Kate Anahita, Tallapelly Haritha Goud, Jain Neha, Yukti Kumari, Basu Sayan
Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Vijayawada, Andhra Pradesh, India.
Academy for Eye Care Education, LV Prasad Eye Institute, Hyderabad, India.
Cornea. 2025 Jan 9;44(9):1078-1083. doi: 10.1097/ICO.0000000000003786.
The purpose of this study was to report the indications and outcomes of oral cyclosporine A (oCsA) use in vernal keratoconjunctivitis (VKC) and to assess its effect on corticosteroid use.
This retrospective review of VKC cases included patients who were prescribed oCsA. Data on clinical characteristics, demographic profile, and treatment were collected. An acute episode was defined as one requiring oral/topical corticosteroids. The outcome measure was the difference in the number of acute episodes before and after oCsA use.
The study included 27 cases (54 eyes) of VKC from 2016 to 2024. The median age was 20 years. Thirty eyes had sequelae due to VKC, the most common of which was limbal stem cell deficiency (46%). The median duration of follow-up was 11 months. Indications for oCsA were recalcitrant disease (23/27, 85%) and severe active allergy in steroid-induced glaucoma/steroid responders (4/27, 15%). None of the cases experienced progression of sequelae with oCsA use. Forty-two acute episodes were observed before oCsA initiation over 403 person-months, which reduced to 10 episodes over 250 person-months with oCsA use. Without oCsA use, the odds of developing an acute exacerbation of the ocular allergy were 2.6 times (95% confidence interval: 1.3-5.2) higher compared with that with oCsA usage.
Oral cyclosporine reduces corticosteroid use in VKC and can be considered in recalcitrant disease or in eyes with steroid-induced glaucoma and active allergy. Oral cyclosporine significantly reduced the risk of acute exacerbations, proving to be an effective modality for controlling inflammation in VKC.
本研究旨在报告口服环孢素A（oCsA）在春季角结膜炎（VKC）中的应用指征及疗效，并评估其对皮质类固醇使用的影响。
本项对VKC病例的回顾性研究纳入了接受oCsA治疗的患者。收集了临床特征、人口统计学资料及治疗相关数据。急性发作被定义为需要口服/局部使用皮质类固醇的情况。观察指标为使用oCsA前后急性发作次数的差异。
本研究纳入了2016年至2024年期间的27例（54只眼）VKC患者。中位年龄为20岁。30只眼因VKC出现后遗症，其中最常见的是角膜缘干细胞缺乏（46%）。中位随访时间为11个月。oCsA的应用指征为顽固性疾病（23/27，85%）以及类固醇诱导性青光眼/类固醇反应者中的严重活动性过敏（4/27，15%）。使用oCsA的病例均未出现后遗症进展。在开始使用oCsA前的403人月中观察到42次急性发作，使用oCsA后的250人月中减少至10次发作。未使用oCsA时，眼部过敏急性加重的几率比使用oCsA时高2.6倍（95%置信区间：1.3 - 5.2）。
口服环孢素可减少VKC中皮质类固醇的使用，对于顽固性疾病或患有类固醇诱导性青光眼及活动性过敏的眼睛可考虑使用。口服环孢素显著降低了急性加重的风险，证明是控制VKC炎症的有效方式。
