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Topical 0.03 % tacrolimus for subepithelial infiltrates secondary to adenoviral keratoconjunctivitis

  • Inflammatory Disorders
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Abstract

Objective

To determine the safety and efficacy of topical 0.03 % tacrolimus ointment treatment for subepithelial corneal infiltrates (SEIs).

Methods

This prospective non-controlled interventional case series included patients with SEIs who had been previously treated with topical corticosteroids with either no improvement or the medication being withdrawn due to associated intraocular pressure (IOP) elevation. The patients were treated with 0.03 % tacrolimus ointment twice daily for 22 weeks (including a 1-month washout). The objective data were best-corrected Snellen visual acuity (BCVA), IOP, and full ocular examination results, including SEI severity and the Schirmer test. The subjective data were the patients’ responses to a questionnaire at all follow-up visits.

Results

The patients consisted of five males (45 %) and six females (55 %) (mean age 50 ± 11 years) who were followed up for an average of 22 weeks. The mean BCVA (logarithm of the minimum angle of resolution [logMAR]) before and after treatment was 0.34 ± 0.09 and 0.08 ± 0.04 respectively (p = 0.042). All the patients evidenced significant objective clinical improvement, and none had a severe degree of SEI at the end of the treatment. The patients reported considerable reduction in the severity of their symptoms (foreign body sensation, glare, etc.). Three patients were excluded due to side-effects (one had severe dizziness and discomfort), and their data were excluded from the study.

Conclusion

Topical tacrolimus 0.03 % is a safe and effective alternative treatment in patients with SEIs who do not respond to other treatment modalities or have untoward side-effects from topical steroids.

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References

  1. Hillenkamp J, Reinhard T, Ross RS, Böhringer D, Cartsburg O, Roggendorf M, De Clercq E, Godehardt E, Sundmacher R (2002) The effects of cidofovir 1% with and without cyclosporin A 1% as a topical treatment of acute adenoviral keratoconjunctivitis: a controlled clinical pilot study. Ophthalmology 109:845–850

    Article  PubMed  Google Scholar 

  2. Gordon YJ, Araullo-Cruz T, Romanowski EG (1998) The effects of topical nonsteroidal anti-inflammatory drugs on adenoviral replication. Arch Ophthalmol 116:900–905

    Article  CAS  PubMed  Google Scholar 

  3. Hillenkamp J, Reinhard T, Ross RS, Böhringer D, Cartsburg O, Roggendorf M, De Clercq E, Godehardt E, Sundmacher R (2001) Topical treatment of acute adenoviral keratoconjunctivitis with 0.2% cidofovir and 1% cyclosporine: a controlled clinical pilot study. Arch Ophthalmol 119:1487–1491

    Article  CAS  PubMed  Google Scholar 

  4. Lund OE, Stefani FH (1978) Corneal histology after epidemic keratoconjunctivitis. Arch Ophthalmol 96:2085–2088

    Article  CAS  PubMed  Google Scholar 

  5. Sahin A, Bozkurt B, Irkec M (2008) Topical cyclosporine a in the treatment of superior limbic keratoconjunctivitis: a long-term follow-up. Cornea 27:193–195

    Article  PubMed  Google Scholar 

  6. Ozcan AA, Ersoz TR, Dulger E (2007) Management of severe allergic conjunctivitis with topical cyclosporin a 0.05% eyedrops. Cornea 26:1035–1038

    Article  PubMed  Google Scholar 

  7. Doan S, Gabison E, Abitbol O, Gatinel D, Chast F, Hoang-Xuan T (2007) Efficacy of topical 2% cyclosporine A as a steroid-sparing agent in steroid-dependent vernal keratoconjunctivitis. J Fr Ophtalmol 30:697–701

    Article  CAS  PubMed  Google Scholar 

  8. Kino T, Hatanaka H, Hashimoto M, Nishiyama M, Goto T, Okuhara M, Kohsaka M, Aoki H, Imanaka H (1987) FK-506, a novel immunosuppressant isolated from a Streptomyces. I. Fermentation, isolation, and physico-chemical and biological characteristics. J Antibiot 40:1249–1255

    Article  CAS  PubMed  Google Scholar 

  9. Gallego-Pinazo R, Dolz-Marco R, Martínez-Castillo S, Arévalo JF, Díaz-Llopis M (2013) Update on the principles and novel local and systemic therapies for the treatment of non-infectious uveitis. Inflamm Allergy Drug Targets 12:38–45

    Article  CAS  PubMed  Google Scholar 

  10. Dhaliwal JS, Mason BF, Kaufman SC (2008) Long-term use of topical tacrolimus (FK506) in high-risk penetrating keratoplasty. Cornea 27:488–493

    Article  PubMed  Google Scholar 

  11. Meyer-Rüsenberg B, Loderstädt U, Richard G, Kaulfers P-M, Gesser C (2011) Epidemic keratoconjunctivitis: the current situation and recommendations for prevention and treatment. Dtsch Arztebl Int 108:475–480

    PubMed Central  PubMed  Google Scholar 

  12. Shiuey Y, Ambati BK, Adamis AP (2000) A randomized, double-masked trial of topical ketorolac versus artificial tears for treatment of viral conjunctivitis. Ophthalmology 107:1512–1517

    Article  CAS  PubMed  Google Scholar 

  13. Kowalski RP, Foulks GN, Gordon YJ (2000) Comparison of treatment regimens for ocular infections: community vs academic practice. Ann Ophthalmol 32:295–300

    Article  Google Scholar 

  14. Romanowski EG, Yates KA, Gordon YJ (2002) Topical corticosteroids of limited potency promote adenovirus replication in the Ad5/NZW rabbit ocular model. Cornea 21:289–291

    Article  PubMed  Google Scholar 

  15. Romanowski EG, Pless P, Yates KA, Gordon YJ (2005) Topical cyclosporine A inhibits subepithelial immune infiltrates but also promotes viral shedding in experimental adenovirus models. Cornea 24:86–91

    Article  PubMed  Google Scholar 

  16. Lucchina S, Parvex SL, Biegger P, Fusetti C (2009) FK-506 ointment: an effective adjuvant therapy to treat a dramatic case of pyoderma gangrenosum of unilateral hand. Chin J Traumatol 12:181–183

    PubMed  Google Scholar 

  17. Lauerma AI, Granlund H, Reitamo S (1997) Use of the newer immunosuppressive agents in dermatology. BioDrugs 8:96–106

    Article  CAS  PubMed  Google Scholar 

  18. Caffier PP, Harth W, Mayelzadeh B, Haupt H, Sedlmaier B (2007) Tacrolimus: a new option in therapy-resistant chronic external otitis. Laryngoscope 117:1046–1052

    Article  CAS  PubMed  Google Scholar 

  19. Kymionis GD, Kankariya VP, Kontadakis GA (2012) Tacrolimus ointment 0.03% for treatment of refractory childhood phlyctenular keratoconjunctivitis. Cornea 31:950–952

    Article  PubMed  Google Scholar 

  20. Attas-Fox L, Barkana Y, Iskhakov V, Rayvich S, Gerber Y, Morad Y, Avni I, Zadok D (2008) Topical tacrolimus 0.03% ointment for intractable allergic conjunctivitis: an open-label pilot study. Curr Eye Res 33:545–549

    Article  CAS  PubMed  Google Scholar 

  21. MedLine Plus (2013) Tacrolimus TM Drug Insert. National Institutes of Health (nlm.nih.gov)

  22. Ebihara N, Ohashi Y, Fujishima H, Fukushima A, Nakagawa Y, Namba K, Okamoto S, Shoji J, Takamura E, Uchio E, Miyazaki D (2012) Blood level of tacrolimus in patients with severe allergic conjunctivitis treated by 0.1% tacrolimus ophthalmic suspension. Allergol Int 61:275–282

    CAS  PubMed  Google Scholar 

  23. Ohashi Y, Ebihara N, Fujishima H, Fukushima A, Kumagai N, Nakagawa Y, Namba K, Okamoto S, Shoji J, Takamura E, Hayashi K (2010) A randomized, placebo-controlled clinical trial of tacrolimus ophthalmic suspension 0.1% in severe allergic conjunctivitis. J Ocul Pharmacol Ther 26:165–174

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Conflict of interest

The authors did not receive any financial support from any public or private sources. The authors have no financial or proprietary interest in a product, method, or material described herein.

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Authors and Affiliations

  1. Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Eliya Levinger, Omer Trivizki, Yonathan Shachar & David Verssano

  2. Enaim Medical Center, Tel-Aviv, Israel

    Eliya Levinger, Omer Trivizki & Samuel Levinger

Authors
  1. Eliya Levinger
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  2. Omer Trivizki
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  3. Yonathan Shachar
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  4. Samuel Levinger
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  5. David Verssano
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Corresponding author

Correspondence to Omer Trivizki.

Additional information

Drs. Levinger and Trivizki contributed equally to this work

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Levinger, E., Trivizki, O., Shachar, Y. et al. Topical 0.03 % tacrolimus for subepithelial infiltrates secondary to adenoviral keratoconjunctivitis. Graefes Arch Clin Exp Ophthalmol 252, 811–816 (2014). https://doi.org/10.1007/s00417-014-2611-9

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  • DOI: https://doi.org/10.1007/s00417-014-2611-9

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