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Application of topical 2% cyclosporine A in inflammatory ocular surface diseases

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Abstract

Purpose

To report our experience with the 2% cyclosporin A (CsA) in a series of challenging inflammatory ocular surface diseases due to different etiologies.

Methods

The records of patients who received topical 2% CsA for different indications were reviewed retrospectively. Demographic characteristics, indications for treatment, patient symptoms and clinical findings were recorded.

Results

Fifty-two eyes of 52 patients were included. Mean age was 43.2 ± 14.3 (11–66) years with a F/M ratio of 34/18. Indications included pediatric acne rosacea (n = 4), adenoviral corneal subepithelial infiltrates (n = 12), filamentary keratitis (n = 14), pterygium recurrence (n = 15), herpetic marginal keratitis (n = 2) and graft versus host disease (n = 5 patients). Mean duration of treatment was 7.3 ± 2.8 (3–10) months. Forty-three (83%) patients reported favorable outcome with improvement in symptoms after a mean time of 4.4 ± 2.7 (2–6) months.

Conclusions

Topical 2% CsA may address the needs of different cases with ocular surface inflammation, as a safe option for long-term therapy.

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References

  1. Utine CA, Stern M, Akpek EK (2010) Clinical review: topical ophthalmic use of cyclosporin A. Ocul Immunol Inflamm 18(5):352–361. https://doi.org/10.3109/09273948.2010.498657

    Article  CAS  PubMed  Google Scholar 

  2. Donnenfeld E, Pflugfelder SC (2009) Topical ophthalmic cyclosporine: pharmacology and clinical uses. Surv Ophthalmol 54:321–338

    Article  PubMed  Google Scholar 

  3. Boboridis KG, Konstas AGP (2018) Evaluating the novel application of cyclosporine 0.1% in ocular surface disease. Expert Opin Pharmacother 19:1027–1039

    Article  CAS  PubMed  Google Scholar 

  4. Leonardi A, Van Setten G, Amrane M, Amrane M, Ismail D, Garrigue JS et al (2016) Efficacy and safety of 0.1% cyclosporine A cationic emulsion in the treatment of severe dry eye disease: a multicenter randomized trial. Eur J Ophthalmol 26:287–296

    Article  PubMed  Google Scholar 

  5. Malta JB, Soong HK, Shtein RM, Musch DC, Rhoades W, Sugar A et al (2010) Treatment of ocular graft-versus-host disease with topical cyclosporine 0.05%. Cornea 29:1392–6

    Article  PubMed  Google Scholar 

  6. Rao SN (2006) Treatment of herpes simplex virus stromal keratitis unresponsive to topical prednisolone 1% with topical cyclosporine 0.05%. Am J Ophthalmol 141:771–2

    Article  CAS  PubMed  Google Scholar 

  7. Foulks GN (2006) Topical cyclosporine for treatment of ocular surface disease. Int Ophthalmol Clin 46:105–122

    Article  PubMed  Google Scholar 

  8. Sacchetti M, Mantelli F, Lambiase A (2014) Systematic review of randomized clinical trials on topical cyclosporine A for the treatment of dry eye disease. Br J Ophthalmol 98:1016–1022

    Article  PubMed  Google Scholar 

  9. Baudouin C, Figueiredo FC, Messmer EM, Ismail D, Amrane M, Garrigue JS et al (2017) A randomized study of the efficacy and safety of 0.1% cyclosporine A cationic emulsion in treatment of moderate to severe dry eye. Eur J Ophthalmol 27:520–530

    Article  PubMed  PubMed Central  Google Scholar 

  10. Doan S, Gabison E, Gatinel D, Duong MH, Abitbol O, Hoang-Xuan T (2006) Topical cyclosporine A in severe steroid-dependent childhood phlyctenular keratoconjunctivitis. Am J Ophthalmol 141:62–66

    Article  CAS  PubMed  Google Scholar 

  11. Heiligenhaus A, Steuhl KP (1999) Treatment of HSV-1 stromal keratitis with topical cyclosporin A: a pilot study. Graefes Arch Clin Exp Ophthalmol 237:435–438

    Article  CAS  PubMed  Google Scholar 

  12. Reinhard T, Sundmacher R (1999) Topical cyclosporin A in Thygeson’s superficial punctate keratitis. Graefes Arch Clin Exp Ophthalmol 237:109–112

    Article  CAS  PubMed  Google Scholar 

  13. Hingorani M, Moodaley L, Calder VL, Buckley RJ, Lightman S (1998) A randomized, placebo-controlled trial of topical cyclosporin A in steroid dependent atopic keratoconjunctivitis. Ophthalmology 105:1715–1720

    Article  CAS  PubMed  Google Scholar 

  14. Pucci N, Novembre E, Cianferoni A, Lombardi E, Bernardini R, Caputo R et al (2002) Efficacy and safety of cyclosporine eyedrops in vernal keratoconjunctivitis. Ann Allergy Asthma Immunol 89:298–303

    Article  CAS  PubMed  Google Scholar 

  15. Cetinkaya A, Akova YA, Dursun D, Pelit A (2004) Topical cyclosporine in the management of shield ulcers. Cornea 23:194–200

    Article  PubMed  Google Scholar 

  16. Deshmukh R, Ting DSJ, Elsahn A, Mohammed I, Said DG, Dua HS (2022) Real-world experience of using ciclosporin-A 0.1% in the management of ocular surface inflammatory diseases. Br J Ophthalmol. 106(8):1087–1092

    PubMed  Google Scholar 

  17. Pflugfelder SC (2004) Antiinflammatory therapy for dry eye. Am J Ophthalmol 137:337–342

    Article  PubMed  Google Scholar 

  18. Kashani S, Mearza AA (2008) Uses and safety profile of cyclosporin in ophthalmology. Expert Opin Drug Saf 7:79–89

    Article  CAS  PubMed  Google Scholar 

  19. Aragona P (2014) Topical cyclosporine: are all indications justified? Br J Ophthalmol 98(8):1001–1002

    Article  PubMed  Google Scholar 

  20. Perry HD, Doshi-Carnevale S, Donnenfeld ED, Solomon R, Biser SA, Bloom AH (2006) Efficacy of commercially available topical cyclosporine A 0.05% in the treatment of meibomian gland dysfunction. Cornea 25:171–175

    Article  PubMed  Google Scholar 

  21. Rubin M, Rao SN (2006) Efficacy of topical cyclosporin 0.05% in the treatment of posterior blepharitis. J Ocul Pharmacol Ther 22:47–53

    Article  CAS  PubMed  Google Scholar 

  22. Schechter BA, Katz RS, Friedman LS (2009) Efficacy of topical cyclosporine for the treatment of ocular rosacea. Adv Ther 26:651–659

    Article  CAS  PubMed  Google Scholar 

  23. van Zuuren EJ, Kramer S, Carter B, Graber MA, Fedorowicz Z (2011) Interventions for rosacea. Cochrane Database Syst Rev 3:Cd003262

    Google Scholar 

  24. Rousta ST (2017) Pediatric blepharokeratoconjunctivitis: is there a “right” treatment? Curr Opin Ophthalmol 28:449–453

    Article  PubMed  Google Scholar 

  25. Albietz J, Sanfilippo P, Troutbeck R, Lenton LM (2003) Management of filamentary keratitis associated with aqueous-deficient dry eye. Optom Vis Sci 80:420–430

    Article  PubMed  Google Scholar 

  26. Marsh P, Pflugfelder SC (1999) Topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjogren syndrome. Ophthalmology 106:811–816

    Article  CAS  PubMed  Google Scholar 

  27. Grinbaum A, Yassur I, Avni I (2001) The beneficial effect of diclofenac sodium in the treatment of filamentary keratitis. Arch Ophthalmol 119:926–927

    CAS  PubMed  Google Scholar 

  28. Perry HD, Doshi-Carnevale S, Donnenfeld ED, Kornstein HS (2003) Topical cyclosporine A 0.5% as a possible new treatment for superior limbic keratoconjunctivitis. Ophthalmology 110:1578–1581

    Article  PubMed  Google Scholar 

  29. Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB (2015) Adenoviral keratoconjunctivitis. Surv Ophthalmol 60:435–443

    Article  PubMed  Google Scholar 

  30. Levinger E, Slomovic A, Sansanayudh W, Bahar I, Slomovic AR (2010) Topical treatment with 1% cyclosporine for subepithelial infiltrates secondary to adenoviral keratoconjunctivitis. Cornea 29:638–640

    Article  PubMed  Google Scholar 

  31. Okumus S, Coskun E, Tatar MG, Kaydu E, Yayuspayi R, Comez A et al (2012) Cyclosporine a 0.05% eye drops for the treatment of subepithelial infiltrates after epidemic keratoconjunctivitis. BMC Ophthalmol 18:12–42

    Google Scholar 

  32. Asena L, Şıngar Özdemir E, Burcu A, Ercan E, Çolak M, Altınörs DD (2017) Comparison of clinical outcome with different treatment regimens in acute adenoviral keratoconjunctivitis. Eye 31(5):781–787

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Nuzzi R, Tridico F (2018) How to minimize pterygium recurrence rates: clinical perspectives. Clin Ophthalmol 12:2347–2362

    Article  PubMed  PubMed Central  Google Scholar 

  34. Turan-Vural E, Torun-Acar B, Kivanc SA, Acar S (2011) The effect of topical 0.05% cyclosporine on recurrence following pterygium surgery. Clin Ophthalmol 5:881–5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Özülken K, Koç M, Ayar O, Hasiripi H (2012) Topical cyclosporine A administration after pterygium surgery. Eur J Ophthalmol 22(Suppl 7):5–10

    Article  Google Scholar 

  36. Gunduz K, Ozdemir O (1997) Topical cyclosporin as an adjunct to topical acyclovir treatment in herpetic stromal keratitis. Ophthalmic Res 29:405–408

    Article  CAS  PubMed  Google Scholar 

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Funding

The authors declare that no funds, grants or other support were received during the preparation of this manuscript. The authors have no relevant financial or nonfinancial interests to disclose.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Ophthalmology, Baskent University, Fevzi Çakmak Caddesi, Bahçelievler, 06490, Ankara, Turkey

    Leyla Asena & Dilek Dursun Altınörs

Authors
  1. Leyla Asena
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  2. Dilek Dursun Altınörs
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Contributions

All authors contributed to the study conception, design, data collection and analysis. The first draft of the manuscript was written by LA, MD and DA, MD commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Leyla Asena.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

The study was approved by the Institutional Review Board of Baskent University Faculty of Medicine and adhered to the tenets of the Declaration of Helsinki.

Informed consent

Informed consent was obtained for the off-label use of topical 2% cyclosporin A from all individual participants included in this retrospective study.

Consent for publication

The authors affirm that participants provided informed consent for publication of the images in Figs. 1, 2, 3, 4 and 5.

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Asena, L., Dursun Altınörs, D. Application of topical 2% cyclosporine A in inflammatory ocular surface diseases. Int Ophthalmol 43, 3943–3952 (2023). https://doi.org/10.1007/s10792-023-02796-x

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  • DOI: https://doi.org/10.1007/s10792-023-02796-x

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