Reinhard T, Sundmacher R
Augenklinik der Heinrich-Heine-Universität, Düsseldorf.
Klin Monbl Augenheilkd. 1997 Mar;210(3):165-8. doi: 10.1055/s-2008-1035037.
Steroid therapy for persistent or recurrent nummular adenoviral keratoconjunctivitis (AK) has little benefit because of the frequent recurrences, and mostly "offers" only serious steroid side effects. Since January 1995, we have treated different patients with nummuli after AK with topical Ciclosporin A (CSA) in an attempt to achieve at least the same symptomatic effect as with steroids, however, without side effects. Here, we report about our experiences in a very severe case with longterm treatment.
The patient was sent to our clinic 4 months after AK with confluent nummuli and Descemet folds, more severe in the right than in the left eye. Best corrected visual acuity was 0.05 in the right and 0.5 in the left eye. Topical CSA 2% 4 times daily was first administered only in the right eye. When after 6 weeks a reduction of nummuli was noted in the right eye, the left eye, which had not improved, was started on the same regime. Therapy was tapered and finally stopped after 12 months in the right and 10 months in the left eye, when only minor changes were left in the corneae. A prompt recurrence of nummuli in both eyes within 4 weeks forced us to resume CSA therapy. At present, both corneae are clear with full vision, and this result is stable with 1 drop of CSA daily. No side effects of CSA therapy have been noted.
The disappearance of nummuli with topical CSA and even more the reappearance of nummuli after cessation of CSA therapy show that topical CSA is about as effective as topical steroids in the symptomatic treatment of non-scarred nummuli after KE without the serious steroid side effects. Topical CSA treatment of nummuli after KE is, therefore, a very recommendable alternative for the potentially dangerous steroid therapy. Generally valid data on risk of recurrences, dosage and general effectiveness could only be learned from prospective studies with large numbers of AK patients, which, however, are not available outside epidemics.
由于持续性或复发性钱币状腺病毒性角结膜炎（AK）频繁复发，类固醇疗法益处不大，且大多只会带来严重的类固醇副作用。自1995年1月以来，我们用局部环孢素A（CSA）治疗了不同的AK后钱币状病变患者，试图获得与类固醇至少相同的症状改善效果，同时避免副作用。在此，我们报告一例长期治疗的严重病例的经验。
患者在AK发病4个月后因融合性钱币状病变和Descemet皱襞被送至我们诊所，右眼比左眼更严重。最佳矫正视力右眼为0.05，左眼为0.5。首先仅在右眼每日4次局部应用2%的CSA。6周后右眼钱币状病变减少，未改善的左眼开始相同治疗方案。治疗逐渐减量，右眼在12个月、左眼在10个月后最终停药，此时角膜仅留轻微改变。双眼在4周内钱币状病变迅速复发，迫使我们重新开始CSA治疗。目前，双眼角膜清晰，视力正常，每日1滴CSA维持该结果稳定。未观察到CSA治疗的副作用。
局部应用CSA后钱币状病变消失，尤其是停用CSA治疗后钱币状病变再次出现，表明局部应用CSA在治疗AK后无瘢痕钱币状病变的症状方面与局部应用类固醇效果相当，且无严重的类固醇副作用。因此，KE后钱币状病变的局部CSA治疗是潜在危险的类固醇疗法的非常值得推荐的替代方法。关于复发风险、剂量和总体有效性的普遍有效数据只能从对大量AK患者的前瞻性研究中获得，然而，在非流行期间无法获得此类研究。
