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S. Manvikar, F.C. Figueiredo; Thygeson's Superficial Punctate Keratitis: Topical Cyclosporin A Drops Use in Patients Resistant to Topical Steriods . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3745.
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Purpose: Thygeson's Superficial Punctate Keratitis (TSPK) is a chronic recurrent corneal condition with episodes of exacerbation characterised by blurred vision and eye irritation. TSPK may be selflimiting and often recurrent, usually respond well to topical corticosteriods. Due to the recurrent nature of these lesions, this may have to be used on a long-term basis with the risk of complications from long-term topical steroids such as glaucoma and cataract; may also prolong the course of the disease. In our study, we evaluate the efficacy of topical 2% Cyclosporine A (CSA) drops in treating TSPK resistant to topical corticosteriods. Methods: A retrospective review of consecutive cases of TSPK from the Ocular Surface Service who were using topical CSA 2% for the management of the disease. All patients had previously been treated with topical steroids for more than a year but had very frequent recurrences after stopping or tapering the treatment. Results: Six patients (1 male: 5 females) were studied. The mean age of the patients was 47.33 years (range 33 to 70 years). All patients were followed up for a mean period of 14 months (range 5 to 21 months) between Jan 2001 and Oct 2002. Five patients had bilateral involvement, while one patient had uniocular disease. In total 11 eyes were studied. 2% Cyclosporine drops in olive oil were used once every other day. To begin with, all patients had adjuvant topical steroids on a tapering dose for 2-4 weeks. Only one of the patients had typical small subepithelial corneal opacities after treatment with CSA, which did not affect visual acuity. 83% of the patients, remained on CSA drops once every other day. The only patient, who had stopped CSA completely, came back with recurrence eleven months after stopping the treatment. This patient needed CSA to be restarted. 66.7% complained of stinging and soreness after applying CSA drops for a period of up to five minutes. However there was no evidence of any other significant side effects. Conclusions: Topical CSA is effective in long-term management of TSPK. Transient stinging and soreness, which are the only side effects, noted. No other systemic side effects were noted during the treatment. CSA may be used as an alternative for patients not responding to steroids or steroid responders with high intra-ocular pressure or as a first-line treatment in high-risk groups such as ocular hypertensives and glaucoma. However, a prospective study in a larger population for a longer period of time would be recommended.
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