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Applications of topical immunomodulators enhance clinical signs of vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC): a meta-analysis

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Abstract

Purpose

This meta-analysis aimed to review the safety and efficacy of topical cyclosporine A (CsA) and topical tacrolimus in allergic eye disease.

Methods

A systematic search identified thirteen studies and a total of 445 patients for inclusion, making this the largest meta-analysis published on the subject. The current review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results

Thirteen randomized control trials were included in the meta-analysis. Eleven studies used CsA as the treatment, and two used Tacrolimus. In total, 445 participants were included, of whom 76.6% were male. The mean age of participants across the included studies was 14 years. All studies reported clinical signs as evaluated by an examining clinician. Signs were usually assessed by anatomical region, with the most common regions being the conjunctiva and the cornea, and the most common signs assessed were hyperemia and papillae. Three studies accounted for more than 50% of the meta-analysis's weight. Effect size (d) ranged from − 2.37 to − 0.03, negative values favoring immunomodulators. Fixed Effect Meta-Analysis returned an SMD of − 0.81 (95% CI [− 0.98, − 0.65]). However, there was significant heterogeneity (I2 = 61%, Qw = 30.76) in the outcome measure (P = 0.0021); therefore, a random-effect meta-analysis was also completed in which the pooled SMD was − 0.98 (95% CI [− 1.26, − 0.69], τ2 = 0.16).

Conclusions

This study affirms the current scientific community's stance that immunomodulators effectively treat clinical signs, including blepharitis, conjunctival hyperemia, edema, papillae, and corneal damage in severe ocular allergic disease.

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Acknowledgements

Dr. Nir Erdinest is grateful to the Azrieli Foundation for the award of the Post-doc Azrieli Fellowship and Hadassah-Hebrew University Medical Center for the award of post-doctoral fellows.

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel

    Nir Erdinest, Itay Lavy, Nadav Levinger, David Landau & Abraham Solomon

  2. Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel

    Dror Ben Ephraim Noyman

  3. Private Practice, Jerusalem, Israel

    Naomi London

  4. Department of Ophthalmology, Enaim Refractive Surgery Center, Jerusalem, Israel

    Nadav Levinger

  5. Department of Ophthalmology, Asaf Harofeh Medical Center, Béer Yáakov, Israel

    Yair Morad

  6. College of Health and Life Sciences, Aston University, Birmingham, UK

    Shehzad A. Naroo

Authors
  1. Nir Erdinest
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  2. Dror Ben Ephraim Noyman
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  3. Naomi London
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  4. Itay Lavy
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  5. Nadav Levinger
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  6. David Landau
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  7. Abraham Solomon
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  8. Yair Morad
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  9. Shehzad A. Naroo
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Contributions

Conceptualization and Methodology: DBEN, NE, IL; Formal analysis and investigation: DBEN, NE; Writing - original draft preparation: DBEN, NE, NL; Writing - review and editing: NL, NL, DL, AS, YM, SN

Corresponding author

Correspondence to Dror Ben Ephraim Noyman.

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Erdinest, N., Noyman, D.B.E., London, N. et al. Applications of topical immunomodulators enhance clinical signs of vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC): a meta-analysis. Int Ophthalmol 44, 157 (2024). https://doi.org/10.1007/s10792-024-03097-7

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