Liendo Vera Lucia, Vola Maria Eugenia, Barreiro Telma Pereira, Wakamatsu Tais Hitomi, Gomes José Álvaro Pereira, Santos Myrna Serapião Dos
Department of Ophthalmology, Universidade Federal de São Paulo São Paulo, SP, Brazil.
Arq Bras Oftalmol. 2017 Jul-Aug;80(4):211-214. doi: 10.5935/0004-2749.20170052.
: Administration of eye drops containing antihistamines or sodium cromoglycate and its derivatives for the treatment of allergic keratoconjunctivitis is often insufficient and usually requires the addition of corticosteroids. However, the risk of complications, such as glaucoma and cataract, limits the use of corticosteroids to short courses, resulting in inadequate long-term treatment response. Immunosuppressive drugs have been considered as a valid alternative to steroids for atopic keratoconjunctivitis and vernal keratoconjunctivitis. This study aimed to evaluate the use of topical tacrolimus (TCL) in improving the clinical signs of severe allergic keratoconjuctivitis in children.
: Patients with severe allergic keratoconjunctivitis associated with corneal epitheliopathy, gelatinous limbal infiltrates, and/or papillary reaction, along with a history of recurrences and resistance to conventional topical anti-allergy agents, were included in this open clinical trial. Patients were treated with 0.03% TCL ointment for ocular use. A severity score ranging from 0 to 9, with 9 being the highest and 0 being the lowest, was assigned based on signs observed on biomicroscopy prior to and following TCL treatment.
: Analyses included 66 eyes of 33 patients. After a mean follow-up period of 13 months (range, 12-29 months), TCL treatment significantly decreased the mean symptom score severity for the right (from 5.56 ± 1.18 to 2.76 ± 1.5; p<0.001) and left (from 5.94 ± 1.16 to 2.86 ± 1.64; p<0.001).
: Topical TCL was effective and significantly improved the clinical signs of allergic keratoconjuctivitis in children. Thus, it is a potential new option for severe and challenging cases of ocular allergy.
使用含有抗组胺药或色甘酸钠及其衍生物的眼药水治疗过敏性角结膜炎往往效果不佳，通常需要加用皮质类固醇。然而，诸如青光眼和白内障等并发症的风险限制了皮质类固醇仅能短期使用，导致长期治疗反应不足。免疫抑制药物已被视为特应性角结膜炎和春季角结膜炎中类固醇的有效替代药物。本研究旨在评估局部使用他克莫司（TCL）改善儿童重度过敏性角结膜炎临床体征的效果。
本开放性临床试验纳入了患有重度过敏性角结膜炎且伴有角膜上皮病变、胶样角膜缘浸润和/或乳头反应，以及有复发史且对传统局部抗过敏药物耐药的患者。患者使用0.03%的眼部用TCL软膏进行治疗。根据TCL治疗前后在生物显微镜下观察到的体征，分配一个从0到9的严重程度评分，9分为最高，0分为最低。
分析包括33例患者的66只眼。平均随访13个月（范围12 - 29个月）后，TCL治疗显著降低了右眼（从5.56±1.18降至2.76±1.5；p<0.001）和左眼（从5.94±1.16降至2.86±1.64；p<0.001）的平均症状严重程度评分。
局部使用TCL有效，且显著改善了儿童过敏性角结膜炎的临床体征。因此，对于严重且具有挑战性的眼部过敏病例，它是一个潜在的新选择。
