Abstract
Purpose::
We describe a case series of four patients with severe atopic keratoconjunctivitis (AKC) associated with atopic dermatitis, resistant to conventional therapies, who were successfully treated with systemic T-lymphocyte signal transduction inhibitors.
Methods::
Observational case series of four patients with chronic histories of atopic keratoconjunctivitis and atopic dermatitis who were resistant to conventional treatment. Approval from the Massachusetts Eye and Ear Infirmary Institutional Review Board was obtained for this study. The charts of patients with AKC assessed by one of the authors (CSF) were reviewed to identify those who were treated with systemic T cell signal transduction inhibitors. Visual acuities, previous treatments and the response to systemic signal transduction inhibitors was observed and reported.
Results::
Four patients were identified, with a mean duration of AKC for 22 years. All of them had failed topical and systemic corticosteroids and antihistamines, and had active dermatitis before the initiation of treatment. Two patients were treated with systemic cyclosporine, and two were treated with systemic tacrolimus. One patient was subsequently treated with daclizumab in addition to tacrolimus. These patients demonstrated a significant clinical improvement in both dermatological and ocular symptoms, alongwith an increase in visual acuity in all cases.
Conclusions::
Selective immunosuppression of T lymphocytes (integral to the pathogenesis of atopic dermatitis and keratoconjunctivitis) with systemic cyclosporine or tacrolimus has proven to be an effective in the treatment of atopic dermatitis in the past. We report that they are also effective in the treatment of atopic keratoconjunctivitis, and improve visual acuity. We advocate the use of systemic therapy in cases that are resistant to conventional treatment to resolve the underlying immunopathology and immune dysregulation in atopic patients, if vision is to be preserved.
Keywords: clinical (human) or epidemiologic studies: outcomes/complications • signal transduction • keratitis