Doan Serge, Amat Flore, Gabison Eric, Saf Sarah, Cochereau Isabelle, Just Jocelyne
Ophthalmology Department of Fondation A de Rothschild and Hôpital Bichat, Paris, France.
Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Ophthalmol Ther. 2017 Jun;6(1):195-206. doi: 10.1007/s40123-016-0074-2. Epub 2016 Dec 1.
Vernal keratoconjunctivis (VKC) is a severe form of pediatric ocular allergy, characterized by acute and chronic corneoconjunctival inflammation that may lead to visual sequelae. Although topical immunosuppressive drugs such as cyclosporine are usually effective, some severe forms may be refractory and require prolonged steroid therapy. Very few papers report the use of omalizumab in VKC in the literature. In the present study, we describe our clinical experience with omalizumab in severe VKC children.
We retrospectively reviewed the files of four boys treated with omalizumab because of severe VKC, defined as persistent corneal inflammation despite continuous topical 2% cyclosporine and steroid eye drops. We also performed a literature review.
Four boys, aged 7-13 years old, were treated. All children had asthma and one had severe lid eczema. Two patients had required intrapalpebral depot-steroid injections. Omalizumab was administered every 2 weeks by subcutaneous injections, at doses varying from 450 to 600 mg per injection. Three patients out of four responded to the treatment, with a decrease in global symptoms (median symptom rating decreasing from 89 to 29 on a 100-mm visual analog scale), frequency and in duration of the inflammatory flares, and also a decreased need for topical steroid. Their median clinical grade decreased from 4 to 3 (Bonini grading). However, the response was incomplete and they still had inflammatory corneoconjunctival flares despite continuous topical cyclosporine. On the other hand, asthma and lid eczema were completely controlled in these three patients. The fourth child did not respond to omalizumab and needed oral steroids for his VKC and his asthma. Noticeably, this latter patient did not have detectable sensitization to any allergen, contrary to the other cases. The treatment was stopped in this refractory case, but is still ongoing in all other cases, with a median duration of 33 months (range 16-42 months). In the literature (four cases), omalizumab may have a more complete efficacy in some cases, but the results are still variable.
Omalizumab is an interesting treatment in severe refractory forms of VKC, but its efficacy is incomplete in these very severe cases.
春季角结膜炎（VKC）是一种严重的儿童眼部过敏疾病，其特征为急性和慢性角膜结膜炎症，可能导致视力后遗症。尽管局部免疫抑制药物如环孢素通常有效，但一些严重形式可能难以治疗，需要长期使用类固醇疗法。文献中很少有关于奥马珠单抗用于VKC的报道。在本研究中，我们描述了奥马珠单抗治疗重度VKC患儿的临床经验。
我们回顾性分析了4名因重度VKC接受奥马珠单抗治疗的男孩的病历，重度VKC定义为尽管持续使用局部2%环孢素和类固醇眼药水，但角膜炎症仍持续存在。我们还进行了文献综述。
治疗了4名年龄在7至13岁的男孩。所有儿童均患有哮喘，1名儿童患有严重的睑湿疹。2名患者需要进行睑内注射长效类固醇。奥马珠单抗每2周皮下注射一次，每次剂量为450至600毫克。4名患者中有3名对治疗有反应，总体症状减轻（在100毫米视觉模拟量表上，症状评分中位数从89降至29），炎症发作的频率和持续时间减少，局部类固醇的需求也减少。他们的临床分级中位数从4降至3（博尼尼分级）。然而，反应并不完全，尽管持续使用局部环孢素，他们仍有角膜结膜炎症发作。另一方面，这3名患者的哮喘和睑湿疹得到了完全控制。第四名儿童对奥马珠单抗无反应，其VKC和哮喘需要口服类固醇治疗。值得注意的是，与其他病例不同，后一名患者对任何过敏原均无可检测到的致敏反应。在这个难治性病例中停止了治疗，但在所有其他病例中仍在继续，治疗的中位持续时间为33个月（范围16至42个月）。在文献（4例）中，奥马珠单抗在某些情况下可能有更完全的疗效，但结果仍然存在差异。
奥马珠单抗是治疗重度难治性VKC的一种有意义的治疗方法，但在这些非常严重的病例中其疗效并不完全。
