Abstract
Abstract: :
Purpose: To evaluate the efficacy and safety of topical 2% cyclosporine (CsA) in childhood steroid–dependent ocular surface diseases : vernal keratoconjunctivitis (VKC) and phlyctenular keratoconjunctivitis (PKC). Methods: In this prospective non–controlled study, 18 children with steroid–dependent VKC (mean age: 13 years old) and 11 children with steroid–dependent PKC (mean age: 9 years old) were treated with CsA qid. Topical steroids were tapered and stopped after 2 weeks. Efficacy was evaluated at 1 and 6 months (symptoms, conjunctival inflammation, corneal complications, need for topical steroids). Safety was assessed clinically and biologically (cyclosporinemia, creatininemia). Results: At 1 month, 11 out of 18 VKC patients (61%), and all PKC patients had their symptoms and inflammatory signs completely vanished without steroids. Efficacy of CsA was partial in 4 VKC patients (good clinical control with reduced dosing of steroids). Three VKC patients remained high–dose steroid dependent despite CsA, and experienced recurrent corneal complications. Results at 6 months were comparable. Local tolerance was good in all cases. Mild and transient stinging at instillation occured at the onset of treatment in 2 VKC patients and 2 PKC patients. A cutaneous rash occurred in one PKC patient. Cyclosporinemia remained undetectable in all cases. Conclusions: CsA was well tolerated in children. Efficacy of CsA was total in PKC, whereas it was only partial in VKC. Lymphocytes are probably the main effectors in PKC, whereas VKC seems to be a more complex disease.
Keywords: drug toxicity/drug effects • cyclosporine • conjunctivitis