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A. Iovieno, M. Sacchetti, R. Sgrulletta, A. Lambiase, M. Cortes, S. Bonini, S. Bonini; Probiotic Eye–Drops Treatment in Patients Affected by Vernal Keratoconjunctivitis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4998.
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Probiotics have been shown to potentially affect allergic inflammation by modulating Th1/Th2 balance. The aim of this study is to evaluate the efficacy of probiotic eye–drops treatment in controlling signs and symptoms of vernal keratoconjunctivitis (VKC).
Six patients (age:7–17, mean age 10.8; sex: 4 M, 2 F) affected by moderate to severe VKC in active phase have been included in the study. Solution of freeze–dried inactivated Lactobacillus Acidophilus in saline solution (concentration: 2 x 108/ml) has been administrated as eye–drops 4 times daily for 4 weeks in both eyes. Clinical signs (conjunctival hyperemia, chemosis and secretion, upper tarsal papillae, limbal lesions, superficial punctuate keratitis) and symptoms (itching, photophobia, burning, tearing) were evaluated and scored form 0 to 3 at baseline, after 2 weeks and after 4 weeks of treatment with probiotic eye–drops (follow–up: 2–7 weeks). Topical steroids were allowed as rescue medication. The total signs (TSS) and the total symptoms (TSyS) scores were calculated. Mann–Whitney U–test was used to compare signs and symptoms at different time–points.
After two weeks of treatment 4 out of 6 patients showed improvement of symptoms (TSyS baseline 5.5±1.5 vs. 3.6±2.4, p=0.028) with significant improvement of photophobia (baseline 2±0.6 vs. 1±0.9; p=0.050). Clinical signs showed improvement from baseline in 5 out of 6 patients after two weeks of treatment that did not reach statistically significant values (TSS: baseline 7 ± 2.8 vs. 2 weeks 5.4 ± 3.2; nss). After two weeks of treatment 1 patients dropped–out because of severe ocular surface inflammation that required topical steroid treatment. At the end of the study patients showed improvement of symptoms (TSyS baseline 5.5±1.5 vs. 4±2.6, nss) and signs with total signs score significantly decreased with respect to baseline (TSS: baseline 7 ± 2.8 vs. 4±2.8; p=0.043). Conjunctival secretion was the only clinical sign improved both at 2 and 4 weeks of treatment with respect to baseline (baseline 1.8±0.3 vs. 1.2±0.8; p=0.030).
Our data suggest that probiotic eye–drops treatment improves symptoms and signs in patients affected by vernal keratoconjunctivitis. Further extended studies are necessary to establish the possible use of Lactobacillus Acidophilus eye–drops as a therapy for vernal keratoconjunctivitis.
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