute, Singapore 169856, Singapore
- Department of Glaucoma, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Jodhbir S. Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.-C.L.); (M.T.-Y.L.)
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore 168751, Singapore;
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
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