Abstract
Purpose :
Inflammatory ocular surface diseases have a myriad of topical and systemic treatments (steroids, immunomodulatory treatments). Many of these treatments have dose-limiting ocular and systemic side effects such as intraocular pressure (IOP) elevation and leukocytopenia. Tacrolimus use has been successfully documented in certain ocular diseases. Here, we describe several inflammatory conditions where we found topical tacrolimus to be effective as an adjunct to existing therapies.
Methods :
Retrospective review of medical records of patients from the Illinois Eye and Ear Infirmary, Chicago, IL (2017-2018) with inflammatory ocular surface disease who failed to respond to, or had inflammatory recurrences while on topical steroids, with or without systemic steroids and immunomodulatory therapy. All patients were started on topical tacrolimus therapy (0.03% – 0.1%). Primary outcome was time until clinical control of inflammation. Secondary outcome was IOP difference while using steroids versus while using tacrolimus.
Results :
Seven patients were identified who met the above criteria, with an average age of 39 years (range 20 to 52 years). Treated diagnoses included limbal stem cell transplant rejection (on topical and systemic immunosuppression), high risk penetrating keratoplasty epithelial rejection (while on q2h topical steroids), mucous membrane pemphigoid on maximum systemic therapy (2 patients), chronic follicular conjunctivitis unresponsive to loteprednol, recurrent (steroid dependent) subepithelial infiltrates, and recurrent phlyctenulosis. The patients were on an average number of 2.4 medications prior to initiating tacrolimus. Tacrolimus treatment (commercial tacrolimus ointment 0.1% [n=1], commercial 0.03% tacrolimus ointment [n=2], and 0.03% compounded tacrolimus eye drops [n=4]) led to clinical improvement of inflammation in all 7 patients. Average time to inflammation control was 1.58 months (range 0.5-3 months). IOP difference between steroid treatment and tacrolimus treatment was -8.2 mmHg.
Conclusions :
Tacrolimus was able to control nonresponsive or refractory inflammation in all 7 of these patients with minimal use of steroids. This emerging medication offers an alternative treatment for refractory inflammation without the risk for side effects from other medications.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.