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Gagrani M, Conner EA, Scanga H, Hiasat JG, Tripi KS, Pihlblad MS, Jhanji V, Nischal KK. Thygeson's superficial punctate keratitis in children. Eye (Lond) 2023; 37:3455-3460. [PMID: 37085721 PMCID: PMC10630495 DOI: 10.1038/s41433-023-02533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/07/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE To describe the first paediatric case series of Thygesons' superficial punctate keratitis (TSPK) with management outcomes. METHODS A retrospective chart review was done for all children either diagnosed at initial presentation or referred with TSPK from 01/2012 to 08/2021 at a tertiary children's hospital. Records were assessed for signs, symptoms, diagnosis, steroid and cyclosporine 0.05% use. The main outcome measures were visual acuity, treatment response and total steroid exposure. RESULTS Fifteen children (7 females), mean age at presentation 8 ± 4 years were included. All had bilateral disease and a BCVA of >20/40 in the better eye. All patients received topical fluorometholone 0.1%, (FML) initially. 80% had a good response to FML. Corneal scraping was done to exclude infectious causes in four cases due to poor initial response or clinical suspicion. All 4 needed EUA for scraping and anterior segment OCT, after which 2 had molecularly confirmed TGFBI-related stromal dystrophy. For the rest, slow steroid taper was done every 4-6 weeks and recurrences were treated by increasing steroid frequency. Cyclosporine 0.05% was started in nine patients (69%), 8 ± 6 months after initial presentation. The decrease in total steroid exposure per week after starting cyclosporine was statistically significant (p < 0.05). CONCLUSION Children with TSPK respond quickly to steroids, however, recurrences are common, necessitating a slow taper. Non-response to steroid needs careful reconsideration of the diagnosis and may necessitate the use of an EUA. Using cyclosporine 0.05% reduces the total steroid exposure in TSPK.
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Affiliation(s)
- Meghal Gagrani
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth A Conner
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hannah Scanga
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamila G Hiasat
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly Schooping Tripi
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Matthew S Pihlblad
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vishal Jhanji
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Recent advances in novel formulation approaches for tacrolimus delivery in treatment of various ocular diseases. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Thygeson’s superficial punctate keratitis. Graefes Arch Clin Exp Ophthalmol 2022; 260:1837-1841. [DOI: 10.1007/s00417-022-05617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/04/2022] Open
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Bernales A, Berger O, Hamada S. Topical tacrolimus for the treatment of external eye inflammation in children. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2039628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Osvaldo Berger
- Corneoplastic department. Queen Victoria Hospital. East Grinstead. United Kingdom
| | - Samer Hamada
- Corneoplastic department. Queen Victoria Hospital. East Grinstead. United Kingdom
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Priyadarshini SR, Roy A, Das S. Thygeson's superficial punctate keratopathy: A review and case series. Indian J Ophthalmol 2021; 69:806-811. [PMID: 33727439 PMCID: PMC8012948 DOI: 10.4103/ijo.ijo_1624_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thygeson's superficial punctate keratitis (TSPK) is a chronic disorder with episodes of exacerbations and remissions which span over years to decades. Typical features of the disease include multiple, grayish white, intraepithelial corneal lesions with minimal or no conjunctival involvement. The exact etiopathogenesis of this entity is unknown. However, it may have a genetic association with HLA-DR3, an antigen proved to be associated with immunogenic responses. Treatment of the disease consists of artificial tears, topical corticosteroids, topical cyclosporine, topical tacrolimus, or usage of soft contact lenses. TSPK should be considered as a diagnosis of exclusion in cases of bilateral superficial punctate keratopathy of long duration. Thirteen patients of TSPK were examined during the last 6 years (2014-2019) at our Institute. Visual acuity was 20/20 to 20/30 in majority cases. All patients required lubricants.
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Affiliation(s)
| | - Aravind Roy
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sujata Das
- Cornea & Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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Saad R, Saad S, Haigh O, Molinari D, Labetoulle M, Rousseau A. Using pre-existing social networks to determine the burden of disease and real-life needs in rare diseases: the example of Thygeson's superficial punctate keratitis. Orphanet J Rare Dis 2021; 16:55. [PMID: 33516254 PMCID: PMC7847580 DOI: 10.1186/s13023-021-01707-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Thygeson’s superficial punctate keratitis (TSPK) is a rare and still poorly understood disease of the ocular surface, responsible for recurrent episodes of photophobia and eye pain. While TSPK is considered as a benign condition, a subset of patients has frequent recurrences or even chronic disease, two situations in which there are currently no therapeutic guidelines. We used a preexisting Facebook TSPK patient support group to assess the clinical journey and the burden of disease of TSPK. Results An online survey was sent to the patient support group. The first part of the questionnaire gathered information on demographics and the patient’s clinical journey [diagnostic modalities, symptoms, duration and frequency of recurrent episodes (RE), efficacy and tolerance to treatments]. The second part focused on quality of life (QoL) using the Ocular Surface Disease-QoL (OSD-QoL) questionnaire. Seventy-two patients out of 595 members of the support group completed the questionnaire during the 3-months study period. Eighty percent of patients developed symptoms before 30 years old, and 47% reported a delay in the diagnosis above 1 year. Sixty percent of patients reported over 5 RE yearly, and 18% of RE lasted more than 3 months. Forty percent of all patients used cyclosporine eyedrops (50% of those with > 5 episodes/year) and it was perceived as effective by 72% of these patients. The impact on daily life activities was judged as severe by 22% of patients, while 38% reported reduced professional activity and 80% were deeply saddened by their eye condition. Conclusion TSPK patients may present with frequent recurrences and/or chronic disease, that result in a severe impact on QoL, and an off-label use of topical immunomodulatory eye drops, suggesting the urgent need for controlled studies. The utility of using social networks for rare ophthalmic disease research includes, faster data collection, data from patients across the globe, and also raises relevant questions about their real needs.
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Affiliation(s)
- Rana Saad
- Service d'Ophtalmologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, Centre de Référence Maladies Rares en Ophtalmologie (OPHTARA), 78, rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Sami Saad
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Oscar Haigh
- CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses, Le Kremlin-Bicêtre, France
| | - Domitille Molinari
- Unité de Recherche Clinique Paris-Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Marc Labetoulle
- Service d'Ophtalmologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, Centre de Référence Maladies Rares en Ophtalmologie (OPHTARA), 78, rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.,CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses, Le Kremlin-Bicêtre, France
| | - Antoine Rousseau
- Service d'Ophtalmologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, Centre de Référence Maladies Rares en Ophtalmologie (OPHTARA), 78, rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. .,CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses, Le Kremlin-Bicêtre, France.
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