Efficacy of combined 0.05% cyclosporine and 1% methylprednisolone treatment for chronic dry eye.

Published on May 1, 2012in Cornea2.215
· DOI :10.1097/ICO.0B013E31818C69EF
Yeo Jue Byun5
Estimated H-index: 5
(Yonsei University),
Yeo-Jue Byun2
Estimated H-index: 2
+ 4 AuthorsWoo Chan Park1
Estimated H-index: 1
Sources
Abstract
PURPOSE: To compare the efficacy of topical cyclosporine 0.05% (tCsA) and combined treatment with 1% methylprednisolone acetate for the treatment of moderate-to-severe chronic dry eye. PATIENTS AND METHODS: Forty-four patients with moderate-to-severe dry eye who had not responded to conventional treatment were treated with tCsA for 3 months. Twenty-one subjects (Group 1) were treated with 1% methyl prednisolone acetate and tCsA for the initial 3 weeks, and treated with tCsA only thereafter, and 23 subjects (Group 2) were treated with tCsA only. Symptom scores, tear break-up time (TBUT), Schirmer score, and corneal and conjunctival fluorescein staining were evaluated before and at 1, 2, and 3 months after treatment. Proinflammatory factors, interleukin-6 (IL-6), and interleukin-8 (IL-8) tear concentration were measured before treatment and at 3 months. RESULTS: Symptom scores, Schirmer scores, TBUT score, corneal fluorescein, and conjunctival staining showed significant improvement at 1 month compared to baseline in group 1 (all P < 0.001), and all the same but few exceptions in group 2 (P = 0.002 on Schirmer, P = 0.267 on cornea stating). In symptom scores, Schirmer scores, and corneal staining, greater improvements were observed for group 1 at 1 month compared to group 2 (P < 0.001, P = 0.039, P = 0.01, respectively). However, in TBUT score and conjunctival staining, there were no between-group differences (P = 0.277, P = 0.254, respectively). The time interval from treatment initiation to symptom relief was shorter for group 1 than group 2. Both groups showed decreased tear IL-6 and IL-8 concentrations at 3 months compared to baseline levels (P < 0.05). However, no between-group differences were noted in mean concentrations of IL-6 and IL-8 at baseline and at 3 months. CONCLUSIONS: Treatment with tCsA appears to be safe and effective in moderate-to-severe chronic dry eye. Additional short-term use of a topical steroid had the benefit of providing faster symptom relief and improvement of ocular sign without serious complications.
📖 Papers frequently viewed together
4 Authors (Kenneth Sall, ..., Brenda L. Reis)
676 Citations
12 Authors (Michael A. Lemp, ..., Ikuko Toda)
2,210 Citations
4 Authors (Kenneth Sall, ..., Brenda L. Reis)
345 Citations
References17
Newest
#1Steven E. Wilson (Cleveland Clinic)H-Index: 83
#2Henry D. PerryH-Index: 52
Purpose To report the resolution of symptoms and signs of chronic dry eye for at least 1 year after completion of a minimum 6-month course of topical 0.05% cyclosporine in a subgroup of patients from 2 practices. Design Retrospective case series. Participants Eight patients who had had chronic dry eye disease for 3 to 20 years were treated with topical cyclosporine for 6 to 72 months, and then remained free of symptoms or signs of disease for at least 1 year (range, 16–29 months; mean, 21 months...
66 CitationsSource
#1Kaevalin Lekhanont (Johns Hopkins University)H-Index: 5
#2Ilya M. Leyngold (Johns Hopkins University)H-Index: 11
Last. Roy S. Chuck (Johns Hopkins University)H-Index: 29
view all 5 authors...
Purpose:To compare the effects of topical dry eye medications including anti-inflammatory agents and lubricant eyedrops for the treatment of keratoconjunctivitis sicca (KCS) in a botulinum toxin B (BTX-B)-induced mouse model.Methods:CBA mice were randomized into 10 groups. The first 5 groups receive
28 CitationsSource
#1Hyung Keun Lee (Yonsei University)H-Index: 25
#1Hyung Keun Lee (Yonsei University)H-Index: 15
Last. Eung Kweon Kim (Yonsei University)H-Index: 49
view all 6 authors...
Purpose To compare nerve growth factor (NGF) levels in tears and on the ocular surfaces of normal control and non–Sjogren's type keratoconjunctivitis sicca subjects, and to investigate the effect of 0.1% prednisolone eyedrops on NGF levels in keratoconjunctivitis sicca patients. Design Prospective, double-masked, randomized, comparative clinical trial. Participants Forty-one keratoconjunctivitis sicca patients and 23 age- and gender-matched healthy subjects. Methods Baseline tear NGF levels were...
66 CitationsSource
Purpose.To evaluate the efficacy of marketed artificial tears in relieving the signs and symptoms of dry eye when used as supportive therapy to a cyclosporine-based ophthalmic emulsion.Methods.Sixty-one patients were enrolled in this randomized, investigator-masked, parallel study of 6 months' durat
41 CitationsSource
#1Laurie D. Barber (UALR: University of Arkansas at Little Rock)H-Index: 1
Last. Gary N. Foulks (University of Pittsburgh)H-Index: 29
view all 4 authors...
Objective To evaluate cyclosporine 0.1% ophthalmic emulsion over a 1- to 3-year period in moderate to severe dry eye disease patients. Design Nonrandomized, multicenter, open-label clinical trial extending 2 ophthalmic cyclosporine phase III clinical trials. Participants Four hundred twelve patients previously dosed for 6 to 12 months with cyclosporine 0.05% or 0.1% in prior phase III trials. Intervention Patients instilled ophthalmic cyclosporine 0.1% twice daily into both eyes for up to 3 cons...
131 CitationsSource
#1Lihui Luo (BCM: Baylor College of Medicine)H-Index: 10
#2De-Quan LiH-Index: 64
Last. Stephen C. PflugfelderH-Index: 108
view all 4 authors...
Purpose.To investigate whether hyperosmolar stress stimulates production of inflammatory mediators and activates the mitogen-activated protein kinase (MAPK) signaling pathways, c-jun n-terminal kinases (JNKs), extracellular-regulated kinases (ERKs), and p38 on the mouse ocular surface.Methods.129SvE
244 CitationsSource
#1Avni Murat Avunduk (LSU: Louisiana State University)H-Index: 15
#1Avni Murat Avunduk (LSU: Louisiana State University)H-Index: 3
Last. Herbert E. Kaufman (LSU: Louisiana State University)H-Index: 87
view all 4 authors...
Abstract Purpose To investigate whether conjunctival inflammation represents a primary event in the pathogenesis of keratoconjunctivitis sicca or whether it is a secondary inflammatory reaction caused by enhanced mechanical irritation as a result of surface dryness and whether anti-inflammatory drops (corticosteroids and nonsteroidal anti-inflammatory) have therapeutic effects and are similar. Design Single-masked, randomized, prospective clinical trial. Methods Thirty-two keratoconjuctivitis pa...
149 CitationsSource
#1Horst Brewitt (Hochschule Hannover)H-Index: 8
#2Firouzeh Sistani (Hochschule Hannover)H-Index: 1
Abstract Dry eye disease, or keratoconjunctivitis sicca, is among the most frequently established diagnoses in ophthalmology; in Germany, one in four patients consulting an ophthalmologist complains of the symptoms of dry eye. Although epidemiological studies investigating the prevalence of dry eye disease are rare, published studies indicate that up to 20% of adults aged 45 years or more experience dry eye symptoms. Recent studies have shown that immunologic changes play a role in the pathogene...
237 CitationsSource
#1Françoise BrignoleH-Index: 21
#2Pierre-Jean Pisella (University of Paris)H-Index: 26
Last. Christophe BaudouinH-Index: 80
view all 6 authors...
PURPOSE. Immune-based inflammation has been observed as a common mechanism of keratoconjunctivitis sicca (KCS). In KCS-affected eyes, upregulated expression of HLA DR and various immune- or apoptosis-related markers by conjunctival epithelial cells has been demonstrated in an earlier study, by a technique of flow cytometry in impression cytology (IC) specimens. The purpose of this study was to monitor the effects of topical cyclosporin A on the expression of these markers throughout a 6-month pe...
198 Citations
#1Kathleen S. Kunert (BU: Boston University)H-Index: 3
#1Kathleen S. KunertH-Index: 11
Last. Ilene K. GipsonH-Index: 73
view all 5 authors...
Objective: To study the effect of topical cyclosporine on lymphocyte activation within the conjunctiva of patients with moderate to severe dry eye syndrome (Sjogren and non-Sjogren). Methods: Biopsy specimens were obtained at baseline and after 6 months of cyclosporine treatment from eyes of 32 patients with moderate to severe dry eye syndrome; 19 were cyclosporine treated (0.05% cyclosporine, n=13; 0.1% cyclosporine, n=6) and 13 were vehicle treated. Within this group there were 12 with Sjogren...
275 CitationsSource
Cited By33
Newest
#1Carlos Vergés (UPC: Polytechnic University of Catalonia)H-Index: 1
#2José Salgado-Borges (University of Minho)H-Index: 1
Last. Verónica Ribas (UPC: Polytechnic University of Catalonia)
view all 4 authors...
Source
Source
#1Pragnya R. Donthineni (LVPEI: L V Prasad Eye Institute)H-Index: 6
#2Swapna S Shanbhag (LVPEI: L V Prasad Eye Institute)H-Index: 13
Last. Sayan Basu (LVPEI: L V Prasad Eye Institute)H-Index: 25
view all 3 authors...
Dry eye disease (DED) is an emerging health concern causing significant visual, psychological, social, and economic impact globally. In contrast to visual rehabilitation undertaken at late stages of DED, measures instituted to prevent its onset, establishment, or progression can alter its natural course and effectively bring down the associated morbidity. This review attempts to present the available literature on preventive strategies of DED at one place, including strategies for risk assessmen...
1 CitationsSource
#1Hayley Favre (University of Texas at Austin)
#2Sejal Lahoti (University of Texas at Austin)H-Index: 1
Last. Ahmad Kheirkhah (University of Texas at Austin)H-Index: 25
view all 5 authors...
To review current literature on the use of topical steroids for treatment of both aqueous-deficient and evaporative subtypes of dry eye disease (DED). Recent studies have shown that topical steroids are effective for the treatment of patients with moderate or severe DED who have failed to respond to more conservative measures. These medications are useful for patients with both aqueous-deficient and evaporative subtypes of DED. Although topical steroids are often used for a short period of time,...
Source
#1Saama Sabeti (Harvard University)H-Index: 2
#2Ahmad Kheirkhah (University of Texas Health Science Center at San Antonio)H-Index: 25
Last. Reza Dana (MEE: Massachusetts Eye and Ear Infirmary)H-Index: 86
view all 4 authors...
Abstract Meibomian gland dysfunction (MGD) is the leading cause of evaporative dry eye disease and is one of the most common conditions encountered by eye care providers. MGD is characterized by obstruction of the meibomian gland terminal ducts and/or changes in their glandular secretion, resulting in changes in tear film stability, inflammation, and symptoms of irritation. There is no gold standard treatment for MGD, but rather a diversity of options. Conservative measures include warm compress...
18 CitationsSource
#1Jae Yeong Park (PNU: Pusan National University)H-Index: 2
#2Sang Cheol Yang (PNU: Pusan National University)H-Index: 3
Last. Jong Soo Lee (PNU: Pusan National University)H-Index: 17
view all 6 authors...
1 CitationsSource
#1Shaveta Singla (Safdarjang Hospital)H-Index: 1
#2Lopamudra Sarkar (Safdarjang Hospital)H-Index: 1
Last. Lopamudra Sarkar (Safdarjang Hospital)
view all 3 authors...
PURPOSE: The purpose of this study is to compare the efficacy of topical cyclosporine (Cs) 0.05% alone and topical Cs 0.05% with loteprednol 0.5% in patients with moderate dry eye. STUDY DESIGN: This was a comparative, prospective, interventional study. PATIENTS AND METHODS: A total of 140 patients diagnosed with moderate dry eyes were randomly divided into two groups. Group A patients received treatment with topical loteprednol 0.5% started as QID dosage for 2 weeks and tapered to BID dosage ov...
3 CitationsSource
: Dry eye disease (DED) is a multifactorial disease of ocular surface and tear film, and is a common disorder treated by eye care providers. It is well established that ocular surface inflammation has an important role in the pathophysiology of DED and that anti-inflammatory cyclosporine A (CsA) improves the treatment outcomes of most patients with DED. The purpose of this review is to provide guidance for practitioners in the use of topical CsA for the management of DED to improve patient satis...
6 CitationsSource
ABSTRACTDry eye disease (DED) is a multifactorial disease that results in symptoms of discomfort, visual disturbance, and damage to the ocular surface. Because chronic inflammation plays an important role in DED, treatment with topical corticosteroids has been demonstrated to ameliorate the signs and symptoms of the disease. Although these agents have proven short-term efficacy, their long-term use may cause intraocular pressure elevation and cataract progression. A carefully review of the diffe...
16 CitationsSource
#1Eilidh Martin (GCU: Glasgow Caledonian University)H-Index: 4
#2Katherine M. Oliver (GCU: Glasgow Caledonian University)H-Index: 10
Last. Suzanne Hagan (GCU: Glasgow Caledonian University)H-Index: 16
view all 6 authors...
Abstract Purpose Three tear supplements were compared for their effects on the signs, symptoms and inflammatory status of subjects with dry eye disease. Assessments were made before and after both 2 and 4 weeks of treatment. Methods In this masked, randomized, 3-way crossover trial, eighteen dry eye subjects were recruited. At each visit, symptoms, tear evaporation rate, stability and osmolarity were measured and tear samples were analyzed for 7 inflammatory markers, using multiplex immunoassays...
11 CitationsSource