Original articleTopical Cyclosporine A in Severe Steroid-Dependent Childhood Phlyctenular Keratoconjunctivitis
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.
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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.