Mah Francis, Milner Mark, Yiu Samuel, Donnenfeld Eric, Conway Taryn M, Hollander David A
University of Pittsburgh, Pittsburgh, PA.
Clin Ophthalmol. 2012;6:1971-6. doi: 10.2147/OPTH.S30261. Epub 2012 Nov 28.
Chronic dry eye disease often requires long-term therapy. Tear film alterations in the setting of dry eye may include reduced tear volume as well as an increase in inflammatory cytokines and osmolarity. Topical cyclosporine ophthalmic emulsion 0.05% (Restasis(®); Allergan Inc, Irvine, CA) is indicated to increase tear production in patients with dry eye and reduced tear production presumed to be due to ocular inflammation. This study was designed to evaluate the efficacy of a second trial of topical cyclosporine in patients with dry eye who were previously considered treatment failures.
This multicenter (three cornea practices) retrospective chart review evaluated clinical outcomes in patients with dry eye who received a second trial of cyclosporine after a prior treatment failure, defined as prior discontinuation of topical cyclosporine after less than 12 weeks.
Thirty-five patients, most of whom were female (71.4%) and Caucasian (62.9%), were identified. Prior discontinuation was most commonly due to burning/stinging (60%). The median duration of second treatment was 10 months (range 1 week to 45 months). Physician education was provided in the second trial in 97.1% of cases. At initiation of the second trial of cyclosporine, 10 (28.6%) patients received courses of topical corticosteroids. Physicians reported on a questionnaire that 80% of patients achieved clinical benefit with a second trial of cyclosporine.
A repeat trial with topical cyclosporine can achieve clinical success. Direct patient education via the physician and staff may be key to success. Proper patient education may overcome adherence issues, particularly with respect to the need for long-term treatment of chronic dry eye. This study has the usual limitations associated with a retrospective chart review, and future prospective studies are warranted.
慢性干眼病通常需要长期治疗。干眼病患者的泪膜改变可能包括泪液量减少以及炎性细胞因子和渗透压增加。0.05%的局部用环孢素眼用乳剂（Restasis(®)；爱尔康公司，加利福尼亚州欧文市）被用于增加干眼且泪液分泌减少（推测是由于眼部炎症所致）患者的泪液分泌。本研究旨在评估局部用环孢素再次治疗先前被认为治疗失败的干眼患者的疗效。
这项多中心（三家角膜诊疗机构）回顾性病历审查评估了干眼患者在先前治疗失败后接受环孢素再次治疗的临床结局，先前治疗失败定义为局部用环孢素使用少于12周后停药。
共纳入35例患者，其中大多数为女性（71.4%）和白种人（62.9%）。先前停药最常见的原因是烧灼感/刺痛感（60%）。第二次治疗的中位持续时间为10个月（范围为1周至45个月）。97.1%的病例在第二次治疗时提供了医生指导。在开始第二次环孢素治疗时，10例（28.6%）患者接受了局部用皮质类固醇疗程。医生在问卷中报告称，80%的患者在第二次环孢素治疗中获得了临床益处。
局部用环孢素再次治疗可取得临床成功。通过医生和工作人员对患者进行直接指导可能是成功的关键。适当的患者指导可能会克服依从性问题，特别是对于慢性干眼病长期治疗的必要性。本研究具有回顾性病历审查通常存在的局限性，未来有必要进行前瞻性研究。
