The Therapeutic Effects of a 0.03% Tacrolimus Ointment on Childhood Phlyctenular Keratitis

Purpose: We explored the therapeutic effects of a 0.03% tacrolimus ointment (Protopic) on steroid-resistant phlyctenular keratitis in children. Methods: We enrolled seven eyes of five children with recurrent phlyctenular keratitis despite 3 months of steroid treatment. The topical steroids were tapered and the patients treated with a combination of 0.03% tacrolimus and 0.3% ofloxacin ointment. The logarithm of minimal angle of resolution (logMAR) visual acuity, corneal neovascularization status, and changes in corneal opacity between the baseline and final visit were checked on anterior photographs using Image J software. Results: The average patient age was 6.8 ± 3.0 years (range, 3-9 years) and the treatment duration 8.0 ± 2.0 days (range, 5-10 days). The baseline logMAR visual acuity was 0.42 ± 0.32 and the final value 0.19 ± 0.22. Visual acuity thus improved significantly after treatment (p = 0.026). Corneal neovascularization and phylctenulosis improved in all seven eyes; the fibrotic corneal opacity decreased in two eyes. Conclusions: Topical 0.03% tacrolimus ointment may usefully treat steroid-resistant phlyctenular keratitis of childhood.

Download Full-text

Two Cases of Corneal Neovascularization Treatment Using High-frequency Radio Wave Electrosurgery

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2021.62.8.1129 ◽

2021 ◽

Vol 62 (8) ◽

pp. 1129-1134

Author(s):

Young Joo Choi ◽

Gyu Le Han ◽

Tae Young Chung ◽

Dong Hui Lim

Keyword(s):

Visual Acuity ◽

Radio Wave ◽

High Frequency ◽

Laser Photocoagulation ◽

Corneal Opacity ◽

Corneal Neovascularization ◽

Eye Pain ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity ◽

Observation Period

Purpose: To report two cases of treatment using high-frequency radio wave electrosurgery for corneal neovascularization that recurred after medication and laser photocoagulation attempts.Case summary: (Case 1) A 53-year-old man visited our hospital complaining of corneal opacity. The best-corrected visual acuity in the left eye was 0.6. Lipid keratopathy indicated new inferior vessels. There was no significant change in corneal opacity after medication and laser photocoagulation; however, the recurrence of feeder vessels was observed. Therefore, electrocautery was performed via high-frequency radio wave electrosurgery. Visual acuity, measured 1 month later, improved to 0.9. Over the subsequent 4-year observation period, new vessels did not recur and the corneal opacity decreased gradually. (Case 2) A 23-year-old woman visited complaining of left eye pain. She had undergone laser photocoagulation three times for corneal new vessels. Visual acuity in her left eye was 0.4. Recurrence of new vessels at the upper cornea was observed, and electrocautery was performed. After 2 months, corneal opacity decreased without revascularization, and visual acuity improved to 0.5.Conclusions: In patients with corneal neovascularization, electrocautery using high-frequency radio wave electrosurgery is simple and effective and can reduce corneal opacity and improve vision without complications.

Download Full-text

Efficacy of Topical Tacrolimus 0.05% Suspension in Steroid-Resistant and Steroid-Dependent Vernal Keratoconjunctivitis

10.53350/pjmhs211572150 ◽

2021 ◽

Vol 15 (7) ◽

pp. 2150-2155

Author(s):

Mitra Akbari

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Corneal Opacity ◽

Vernal Keratoconjunctivitis ◽

Topical Steroids ◽

Steroid Resistant ◽

Topical Tacrolimus ◽

Steroid Dependent ◽

The Mean

Objective: The purpose of this study was to investigate the safety and effectiveness of topical tacrolimus 0.05% suspension in the management of prolonged steroid-dependent and -resistant vernal keratoconjunctivitis (VKC). Materials and methods: The present interventional prospective case series were conducted on the research units suffering from refractory VKC between 2017, April and 2020, December. Despite routine drug treatment, consisting of topical steroids (steroid-resistant group), all subjects exhibited active symptomatic illness or were dependent on topical steroids (steroid-dependent group). After discontinuation of all medications for at least 1 week, the patients received eye drop (topical tacrolimus 0.05%) minimally for six months. Objective and subjective signs and symptoms were examined for alterations after one week, and one and six months of treatment. Analyses were continued for probable systemic and ocular adverse effects. Results: The study included 28 eyes of 14 participants (including 4 females and 10 males), with the mean age of 22 ± 8 years (between 11 and 38 years), and the mean VKC duration of 12 ± 6 years (between 5 and 23 years), as well as follow up period of 10±2 months (between 6 and 12 months). The results showed an improvement (P<0.001) in the symptoms such as mucus discharge, foreign body sensation, photosensitivity, redness, burning and itching. The initial sign was conjunctival hyperemia, which improved one week after treatment. Other objective signs including, conjunctival and limbal papillary hypertrophy, corneal pannus and corneal punctate epithelial erosions improved at least one month after treatment. No changes were observed in corneal opacity during follow-up (p> 0.05). There were no systemic or ocular adverse effects. Conclusion: This is the first time that tacrolimus suspension drops 0.05%, are used in these cases. Topical tacrolimus 0.05% was shown to be an effectiveness and safe agent to treat the refractory VKC. This drug is recommended to be prescribed prior to the appearance of side effects such as corneal opacity, irreversible deficiency in limbal stem cell, and steroid side effects. Keywords: Vernal keratoconjunctivitis, Tacrolimus eye drop, Refractory

Download Full-text

Ion-Complex Microcrystal Formulation Provides Sustained Delivery of a Multimodal Kinase Inhibitor from the Subconjunctival Space for Protection of Retinal Ganglion Cells

Pharmaceutics ◽

10.3390/pharmaceutics13050647 ◽

2021 ◽

Vol 13 (5) ◽

pp. 647

Author(s):

Henry T. Hsueh ◽

Yoo-Chun Kim ◽

Ian Pitha ◽

Matthew D. Shin ◽

Cynthia A. Berlinicke ◽

...

Keyword(s):

Retinal Ganglion Cells ◽

Rat Model ◽

Kinase Inhibitor ◽

Ganglion Cells ◽

Corneal Neovascularization ◽

Therapeutic Effects ◽

Subconjunctival Injection ◽

Retinal Ganglion ◽

Drug Concentrations ◽

Complementary Strategy

Glaucoma is the leading cause of irreversible blindness worldwide. Elevated intraocular pressure (IOP) is one of the major risk factors for glaucoma onset and progression, and available pharmaceutical interventions are exclusively targeted at IOP lowering. However, degeneration of retinal ganglion cells (RGCs) may continue to progress despite extensive lowering of IOP. A complementary strategy to IOP reduction is the use of neuroprotective agents that interrupt the process of cell death by mechanisms independent of IOP. Here, we describe an ion complexation approach for formulating microcrystals containing ~50% loading of a protein kinase inhibitor, sunitinib, to enhance survival of RGCs with subconjunctival injection. A single subconjunctival injection of sunitinib-pamoate complex (SPC) microcrystals provided 20 weeks of sustained retina drug levels, leading to neuroprotection in a rat model of optic nerve injury. Furthermore, subconjunctival injection of SPC microcrystals also led to therapeutic effects in a rat model of corneal neovascularization. Importantly, therapeutically relevant retina drug concentrations were achieved with subconjunctival injection of SPC microcrystals in pigs. For a chronic disease such as glaucoma, a formulation that provides sustained therapeutic effects to complement IOP lowering therapies could provide improved disease management and promote patient quality of life.

Download Full-text

Corneal Neovascularization and Lipid Keratopathy after Intacs SK in Keratoconus

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1066 ◽

2013 ◽

Vol 2 (3) ◽

pp. 133-138

Author(s):

Ramez Barbara ◽

David Zadok ◽

Adel Barbara ◽

Shay Gutfreund

Keyword(s):

Visual Acuity ◽

Penetrating Keratoplasty ◽

Corneal Neovascularization ◽

Young Female ◽

Spherical Equivalent ◽

Corrected Visual Acuity ◽

Optical Zone ◽

Positive Results ◽

Oval Shape ◽

Best Corrected Visual Acuity

ABSTRACT Intacs have yielded positive results for the treatment of keratoconus in terms of reducing the keratometry readings astigmatism and spherical equivalent and consequently improving the uncorrected and best corrected visual acuity. Intacs severe keratoconus (SK) are new design of Intacs with a smaller optical zone (6 mm) and oval shape, they are indicated for severe keratocnus. Pannus is one of the complications of Intacs, as it has never been reported after Intacs SK. We report on corneal neovascularization in the corneal periphery which developed few months after Intacs SK implantation in the cornea of a young female who suffered from advanced keratoconus. The uncorrected visual (UCVA) acuity was satisfactory and the Intacs SK where not removed. Four years after the implantation she presented to our clinic complaining about eye irritation and photophobia, lipid keratopathy was observed. We gave here the choice of explanting the Intacs SK or to try to treat the neovascularization by subconjunctival Avastin, she preferred the second option because of a satisfactory UCVA (0.9). Avastin was injected in the subconjunctival, 10 weeks later Avastin and Kenelog were injected in the subconjunctival, few days after the second injection perforation and melting developed in the cornea, the patient underwent a tectonic graft and few months later penetrating keratoplasty with no intraoperative or postoperative complications. How to cite this article Barbara A, Zadok D, Gutfreund S, Barbara R. Corneal Neovascularization and Lipid Keratopathy after Intacs SK in Keratoconus. J Kerat Ect Cor Dis 2013;2(3):133-138.

Download Full-text

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

10.21203/rs.3.rs-694131/v1 ◽

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.

Download Full-text

Cyclosporine in the treatment of idiopathic nephrosis.

Journal of the American Society of Nephrology ◽

10.1681/asn.v541049 ◽

1994 ◽

Vol 5 (4) ◽

pp. 1049-1056

Author(s):

P Niaudet ◽

R Habib

Keyword(s):

Structural Damage ◽

Therapeutic Effects ◽

Steroid Resistant ◽

The Past ◽

Cyclosporine Nephrotoxicity ◽

Steroid Sensitive ◽

Idiopathic Nephrosis ◽

High Doses ◽

Functional Toxicity

Within the past decade, there have been numerous reports on the use of cyclosporine in idiopathic nephrosis. In this review, the results of both uncontrolled and controlled studies of the therapeutic effects of cyclosporine in steroid-sensitive/dependent idiopathic nephrosis and in steroid-resistant idiopathic nephrosis are analyzed. Cyclosporine is efficient in up to 80% of patients with steroid-sensitive/dependent idiopathic nephrosis. Most patients, however, relapse when the drug is withdrawn, thus necessitating prolonged treatments. Although cyclosporine is less efficient in patients with steroid-resistant idiopathic nephrosis, a few studies seem to indicate that this drug may be successful in some patients, especially if combined with corticosteroids. There is no evidence that cyclosporine can prevent the recurrence of nephrotic syndrome on the graft after renal transplantation. However, in patients in whom disease has recurred, high doses of cyclosporine may be effective alone or in combination with plasma exchanges. The main worrisome side effect of cyclosporine is chronic nephrotoxicity, which should be differentiated from acute or "functional" toxicity. Follow-up studies including pretreatment and posttreatment renal biopsies show a lack of correlation between structural damage and renal function, suggesting that a histologic examination of the renal parenchyma is the only reliable way of evaluating chronic cyclosporine nephrotoxicity.

Download Full-text

Small Incision Lenticule Extraction (SMILE) for Moderate and High Myopia: Seven-Year Outcomes of Refraction, Corneal tomography and Wavefront Aberrations

10.21203/rs.2.15558/v1 ◽

2019 ◽

Author(s):

Fei Xia ◽

Yang Shen ◽

Tian Han ◽

Jing Zhao ◽

Hai-Peng Xu ◽

...

Keyword(s):

Visual Acuity ◽

Spherical Aberration ◽

Case Series ◽

Final Visit ◽

Small Incision Lenticule Extraction ◽

Wavefront Aberrations ◽

Distance Visual Acuity ◽

Small Incision ◽

Uncorrected Distance Visual Acuity ◽

Lenticule Extraction

Abstract Background To investigate the long-term corneal stability and wavefront aberrations after small incision lenticule extraction (SMILE) for moderate and high myopia.Methods Prospective, non-consecutive case series. A total of 26 patients (42 eyes) who underwent SMILE from May 2010 to March 2013 at the Fudan University Eye and ENT Hospital (Shanghai, China) were enrolled. The periods of follow-up were 1 month, 1 year, 5 years and 7 years after surgery. The routine eye examinations included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), manifest refraction and corneal topography.Results All surgeries were executed without any complications. At the final visit, a UDVA of 20/20 or better was achieved in 42 eyes (100%), 21 eyes (50%) exhibited no change in CDVA. 15 eyes (36%) gained one line, 6 eyes (14%) gained two lines, and no eyes lost CDVA lines. 93% and 100% of eyes were within ±0.5 D and ±1.00 D of the target refraction, respectively. A mean refractive regression of -0.17 D was observed between 1 month and 7 years postoperatively. Mean corneal front curvature (KMF) were significantly increased between pre- and post-SMILE surgery (P<0.0001). Higher-order aberrations (HOAs) and vertical coma were significantly increased after SMILE compared to those measured before surgery (all P<0.001). There were no significant differences in horizontal coma, trefoil and spherical aberration between pre- and post-SMILE surgery (all P>0.05).Conclusions SMILE is an effective, safe and stable procedure for myopia correction, with relatively constant corneal stability and wavefront aberrations.

Download Full-text

MAGIC biomarkers predict long-term outcomes for steroid-resistant acute GVHD

Blood ◽

10.1182/blood-2018-01-822957 ◽

2018 ◽

Vol 131 (25) ◽

pp. 2846-2855 ◽

Cited By ~ 46

Author(s):

Hannah Major-Monfried ◽

Anne S. Renteria ◽

Attaphol Pawarode ◽

Pavan Reddy ◽

Francis Ayuk ◽

...

Keyword(s):

Clinical Response ◽

Acute Gvhd ◽

Steroid Treatment ◽

Prognostic Biomarkers ◽

Long Term Outcomes ◽

Steroid Resistant ◽

Key Points ◽

Better Than

Key Points Biomarker scores generated after 1 week of steroid treatment of GVHD are prognostic. Biomarkers reflect prognosis better than early clinical response to GVHD treatment.

Download Full-text

Treating Severe Pediatric Keratoconjunctivitis with Topical Cyclosporine A

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1556-1182 ◽

2021 ◽

Author(s):

Julia Biermann ◽

Friederike Bosche ◽

Nicole Eter ◽

Flemming Beisse

Keyword(s):

Cyclosporine A ◽

Treatment Plan ◽

Corneal Opacity ◽

Corneal Neovascularization ◽

Visual Development ◽

Vernal Keratoconjunctivitis ◽

Upper Eyelid ◽

Sparing Effect ◽

One Year

AbstractThe incidence of chronic keratoconjunctivitis, which potentially causes long-term loss of visual acuity due to corneal opacity, is considerably less common in children than in adults. It is therefore in danger of being overlooked. In children the appropriate treatment is therefore often introduced too late, or to an insufficient extent. In this article we would like to raise awareness about the diagnosis of chronic keratoconjunctivitis in children, and to present an effective treatment plan for severe stages of the disease. There are two forms of chronic keratoconjunctivitis that occur most frequently in children: hyperergic blepharokeratoconjunctivitis (hBKC) and vernal keratoconjunctivitis (VKC). With hBKC, the patient often has a history of recurring hordeolum and also presents with blepharitis; it is characterized by the marked presence of corneal neovascularization in the lower circumference of the cornea. VKC is typically characterized by changes under the upper eyelid, with marked changes to the superior limbus. If there is a risk of complications involving the cornea, or in the presence of such complications, a consistent long-term topical immunosuppressive and anti-inflammatory treatment is required. Both of these properties are combined in the active ingredient cyclosporine A. Other advantages of topical CSA treatment are its steroid-sparing effect and the long-term reduction of exacerbations. Parents need to be informed about the chronic nature of these two diseases and their tendency to recur; because of these characteristics, treatment, in most cases, should be envisaged for at least one year in order to effectively disrupt the complex immunologic processes. This safeguards the childʼs visual development and prevents amblyopia caused by scarring and astigmatism. We hope that the data presented will lower the barriers related to prescribing CSA for topical eye application in children.

Download Full-text

Different Types of Maculopathy in Eyes after a High-Voltage Electrical Shock Injury

Case Reports in Ophthalmology ◽

10.1159/000496196 ◽

2019 ◽

Vol 10 (1) ◽

pp. 19-23 ◽

Cited By ~ 1

Author(s):

Hye Rim Choe ◽

Un Chul Park

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

High Voltage ◽

Electrical Current ◽

Final Visit ◽

Electrical Injury ◽

Electrical Shock ◽

Retinal Atrophy ◽

Different Types ◽

The Right

Background: We report a case of different types of maculopathy in eyes after a high-voltage electrical shock injury. Case Report: A 43-year-old male suffered high-voltage electrical injury through his left arm. He underwent cataract surgery in both eyes 3 months after the injury, but there was no vision improvement. Ocular examination, including spectral domain optical coherence tomography, revealed diffuse retinal atrophy in the left eye which did not change until the final visit. In the right eye, an impending macular hole was observed but regressed spontaneously 9 months after the injury, and the visual acuity improved to 20/32 at the final visit. Conclusion: Two different types of maculopathy can occur in each eye after high-voltage electrical shock injury, and this might be due to asymmetric pathogenesis of the eyes according to the proximity to the route of electrical current.

Download Full-text