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P.–J. Pisella, A. Denoyer, D. Bellicaud, M. Serment, Y. Nochez, C. Atlan, C. Combourrieu, H. Nourry, J.–M. Warnet; Topical Ciclosporin in the Treatment of Ocular Surface Disorders Except Primary Dry Eye . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4963.
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© ARVO (1962-2015); The Authors (2016-present)
Topical ciclosporin A is an immunomodulator widely used in primary dry eye patients, and it could be efficient in ocular surface disorders (OSD) involving immune–based inflammation. The purpose of this study was to evaluate the effects of topical ciclosporin in OSD except primary dry eye.
29 patients diagnosed with OSD secondary to vernal keratoconjunctivitis (7 cases), atopic keratoconjunctivitis (8), rheumatoid arthritis (8), or ocular rosacea (6), were treated with B.I.D ciclosporin 0.05% ophthalmic emulsion. Corneal and conjunctival staining, Oxford score, Break up time (BUT) and symptoms severity assessment were conducted from introducing ciclosporin treatment up to the end of study. Other collected data included visual acuity, intraocular pressure (IOP) measurements, adverse effects queries and use of adjunctive corticosteroids therapy.
Mean follow–up was 15.1 months (7 months to 4 years). Topical ciclosporin 0.05% gave significant long–term improvement of corneal (from 2.7±1.6 to 1.2±1.5, p=0.0002) and conjunctival staining (from 4.1±2.5 to 2.4±2.7 for combined nasal and temporal conjunctiva, p=0.003), Oxford score (from 1.7±0.7 log to 0.9±0.7 log, p<0.0001), BUT measurement (from 5±3.1 s to 7.4±3.8 s, p=0.007), and symptoms severity (from 4.8±2.4 to 1.9±2, p=0.0003). Mean visual acuity increased 0.18 (to 0.92±0.16, p=0.018), and mean IOP remained unchanged. No severe adverse effect occurred, but two patients (6.9%) stopped ciclosporin treatment because of increasing ocular symptoms. Among the twenty patients undergoing corticosteroids eye drops before the study, topical ciclosporin allowed to taper off corticosteroids treatment in two cases (10%), and broke it off with no recurrence in thirteen cases (65%).
Given our results, ciclosporin 0.05% ophthalmic emulsion represents a well–tolerated treatment for OSD secondary to immune diseases. This topical immunomodulator could provide visual and functional benefits in these cases, and stop dependence upon corticosteroids therapy.
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