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Juliana Ferreira da Costa Vargas, Ramon Coral Ghanem, Vinícius Coral Ghanem; Tacrolimus for the Treatment of Subepithelial Infiltrates Resistant to Topical Steroids After Adenoviral Keratoconjunctivitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2827.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the use of tacrolimus ophthalmic suspension in patients with symptomatic corneal subepithelial infiltrates (SEI) as a sequelae of adenoviral keratoconjunctivitis (AK) that were resistant to tapering of corticosteroid eye drops.
This is a prospective nonrandomized noncomparative interventional case series that included consecutive patients treated with tacrolimus for resistant SEIs after AK. Patients had active SEI and corrected distance visual acuity (CDVA) of 20/25 or worse when treatment was initiated. Recorded data included age, sex, CDVA, IOP, duration and intensity of symptoms, biomicroscopy findings, and duration of therapy. Tacrolimus 0.03% eye drops two or three times a day was initially associated with a topical corticosteroid that was tapered over three weeks. Tacrolimus was maintained for at least six months. The treatment was considered successful when there was a reduction of SEI along with improvement or stabilization of CDVA. Patients that could not tolerate tacrolimus or that had reappearance of the SEI during its use were considered failed. The SEI were scored using a scale of 0-3 based on the biomicroscopy findings: 0, inactive; 1, mild cellular infiltration; 2, moderate cellular infiltration; 3, intense cellular infiltration.
Two males and five females were included (ten eyes), with mean age of 36.7 ± 12.3 years. The mean duration of tacrolimus therapy was 8.8 ± 2.4 months and the mean duration of follow-up was 13.6 ± 10.7 months. One patient could not tolerate the medication for more than one month due to ocular symptoms. Treatment was successful in eight eyes of the six patients that could tolerate the medication. A statistically significant improvement in CDVA was observed in the last follow up visit (from mean 0.29 to 0.07) (P=0.001). In all eyes IOP remained under normal values. SEI score showed a significant reduction from 2.2 ± 0.9 to 0.25 ± 0.46 in the last visit (P=0.011). All patients that completed treatment had improvement in ocular symptoms, such as tearing, blurred vision, burning, and foreign body sensation. Most patients reported side effects as burning, foreign body sensation and blurred vision for a few minutes after using the medication.
Tacrolimus 0.03% ophthalmic suspension appears to be an effective alternative to patients with SEI resistant to topical steroids.
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