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E.K. Akpek, S. Tatlipinar; Topical Cyclosporin in the Treatment of Ocular Surface Disorders: An Evidence–based Update . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2652.
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Purpose: Mounting evidence suggests that inflammation is the key factor in the pathogenesis of various ocular surface diseases, with a complex interplay of genetic, environmental, and psychosocial factors. Management of these conditions is challenging. Topical corticosteroids, with known side effects, are the mainstay of current treatments for patients with vision–threatening disease. Cyclosporin A is an immunomodulator that specifically inhibits T lymphocytes. Recently, a topical cyclosporin preparation was approved by the U.S. Food and Drug Administration and became available for use in ophthalmology. Given the increasing use of cyclosporin eyedrops, the goal of this study was to analyze the published scientific literature on the efficacy and safety of topical cyclosporin in the treatment of ocular surface diseases and help refine the questions that should be addressed by future investigations. Methods: An online search of the literature, confined to articles in English or with an English abstract, was conducted for the period 1968 to May 2004, using PubMed Central and the Cochrane Collaboration’s database. These sources were augmented by the reference lists of some studies included in the literature review. Grades were assigned to the available evidence, with the highest grade assigned to properly conducted, well–designed, randomized clinical trials, followed by large–scale epidemiological studies, case series, evidence from animal studies, and expert opinion. Results: The literature search produced 531 articles with data on the use of topical cyclosporin. Most were from the dermatology literature and concerned the use of cyclosporin ointment in skin disorders; 149 were from the ophthalmologic literature. This review describes the findings from the 48 articles considered most relevant to evaluation of cyclosporin eyedrops in the treatment of ocular surface diseases. The strength of the available evidence for each indication was assessed, and recommendations summarized based on the level of evidence. Conclusions: The literature supports the safety and efficacy of topical cyclosporin A in the treatment of various ocular surface disorders, particularly the dry eye syndrome and severe allergic keratoconjunctivitis. Future studies should be directed to comparing the efficacy of topical cyclosporin with that of corticosteroids and to its ability to change the natural course of some of these disorders during longer–term follow–up.
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