The University of Illinois at Chicago College of Medicine - Illinois Eye and Ear Infirmary, Chicago, IL, USA.
University of Maryland School of Medicine, Department of Ophthalmology and Visual Sciences, Baltimore, MD, USA; The Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Ocul Surf. 2022 Jan;23:1-11. doi: 10.1016/j.jtos.2021.11.002. Epub 2021 Nov 10.
The current paradigm for therapy of recalcitrant ocular surface diseases (OSD) consists of a sequential, step-up treatment approach. A combinatorial topical therapy (anti-inflammatory/immunosuppressive [steroid] with immunomodulatory [pooled human immune globulin] and tear substitute [serum]) that simultaneously targets several immunological pathways may be more efficacious. This report evaluates if the combinatorial therapy resulted in clinical benefit in patients with recalcitrant OSD.
We performed a retrospective case study of patients receiving topical, preservative-free, compounded formulations of steroids, pooled human immune globulin, and serum tears. Outcome measures included visual acuity, ocular surface disease index (OSDI), ocular discomfort score, subjective global assessment (SGA), corneal staining, conjunctival redness, and slit lamp photographs.
Patients consisted of one male and 11 females ranging in age from 27 to 87 years old. Pathologies included ocular graft-versus-host disease (n = 4), Sjögren's syndrome (n = 3), ocular cicatricial pemphigoid (n = 1), pemphigus vulgaris (n = 1), peripheral ulcerative keratitis (n = 1), Stevens-Johnson syndrome (n = 1), and giant papillary conjunctivitis (n = 1). All patients were "improved" or "much improved" on SGA after combinatorial therapy. There was a clinically meaningful reduction in OSDI, ocular discomfort, corneal staining, and conjunctival injection. Additionally, three patients had improvement in their visual acuity (one from 20/400 to 20/20). Adverse effects included increased intraocular pressure in two patients, presumably due to topical steroid use.
Combinatorial therapy provides clinical benefit by reducing the symptoms and signs in recalcitrant OSD. Our study provides the rationale for performing prospective clinical trials to evaluate the efficacy of combinatorial therapy for treating recalcitrant OSD.
治疗难治性眼表疾病（OSD）的当前范例包括序贯、逐步升级的治疗方法。同时针对多个免疫途径的组合局部治疗（抗炎/免疫抑制[类固醇]与免疫调节[混合人免疫球蛋白]和泪液替代物[血清]）可能更有效。本报告评估了组合疗法是否为难治性 OSD 患者带来了临床益处。
我们对接受局部、无防腐剂、混合类固醇、混合人免疫球蛋白和血清眼泪的患者进行了回顾性病例研究。结果测量包括视力、眼表疾病指数（OSDI）、眼部不适评分、主观整体评估（SGA）、角膜染色、结膜充血和裂隙灯照片。
患者包括 1 名男性和 11 名女性，年龄从 27 岁到 87 岁不等。病变包括眼移植物抗宿主病（n=4）、干燥综合征（n=3）、眼瘢痕性类天疱疮（n=1）、寻常性天疱疮（n=1）、周边溃疡性角膜炎（n=1）、史蒂文斯-约翰逊综合征（n=1）和巨乳头性结膜炎（n=1）。所有患者在组合治疗后 SGA 上“改善”或“明显改善”。OSDI、眼部不适、角膜染色和结膜充血均有明显改善。此外，有 3 名患者的视力有所改善（1 名从 20/400 提高到 20/20）。不良反应包括 2 名患者眼压升高，可能是由于局部使用类固醇。
组合疗法通过减轻难治性 OSD 的症状和体征提供了临床益处。我们的研究为进行前瞻性临床试验提供了依据，以评估组合疗法治疗难治性 OSD 的疗效。
