Reinhard T, Sundmacher R
Eye Hospital, Heinrich Heine University, Düsseldorf, Germany.
Graefes Arch Clin Exp Ophthalmol. 1999 Feb;237(2):109-12. doi: 10.1007/s004170050204.
Since September 1994 we have administered topical cyclosporin A 2% (CSA) in a prospective study to patients with Thygeson's superficial punctate keratitis (TSPK). After our promising short-term results we now present medium-term data of a larger patient group.
Topical CSA was administered to 52 eyes of 28 patients with TSPK. Forty-two were adult eyes (group I), 10 children's eyes (group II). Starting with 3 drops daily during the 1st month, CSA was reduced to 1 drop every 2nd day within 4 months and stopped after 6 months.
Complete suppression of the typical epithelial and supepithelial opacities could be achieved in 71.5% of cases in group I and 40% in group II as long as therapy was administered; the other patients responded only partially or not at all. Recurrences were a problem during tapering off or shortly after cessation of therapy, but they could again be treated effectively with the initial CSA regime. Thirty-one percent of all adult eyes and 20% of all pediatric eyes seemed to have completely healed during the observation time.
In more than two thirds of our adult patients topical CSA 2% suppresses the epithelial and subepithelial opacities for as long as this non-steroid therapy is administered. Definite healing seems to be achieved in almost one third of all adult patients. In another one third, long-term low-dose CSA therapy is necessary before complete healing may be expected. Children probably do not respond to therapy as well as adults. Whereas the only therapeutic alternative, i.e. steroid eye drops, have a significant potential for side effects in the long run, no side effects have been known from low-dose CSA eye drops. We regard CSA eye drops as a significant progress in the symptomatic treatment of TSPK.
自1994年9月起，我们对患有蒂格森浅层点状角膜炎（TSPK）的患者进行了一项前瞻性研究，给予他们局部使用2%环孢素A（CSA）。在取得了令人鼓舞的短期结果后，我们现在展示一个更大患者群体的中期数据。
对28例TSPK患者的52只眼睛给予局部CSA治疗。其中42只为成人眼睛（I组），10只为儿童眼睛（II组）。第1个月开始每天滴3次，4个月内将CSA减至每2天滴1次，6个月后停药。
只要进行治疗，I组71.5%的病例和II组40%的病例能够完全抑制典型的上皮和上皮下混浊；其他患者仅部分有效或完全无效。在逐渐减量或停药后不久复发是个问题，但再次使用初始的CSA治疗方案可有效治疗。在观察期内，所有成人眼睛的31%和所有儿童眼睛的20%似乎已完全愈合。
在超过三分之二的成年患者中，只要给予这种非甾体治疗，局部使用2%的CSA就能抑制上皮和上皮下混浊。几乎三分之一的成年患者似乎已实现明确治愈。在另外三分之一的患者中，可能需要长期低剂量的CSA治疗才能实现完全愈合。儿童对治疗的反应可能不如成人。虽然唯一的替代治疗方法，即类固醇眼药水，从长远来看有显著的副作用风险，但低剂量CSA眼药水尚未发现有副作用。我们认为CSA眼药水是TSPK对症治疗的一项重大进展。
