Late-term topical tacrolimus for subepithelial infiltrates resistant to topical steroids and ciclosporin secondary to adenoviral keratoconjunctivitis

2020 ◽  
pp. bjophthalmol-2020-316196
Author(s):  
Ceyhun Arici ◽  
Burak Mergen
Keyword(s):  
Topical Steroid ◽  
Case Series ◽  
Topical Steroids ◽  
Efficacy And Safety ◽  
Topical Tacrolimus ◽  
Corrected Visual Acuity ◽  
Baseline Visit ◽  
Ciclosporin A ◽  
Breakup Time ◽  
Oxford Score

PurposeInvestigation of the efficacy and safety of 12 months of topical tacrolimus 0.03% ointment treatment against the subepithelial infiltrates (SEIs) due to adenoviral keratoconjunctivitis (AKC) resisting at least 2 years was aimed.MethodsThis case series included consecutive patients with SEIs secondary to AKC who were resistant to topical steroid and ciclosporin-A (CSA) treatment and treated with topical 0.03% tacrolimus (Protopic; Fujisawa Healthcare, Teva, Deerfield, Illinois, USA) for 12 months, at least 2 years after AKC. For the evaluation of treatment efficacy, best-corrected visual acuity (BCVA), Fantes score, corneal subepithelial infiltrate score (CSIS), Oxford score, Schirmer and tear breakup time results were evaluated. Intraocular pressure and complaints of the patients were followed for evaluating the safety profile of the treatment. The patients were followed after the baseline visit at the 1st, 3rd, 6th and 12th month.Results15 eyes of 11 patients with SEIs and 16 eyes of 16 healthy controls were included in this study. 1 patient (9.1%) could not tolerate the treatment. Significant improvements in BCVA, CSIS, Fantes score and Schirmer results were observed in the study group starting from the 3rd-month visit, and the improvements persisted until the end of 12 months of treatment.ConclusionTopical 0.03% tacrolimus might show efficacy against the SEIs persisting at least 2 years despite corticosteroid and/or CSA treatment without any prominent side effect. While at least a period of 3 months was necessary for a significant improvement in the BCVA, SEIs and Schirmer results, a period of 6 months was necessary for a decrease in Oxford score.

scholarly journals When To Start Tacrolimus Ointment For Vernal Keratoconjunctivitis? A Proposed Treatment Protocol

2021 ◽  
Author(s):  
Roee Arnon ◽  
Irit Rozen - Knisbacher ◽  
Tal Yahalomi ◽  
Nir Stanescu ◽  
Yulia Niazov ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Treatment Protocol ◽  
Topical Steroid ◽  
Case Series ◽  
Topical Steroids ◽  
Line Treatment ◽  
Tacrolimus Ointment ◽  
Disease Remission ◽  
The Mean ◽  
Topical Treatments

Abstract PurposeThe aim of this study was to compare treatment regimens of tacrolimus and of topical steroids for VKC and suggest a treatment protocol according to our clinical experience.MethodsThis retrospective, nonrandomized case series enrolled 85 Patients with VKC. Patients were classified clinically according to severity (mild, moderate, severe) and were treated according to a suggested protocol. Analysis was made according to treatment received: tacrolimus ointment as first line treatment (tacrolimus 1st line), tacrolimus ointment after topical steroid drops treatment (tacrolimus 2nd line) and topical steroid drops or artificial tears alone (topical steroid and tears group). Results Significant improvements in clinical signs and symptoms were achieved under tacrolimus treatment 14 months in the moderate group and 5 months in the severe group. The longest duration of treatment was for tacrolimus 2nd line group (p=0.031) and the mean number of visits in the clinic was the highest. The mean number of topical treatments per day was higher in the topical steroid and tears group (2.6 times) than in the two tacrolimus groups (1.3 times for both). The mean time needed to achieve disease remission or relief did not differ between the tacrolimus 1st line and 2nd line groups.ConclusionTacrolimus treatment is effective and safe for VKC. Tacrolimus as 1st line treatment may be preferred for severe cases, for faster disease remission compared to tacrolimus as 2nd line treatment; and with fewer topical treatments per day compared to topical steroids.

scholarly journals Topical Corticosteroids and Fungal Keratitis: A Review of the Literature and Case Series

2021 ◽  
Vol 10 (6) ◽  
pp. 1178
Author(s):  
Karl Anders Knutsson ◽  
Alfonso Iovieno ◽  
Stanislav Matuska ◽  
Luigi Fontana ◽  
Paolo Rama
Keyword(s):  
Rebound Effect ◽  
Clinical Signs ◽  
Topical Steroid ◽  
Case Series ◽  
Signs And Symptoms ◽  
Fungal Keratitis ◽  
Principal Factor ◽  
Topical Steroids ◽  
Review Of The Literature ◽  
Steroid Use

The management of fungal keratitis is complex since signs and symptoms are subtle and ocular inflammation is minimal in the preliminary stages of infection. Initial misdiagnosis of the condition and consequent management of inflammation with corticosteroids is a frequent occurrence. Topical steroid use is considered to be a principal factor for development of fungal keratitis. In this review, we assess the studies that have reported outcomes of fungal keratitis in patients receiving steroids prior to diagnosis. We also assess the possible rebound effect present when steroids are abruptly discontinued and the clinical characteristics of three patients in this particular clinical scenario. Previous reports and the three clinical descriptions presented suggest that in fungal keratitis, discontinuing topical steroids can induce worsening of clinical signs. In these cases, we recommend to slowly taper steroids and continue or commence appropriate antifungal therapy.

Progressive idiopathic unilateral corneal endothelial failure of unknown aetiology in phakic eyes

2018 ◽  
Vol 102 (12) ◽  
pp. 1634-1639 ◽  
Author(s):  
Weng Hon Lee ◽  
Adrian Tey ◽  
Kevin Gales ◽  
Hardeep Singh Mudhar ◽  
Francisco C Figueiredo
Keyword(s):  
Endothelial Cell ◽  
Corneal Thickness ◽  
Topical Steroid ◽  
Case Series ◽  
Acute Onset ◽  
Bullous Keratopathy ◽  
Specular Microscopy ◽  
Corrected Visual Acuity ◽  
Transmission Electron

AimTo describe a cohort of patients with irreversible unilateral bullous keratopathy (BK) of undetermined aetiology.MethodRetrospective, single-centre case series in a tertiary corneal referral centre.ResultsEleven consecutive patients (nine females; mean age 71.7 years) presented from 1999 to 2009 with acute onset unilateral visual loss. At presentation, the best-corrected visual acuity of the affected eyes was 6/9 or worse with mean central corneal thickness (CCT) of 684 (SD 66) μm. Specular microscopy was not possible in the affected eyes. There was no other ocular pathology in the affected eye. The fellow eye remained normal throughout the study (mean endothelial cell density (ECD) of 1980 (SD 736) cells/mm2 and CCT of 536 (SD 34) μm). Topical steroid, antiviral treatments (both topical and systemic) or a combination of both did not yield any improvement. After a mean follow-up of 82.2 months, eight eyes had penetrating keratoplasty (PK). One required two regrafts. Histology showed typical BK features, with endothelial cell (EC) loss and thickened Descemet’s membrane (DM). Transmission electron microscopy revealed DM abnormalities in a non-consistent pattern, featuring variable collagen deposition posterior to the non-banded zone. The ECs were degenerated, reduced or absent. Neither viruses nor pseudoexfoliation material was identified.ConclusionWhile medical treatment is not beneficial, PK appears to offer good results. Non-guttate Fuchs’ corneal endothelial dystrophy merits consideration but it would be unusual to see an exclusively unilateral presentation. DM thickening is reflective of a chronic EC loss but the cause of this loss remains elusive.

scholarly journals Low-Fluence Photodynamic Therapy versus Subthreshold Micropulse Yellow Wavelength Laser in the Treatment of Chronic Central Serous Chorioretinopathy

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Emin Özmert ◽  
Sibel Demirel ◽  
Özge Yanık ◽  
Figen Batıoğlu
Keyword(s):  
Visual Acuity ◽  
Photodynamic Therapy ◽  
Central Serous Chorioretinopathy ◽  
Subretinal Fluid ◽  
Central Macular Thickness ◽  
Efficacy And Safety ◽  
Chronic Central Serous Chorioretinopathy ◽  
Corrected Visual Acuity ◽  
Baseline Visit ◽  
Best Corrected Visual Acuity

Purpose. To compare the efficacy and safety of subthreshold micropulse yellow wavelength laser (SMYL) and low-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC).Methods. Thirty-three eyes of 30 patients with chronic CSC received either PDT (18 eyes) or SMYL (15 eyes) therapy. Best corrected visual acuity (BCVA), subretinal fluid (SRF) height, and central macular thickness (CMT) were evaluated at the baseline visit and one, three, six, nine, and 12 months after the therapy.Results. After 12 months, mean BCVA improved from67.3±14.2to71.5±21.4ETDRS letters in SMYL group and from60.7±16.3to64.4±24.9ETDRS letters in PDT group (p=0.285andp=0.440, resp.). Mean CMT decreased from242.8±80 μm to156.9±60 μm in the PDT group and from287.3±126 μm to138.0±40 μm in the SMYL group (p=0.098andp=0.003, resp.). SRF resolved completely in 72.2% and 80.0% of the eyes in the PDT and SMYL groups, respectively. Mean SRF height decreased from117.2±58 μm to31.3±56 μm in the PDT group and from130.0±104 μm to12.5±21 μm in the SMYL group (p=0.031andp=0.014, resp.).Conclusions. Subthreshold micropulse yellow wavelength laser seems to be effective in the treatment of chronic CSC without any side effect and results in the resorption of SRF without causing visible retinal scarring.

The novel use of convalescent plasma in patients with COVID 19 in Basra governorate, Case series review

2020 ◽  
pp. 1-10 ◽  
Author(s):  
Saad Hammadi ◽  
Ali Hashim ◽  
Abbas Ali ◽  
Rafid Abbood ◽  
Hassanein Ali ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Case Series ◽  
Passive Immunity ◽  
The Novel ◽  
Efficacy And Safety ◽  
Off Label Use ◽  
Plasma Therapy ◽  
Off Label ◽  
Plasma Donation ◽  
Patient Series

Background: The idea of convalescent plasma usage is to give passive immunity to the patients, so their immune system stands a good chance of combating the virus.this study will review 6 cases of eligible covid 19 patients that had been treated with convalescent plasma therapy in Basra covid 19 quarantine Objectives: to demonstrate efficacy and safety of convalescent plasma in the patient series that had been enrolled . Method: this study had pioneered a new method to collect up to 3,000 mL in one session by an off-label use of Spectra Optia Apheresis systems by TerumoBCT /Exchange set to collect convalescent plasma. In this study 250 mL convalescent plasma had been given each of the 6 patients, from one donor. respose in spo2,dyspnoea and tachypnoea was observed ,any reaction to plasma also had been monitored . Result: Our case series have demonstrated both safety and effectiveness of convalescent plasma. This study was successful in reaching our primary and secondary outcomes in all 6 patients (improvement in SpO2 and symptoms). With negligible difference in time of post transfusion response Conclusion: convalescent plasma is apperantly safe and effective, In this study 250 mL convalescent plasma had been given each of the 6 patients, from one donor using Therapeutic Plasma Exchange (TPE) protocol by Spectra Optia Apheresis system/TerumoBCT. Keywords: convalescent plasma, COVID-19, SARS CoV-2, apheresis, plasma exchange, plasma donation

scholarly journals Topical steroids and topical tacrolimus appear safe in relation to the COVID-19 epidemic

2021 ◽  
Author(s):  
K Souaid ◽  
T Klejtman ◽  
N Kramkimel ◽  
C Isnard ◽  
N Dupin ◽  
...  
Keyword(s):  
Topical Steroids ◽  
Topical Tacrolimus

scholarly journals Evaluation of Dry Eye after Implantable Collamer Lens Surgery

2020 ◽  
Author(s):  
Haiting Chen ◽  
Xueyan Feng ◽  
Guangzeng Niu ◽  
Yuxiang Fan
Keyword(s):  
Dry Eye ◽  
Ocular Surface ◽  
Case Series ◽  
Meibomian Gland ◽  
Quality Score ◽  
Control Group ◽  
Ocular Surface Disease Index ◽  
Implantable Collamer Lens ◽  
Lens Surgery ◽  
Breakup Time

<b><i>Objectives:</i></b> To evaluate dry eye (DE) and associated meibomian gland dysfunction parameters after Implantable Collamer Lens (ICL) surgery. <b><i>Methods:</i></b> This is a prospective observational case series. Patients who underwent ICL implantation without previous ocular diseases or ophthalmic treatments were enrolled. Their Ocular Surface Disease Index (OSDI), noninvasive breakup time (NIBUT), meibography, slit-lamp examination of the lid margin, corneal fluorescein staining (CFS), and Schirmer test I were examined preoperatively and at 1 and 3 months postoperatively. <b><i>Results:</i></b> A total of 117 eyes of 60 patients were enrolled, and 107 eyes completed 3-month follow-up period. OSDI, lid marginal abnormality, and meibomian gland (MG) secretion, and meibum quality score were significantly higher at 1 month postoperatively and recovered partially at 3 months after surgeries, while NIBUT was significantly decreased all the time. Patients with previous DE symptoms (OSDI score ≥12) showed not only lower Schirmer and TBUT values but also higher CFS, lid margin score, MG loss, MG secretion, and meibum quality scores compared with those in the control group after operations. Low Schirmer, NIBUT values, and high meibum quality score were determined as risk factors for DE symptoms after ICL surgery. <b><i>Conclusions:</i></b> ICL implantation has a bad influence on the ocular surface and MG functions. The influence may be more obvious in patients with existing DE.

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