Abstract
Purpose :
Recalcitrant ocular allergy causes significant visual morbidity. It necessitates chronic steroid use which can cause sight threatening side effects. Hence, this study was carried out to explore oral cyclosporine as a safe and effective alternative and to report its effect on steroid dependance.
Methods :
A retrospective chart review of patient outcomes before and after institution of oCsA in VKC cases from 2016-2021 was carried out. Data on the baseline clinical characterizes, demographic prolife and treatment instituted were collected. An acute episode was defined as one requiring oral/topical steroids. The primary outcome measure was the number of acute episodes requiring the use of topical or oral corticosteroids before and after use of oCsA.
Results :
A total of 46 eyes (23 cases) were included with 15 male (65%) and 8 female (35%) cases. The median age was 18 years (interquartile range[IQR] 14-25 years). The median duration of disease prior to presentation was 8 years (IQR 6-12 years). The mean vision at presentation was logMAR0.6 ± 0.8 (Snellen equivalent:20/80). The type of VKC was palpebral, limbal and mixed in 10/46 (22%), 14/46(30%), and 22/46(48%) eyes respectively. Seventeen cases had sequelae due to VKC of which limbal stem cell deficiency (18/46,39%) was the most common one. oCsA was prescribed after a median of 0.3 months (range 0.2-6) after the required systemic investigations and clearance. The median duration of follow up was 1.8 years (range:0.4-3years). The median vision before starting cyclosporine was logMAR0.6 (range 0.4-1.2) which improved to logMAR 0.3 (range 0.1-0.8) at the last follow up(p=0.003). The incidence rate of acute episodes was found to be significantly higher before initiating cyclosporine (26 episodes in 197 person-months observed) as compared to that after cyclosporine institution (11 episodes in 221 person-months observed, p=0.005). The patients in the pre-cyclosporine group had 2.64 times (95% CI: 1.31 to 5.35) higher probability of having an acute episode as compared to patients in the post-cyclosporine group. None of the cases had systemic complications requiring discontinuation of oCsA.
Conclusions :
Oral cyclosporine provides a safe and effective modality of control of inflammation in VKC. The rates of steroid dependence are reduced and thus it is indicated in patients with steroid dependent or recalcitrant disease.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.