Abstract
Purpose:
To describe the use of Cyclosporine A (CsA) in patients with chronic follicular conjunctivitis (CFC).
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: 475 conjunctivitis •
489 cyclosporine •
474 conjunctiva