Vision Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
Cornea. 2012 May;31(5):509-13. doi: 10.1097/ICO.0b013e31818c69ef.
To compare the efficacy of topical cyclosporine 0.05% (tCsA) and combined treatment with 1% methylprednisolone acetate for the treatment of moderate-to-severe chronic dry eye.
Forty-four patients with moderate-to-severe dry eye who had not responded to conventional treatment were treated with tCsA for 3 months. Twenty-one subjects (Group 1) were treated with 1% methyl prednisolone acetate and tCsA for the initial 3 weeks, and treated with tCsA only thereafter, and 23 subjects (Group 2) were treated with tCsA only. Symptom scores, tear break-up time (TBUT), Schirmer score, and corneal and conjunctival fluorescein staining were evaluated before and at 1, 2, and 3 months after treatment. Proinflammatory factors, interleukin-6 (IL-6), and interleukin-8 (IL-8) tear concentration were measured before treatment and at 3 months.
Symptom scores, Schirmer scores, TBUT score, corneal fluorescein, and conjunctival staining showed significant improvement at 1 month compared to baseline in group 1 (all P < 0.001), and all the same but few exceptions in group 2 (P = 0.002 on Schirmer, P = 0.267 on cornea stating). In symptom scores, Schirmer scores, and corneal staining, greater improvements were observed for group 1 at 1 month compared to group 2 (P < 0.001, P = 0.039, P = 0.01, respectively). However, in TBUT score and conjunctival staining, there were no between-group differences (P = 0.277, P = 0.254, respectively). The time interval from treatment initiation to symptom relief was shorter for group 1 than group 2. Both groups showed decreased tear IL-6 and IL-8 concentrations at 3 months compared to baseline levels (P < 0.05). However, no between-group differences were noted in mean concentrations of IL-6 and IL-8 at baseline and at 3 months.
Treatment with tCsA appears to be safe and effective in moderate-to-severe chronic dry eye. Additional short-term use of a topical steroid had the benefit of providing faster symptom relief and improvement of ocular sign without serious complications.
比较局部环孢素 0.05%（tCsA）与 1%醋酸甲基泼尼松龙联合治疗中重度慢性干眼症的疗效。
对 44 例经常规治疗无效的中重度干眼症患者进行 tCsA 治疗 3 个月。21 例患者（第 1 组）在最初的 3 周内使用 1%醋酸甲基泼尼松龙和 tCsA 治疗，此后仅使用 tCsA 治疗，23 例患者（第 2 组）仅使用 tCsA 治疗。在治疗前、治疗后 1、2 和 3 个月时评估症状评分、泪膜破裂时间（TBUT）、泪液分泌试验（Schirmer 评分）以及角膜和结膜荧光素染色。在治疗前和治疗 3 个月时测量促炎因子白细胞介素-6（IL-6）和白细胞介素-8（IL-8）的泪液浓度。
第 1 组在治疗后 1 个月时症状评分、Schirmer 评分、TBUT 评分、角膜荧光素和结膜染色均较基线时显著改善（均 P < 0.001），第 2 组除 Schirmer 评分（P = 0.002）和角膜染色（P = 0.267）外，其他各项均较基线时显著改善（均 P < 0.001）。第 1 组在治疗后 1 个月时的症状评分、Schirmer 评分和角膜染色改善程度均明显大于第 2 组（均 P < 0.001，P = 0.039，P = 0.01）。然而，在 TBUT 评分和结膜染色方面，两组间无差异（P = 0.277，P = 0.254）。第 1 组从治疗开始到症状缓解的时间间隔短于第 2 组。两组在治疗后 3 个月时的泪液 IL-6 和 IL-8 浓度均低于基线水平（均 P < 0.05）。然而，两组在基线和治疗 3 个月时的 IL-6 和 IL-8 平均浓度均无差异。
tCsA 治疗中重度慢性干眼症安全有效。短期附加局部皮质类固醇治疗可更快缓解症状，改善眼部体征，且无严重并发症。
