Original article
Topical Cyclosporine A in Severe Steroid-Dependent Childhood Phlyctenular Keratoconjunctivitis

https://doi.org/10.1016/j.ajo.2005.08.035Get rights and content

Purpose

To assess the efficacy of topical cyclosporine A (CsA) in children with phlyctenular keratoconjunctivitis associated with severe steroid-dependent corneal inflammation.

Design

Prospective, noncomparative, interventional case series.

Methods

patients: Children with phlyctenular keratoconjunctivitis associated with severe steroid-dependent corneal inflammation and not responding to oral antibiotics (cyclines or erythromycin). intervention: Topical CsA 2% four times daily, initially combined with topical dexamethasone for the first week. main outcome measures: Efficacy was judged by the patients (symptoms and ocular redness) and by the ophthalmologist (ocular redness and corneal inflammation). The patients were monitored for adverse effects, and cyclosporinemia was determined every 3 months.

Results

We studied 11 children (13 eyes) with a mean age of 9 years (range, 4 to 15 years). Inflammation was controlled in all the eyes within 14 days. Inflammation did not recur during CsA monotherapy, during a mean follow-up of 12 ± 8 months (range, 6 to 31 months). CsA therapy was stopped in eight patients (10 eyes) after a mean treatment duration of 13 ± 9 months (range, 6 to 31 months), and no recurrences occurred during 10 ± 3 months of follow-up (range, 6 to 12 months). Local tolerance of CsA was good. None of the patients had detectable CsA blood levels. CsA was withdrawn in one case after 6 months, because of generalized skin rash.

Conclusions

Long-term topical CsA 2% therapy is safe and effective in children with phlyctenular keratoconjunctivitis associated with severe steroid-dependent corneal inflammation.

Section snippets

Patients

We enrolled children with severe phlyctenular keratoconjunctivitis who failed to respond to oral antibiotics and eyelid hygiene, and who were dependent on topical steroids. The inflammation was considered severe when more than 25% of the lower cornea was involved or when the visual axis was threatened. Steroid dependency was defined as corneal inflammation recurring within 2 months after steroid withdrawal. Informed parental consent was obtained in every case, and the study was approved by our

Results

Eleven patients (four boys and seven girls, 13 eyes) were enrolled in the study (Table 1). Their mean age was 9 ± 4 years (range, 4 to 15 years), and the mean disease duration was 33 months (range, 8 months to 5 years). At enrollment, all the eyes had active uncontrolled inflammation despite therapy including oral antibiotics (erythromycin in seven patients, minocycline in four patients), topical corticosteroids (eight patients, 10 eyes), normal saline, and eyelid hygiene. The three patients

Discussion

Eyelid hygiene and oral antibiotics are not always adequately effective on severe corneal inflammation associated with phlyctenular keratoconjunctivitis. Topical corticosteroids are considered the best option for such patients, but steroid dependency is frequent and carries a risk of cataract, glaucoma, infection, and delayed wound healing. It is crucial to control the inflammation when corneal lesions approach the visual axis, and a safe antiinflammatory treatment is therefore required for

Serge Doan, MD, performed his residency in Paris and his fellowship with Prof Thanh Hoang-Xuan in Paris. He is Assistant Professor in the department of Ophthalmology of Prof Thanh Hoang-Xuan at Hôpital Bichat and Fondation A de Rothschild since 2000.

References (18)

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Serge Doan, MD, performed his residency in Paris and his fellowship with Prof Thanh Hoang-Xuan in Paris. He is Assistant Professor in the department of Ophthalmology of Prof Thanh Hoang-Xuan at Hôpital Bichat and Fondation A de Rothschild since 2000.

Thanh Hoang-Xuan, MD, performed his fellowship in Paris with Yves Pouliquen and in Boston with Steve Foster. He is University Professor and Head of Ophthalmology in Paris since 1990. His department is a reference center in cornea, external diseases and refractive surgery. In these fields, he has contributed to many publications in peer-reviewed journals and chapters of books, and to books as coeditor.

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