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Natasha Nayak, Anton Kolomeyer, Jason Kim, Eliott Kim, Christina Fang, David Chu; Topical Cyclosporine A for the Management of Chronic Follicular Conjunctivitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2079.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the use of Cyclosporine A (CsA) in patients with chronic follicular conjunctivitis (CFC).
This study was a retrospective chart review at a tertiary care center. Patients treated with topical CsA (1% emulsion) for idiopathic CFC between August 2001 and November 2012 were included. Biopsies were performed. Main outcome measures included time to reduced inflammation, final grade of inflammation (0-4; grading performed by one physician [DSC]), ability to taper steroids, final visual acuity (VA), and reported side effects. Unless otherwise noted, mean ± standard deviation (SD) were reported.
Twenty-two eyes of 13 patients (nine [69%] females; 12 [92%] Caucasians; age of 49.5 ± 14.7 years) met study criteria. Two (15%) patients had an associated autoimmune disease (Sarcoidosis and Hashimoto’s thryroiditis/Sjogren’s syndrome). Mean follow-up time was 233 days (range, 33-887 days). CsA was initiated 50.6 days ± 46.9 days after diagnosis. Six (46%) patients ended CsA use after 182.2 ± 95.0 days, in all cases after inflammation was controlled. The remaining seven (54%) patients have ongoing management with CsA (currently for 278.9 ± 206.1 days). Final grade of inflammation (0.2 ± 0.4) was improved compared to initial grade of inflammation (2.1 ± 1.0) [two-tailed t-test, p-value < 0.0001]. Inflammation was controlled on average 40.1 ± 23.1 days (range, 5-84 days) after initiation of CsA. Eleven (85%) patients tapered and eventually discontinued topical steroids 31.5 ± 27.9 days after initiation of CsA treatment. One patient required re-initiation of topical steroids three months after initial discontinuation secondary to a flare up. Mean initial log MAR VA for right and left eyes was 0.090 and 0.067, respectively, whereas mean final VA was 0.089 and 0.028. Three (23%) patients reported mild ocular irritation and/or burning; however, none discontinued the eye drops.
Management of CFC with topical CsA resulted in inflammation control and allowed for steroid taper in the majority of patients without severe complications. Most patients require long-term CsA treatment.
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