Ophthalmology Department, Benha University, Benha, Egypt.
Magrabi Eye Hospital, Eastern Province, Khober City , Kingdom of Saudi Arabia.
Graefes Arch Clin Exp Ophthalmol. 2022 Jan;260(1):353-361. doi: 10.1007/s00417-021-05356-0. Epub 2021 Aug 28.
To compare the effects of ciclosporine A (2%) eye drop and tacrolimus (0.03%) eye ointment on children with vernal keratoconjunctivitis (VKC) who were not responding to corticosteroid eye drops.
A prospective comparative study was carried out on children who were diagnosed with refractory VKC at the ophthalmology clinic in Benha University, Delta area, Egypt, during the period from October 2019 to February 2020.
Fifty-nine patients completed this study. Regarding the individual symptom score, redness, burning, photophobia, and foreign body sensation were significantly reduced in the tacrolimus group compared to those in the ciclosporine A group during the 1st week (p < 0.05). Moreover, the tacrolimus group showed a statistically significant reduction in burning and foreign body sensation at the 4th week (both p = 0.032), and in redness and burning sensation at the 12th week compared to those in the ciclosporine A group (p = 0.005 and 0.048, respectively). The tacrolimus group showed significantly lower mean scores for tarsal conjunctival papillary hypertrophy at the 1st week and 12th week (p = 0.037 and 0.046, respectively), and for punctate erosion and cobblestone papillae at the 1st week (p = 0.029 and 0.037, respectively) than the ciclosporine group. Failure of treatment was observed in 6 patients (19.35%) in the ciclosporine A group and in 5 patients (17.85%) in the tacrolimus group. No serious side effects were detected in any group.
A higher reduction in inflammatory symptoms and signs as well as compliance with tacrolimus 0.03% eye ointment than with ciclosporine A 2% eye drops was observed. Moreover, long-term medication for refractory cases is needed to control inflammation. Overall, our finding suggested that ciclosporine A eye drops and tacrolimus eye ointment could be considered as corticosteroid-sparing drugs in the management of children with refractory VKC.
比较环孢素 A（2%）滴眼液和他克莫司（0.03%）眼膏在对皮质类固醇滴眼液无反应的春季角结膜炎（VKC）患儿中的疗效。
在 2019 年 10 月至 2020 年 2 月期间，在埃及贝尼苏韦夫大学眼科诊所对被诊断为难治性 VKC 的患儿进行了一项前瞻性对照研究。
59 例患者完成了这项研究。在单项症状评分方面，与环孢素 A 组相比，他克莫司组在第 1 周时的眼红、烧灼感、畏光和异物感显著降低（p<0.05）。此外，他克莫司组在第 4 周时烧灼感和异物感（均 p=0.032）以及第 12 周时的眼红和烧灼感均显著降低（与环孢素 A 组相比，p=0.005 和 0.048）。他克莫司组在第 1 周和第 12 周时的睑结膜乳头样增生的平均评分显著较低（p=0.037 和 0.046），第 1 周时的点状糜烂和鹅卵石样乳头的平均评分也显著较低（p=0.029 和 0.037）。环孢素 A 组有 6 例（19.35%）治疗失败，他克莫司组有 5 例（17.85%）。两组均未发现严重不良反应。
与环孢素 A 2%滴眼液相比，他克莫司 0.03%眼膏能更明显地减轻炎症症状和体征，且患儿的依从性更好。此外，需要长期使用药物来控制炎症，以治疗难治性病例。总之，我们的研究结果表明，环孢素 A 滴眼液和他克莫司眼膏可作为皮质类固醇的节约药物，用于治疗难治性春季角结膜炎患儿。
