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Y. Satake, Y. Takano, M. Dogru, K. Fukagawa, J. Shimazaki, H. Fujishima; The Efficacy of Topical Tacrolimus Hydrate in Patients With Akc/vkc. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1929.
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The efficacy of tacrolimus hydrate eye drops (TALYMUS ® OPHTHALMIC SUSPENSION 0.1%, Senju Pharmaceutical Co., Osaka, Japan) for the treatment of severe allergic disorders, such as atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) has been reported. However, there have been no reports concerning the ideal protocol including tapering such medication after remission. In this study, we studied the clinical course of patients after cessation of treatment with tacrolimus eye drops.
Nineteen eyes from 10 patients with AKC/VKC (6/4 cases respectively; 7 male, 3 female patients, mean age 23.0±11.0 years), who discontinued use of tacrolimus ophthalmic suspension due to the remission of clinical symptom and signs, were enrolled in the study. All eyes exhibited giant papillae formation on the upper tarsal conjunctiva at the start of tacrolimus eye drops. Serum IgE levels for perennial antigens, such as mite and house dust were strongly positive in all patients. Clinical course (redness, edema, follicle, and papillary formation of tarsal conjunctiva, Trantas dot and limbal edema, and corneal epithelium) were assessed retrospectively after cessation of tacrolimus treatment.
The mean frequency of instillation of tacrolimus eye drops was 1.3 times per day at cessation of treatment and clinical findings in all patients showed complete resolusion with no giant papillary formation. After cessation, anti-allergic eye drops, steroid eye drops or cyclosporine A eye drops were prescribed as necessary. Three out of the 10 patients were stable after cessation but the other 7 patients experienced recurrence of allergic inflammation. The mean time to recurrence was 4.0 weeks (range 1-12 weeks) and all criteria except Trantas dot and limbal edema worsened in these 7 patients. Six of the 7 patients had to resume use of tacrolimus.
Tacrolimus eye drops are not only effective for elimination of severe allergic ocular inflammation but may also effective in the prevention of recurrence of symptoms and the ocular disease after control of acute inflammation.
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