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      Therapeutic effects of 0.1% tacrolimus eye drops for refractory allergic ocular diseases with proliferative lesion or corneal involvement

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          Abstract

          Background

          The objective of this study was to investigate the efficacy of topical 0.1% tacrolimus in treating refractory allergic conjunctivitis with proliferative lesions and/or corneal involvement.

          Methods

          This prospective observational study included 1436 patients with refractory allergic conjunctivitis whose condition had responded poorly to conventional antiallergic drugs and/or topical steroids and/or topical cyclosporine. All patients received tacrolimus eye drops twice daily during the study period. Ten clinical signs and six clinical symptoms were rated on a four-grade scale. The primary endpoint was the change from baseline in total clinical signs and symptoms score at the last observation or following 6 months of treatment.

          Results

          Total signs and symptoms score significantly decreased after 1 month of treatment (p<0.001). Giant papillae and corneal lesions were also reduced by tacrolimus eye drop use (p<0.001). The drug proved effective in patients whose condition did not respond well to topical cyclosporine therapy. About 50% of all patients using topical steroids were weaned. The most common adverse reaction was a transient burning sensation (3.20%).

          Conclusions

          Tacrolimus eye drops are highly effective in treating refractory allergic conjunctivitis with proliferative lesions and/or corneal involvement, and may reduce or replace topical steroid use.

          Trial registration number

          UMIN 000008640.

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          Most cited references20

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          Allergic and immunologic disorders of the eye. Part II: ocular allergy.

          L Bielory (2000)
          Allergy affects more than 15% of the world population, and some studies have shown that up 30% of the US population has some form of allergy. Most of these patients have various target organs for their allergies, and most have ocular involvement. The ocular component may be the most prominent and sometimes disabling feature of their allergy. Some are affected for only a few weeks to months, whereas others have symptoms that last throughout the year. The seasonal forms may present to clinical allergists, whereas the more chronic forms may present to ophthalmologists. Thus, in the second of this 2-part review series (Part I: Ocular Immunology appeared in the November issue of the Journal), an overview is provided of the spectrum of ocular allergy that ranges from acute seasonal allergic conjunctivitis to chronic variants of atopic keratoconjunctivitis. With a better understanding of the immunologic mechanisms, we now can develop better treatment approaches and design further research in intervention of allergic eye diseases.
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            A randomized, placebo-controlled clinical trial of tacrolimus ophthalmic suspension 0.1% in severe allergic conjunctivitis.

            To examine the efficacy of tacrolimus ophthalmic suspension 0.1% in treating severe allergic conjunctivitis. This was a multicenter, randomized, double-masked, placebo-controlled clinical trial. Fifty-six patients with severe allergic conjunctivitis in whom topical antiallergic agents and corticosteroids had been ineffective were randomized to tacrolimus or placebo treatment. Patients were treated either with tacrolimus or placebo twice-daily for 4 weeks. Severity of objective signs in palpebral and bulbar conjunctiva, limbus, and corneal involvement was assessed using 4 grades. Seven subjective symptoms were evaluated by visual analog scale (VAS) assessment. The primary efficacy endpoint was change in the total score of objective signs at the end of treatment. The secondary efficacy endpoints included change in the score for each objective sign and change in the VAS for each subjective symptom. Safety was assessed based on the severity and the incidence of adverse events. Mean change from baseline in total score for objective signs was significantly greater in the tacrolimus (-5.6 + or - 5.1) than in the placebo group (-0.1 + or - 4.5; P < 0.001). Tacrolimus significantly improved giant papillae (P = 0.001) and corneal involvement (P = 0.005). Five subjective symptoms (itching, discharge, hyperemia, lacrimation, and foreign body sensation) were significantly better in the tacrolimus than in the placebo group. The most frequent treatment-related adverse event in the tacrolimus group was mild ocular irritation upon topical instillation, which was well-tolerated. Tacrolimus ophthalmic suspension 0.1% is effective in treating severe allergic conjunctivitis.
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              Atopic keratoconjunctivitis and atopic dermatitis.

              This review will focus on the diagnostic features of atopic keratoconjunctivitis (AKC), its relationship to atopic dermatitis, the immunopathogenesis, and therapy, and will include strategies used for the management of severe disease unresponsive to conventional therapy. Recent research has demonstrated the importance of various cytokines (IL-33), proteins (thymic stromal lymphopoetin) and effector cells (conjunctival epithelial cells, eosinophils and basophils) in the pathogenesis of chronic ocular inflammation. Current evidence supports the use of tacrolimus and cyclosporin A, topically or systemically, as well tolerated and effective steroid sparing agents. Recalcitrant AKC may be a blinding condition. Understanding the immunopathogenesis of atopic dermatitis and AKC has already influenced therapy and is essential to the development of future immunomodulatory treatments. The successful management of AKC requires the use of topical cromones, antihistamines and calcineurin inhibitors. Severely affected patients also require systemic immunosuppressive therapy. The current challenge is to find more specific topical and systemic immunomodulatory therapies with a better side-effect profile.
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                Author and article information

                Journal
                Br J Ophthalmol
                Br J Ophthalmol
                bjophthalmol
                bjo
                The British Journal of Ophthalmology
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0007-1161
                1468-2079
                August 2014
                2 April 2014
                : 98
                : 8
                : 1023-1027
                Affiliations
                [1 ]Department of Ophthalmology, Kochi Medical School , Kochi, Japan
                [2 ]Department of Ophthalmology, Ehime University School of Medicine , Ehime, Japan
                [3 ]Department of Ophthalmology, Juntendo University School of Medicine , Tokyo, Japan
                [4 ]Department of Ophthalmology, Fukuoka University School of Medicine , Fukuoka, Japan
                [5 ]Okamoto Eye Clinic , Ehime, Japan
                [6 ]Kumagai Eye Clinic , Yamaguchi, Japan
                [7 ]Department of Ophthalmology, Division of Visual Sciences, Nihon University School of Medicine , Tokyo, Japan
                [8 ]Department of Ophthalmology, Tokyo Women's Medical University School of Medicine , Tokyo, Japan
                [9 ]Nakagawa Eye Clinic , Osaka, Japan
                [10 ]Department of Ophthalmology and Visual Science, Hokkaido University Graduate School of Medicine , Hokkaido, Japan
                [11 ]Department of Ophthalmology, Tsurumi University Dental Hospital , Kanagawa, Japan
                [12 ]Department of Ophthalmology, Tottori University School of Medicine , Tottori, Japan
                Author notes
                [Correspondence to ] Dr Atsuki Fukushima, Department of Ophthalmology, Kochi Medical School, Oko-cho Kohasu, Nankoku-shi, Kochi 783-8505, Japan; fukusima@ 123456kochi-u.ac.jp
                Article
                bjophthalmol-2013-304453
                10.1136/bjophthalmol-2013-304453
                4112440
                24695688
                b0af33e6-1618-47e2-96b5-1f27dce77136
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

                History
                : 9 October 2013
                : 26 December 2013
                : 16 March 2014
                Categories
                1506
                Clinical Science
                Custom metadata
                unlocked

                Ophthalmology & Optometry
                conjunctiva,drugs,immunology,inflammation,treatment medical
                Ophthalmology & Optometry
                conjunctiva, drugs, immunology, inflammation, treatment medical

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