TOPICAL CYCLOSPORINE TOPICAL CYCLOSPORINE 0.1% IN THE 0.1% IN THE

TREATMENT OF VERNAL TREATMENT OF VERNAL CATARRHCATARRH

DDR R SSAURABH AURABH SSHAHHAH

Financial Disclosure:I do not have any financial interests or relationships to disclose.

INTRODUCTIONVERNAL KERATOCONJUNCTIVITIS (VKC)VERNAL KERATOCONJUNCTIVITIS (VKC)•Initially described by arit (1846) as conjunctivitis lyphatica and by desmarres (1847) as perikeratic hypertrophy. Von graefe (1871) was first to associate this "gelatinous perilimbal infiltrate" with pavement like proliferation of tarsal conjunctiva.. The disease was subsequently characterized as a clinical entity by saemisch (1876), who insisted on its periodicity and called it spring catarrh.

•This is a chronic form of allergic conjunctivitis, vernal in greek meaning "occurring in spring*"

•In india and tropics the disease is common.

•Warm climates ;

•Personal history of atopic disease ,

•Male to female ratio 2:1

•Early onset with remission by the teens and frequently at the onset of puberty

• AIM OF STUDY AIM OF STUDY • Conduct a prospective clinical trial to observe effect of topical cyclosporine 0.1% in

vernal catarrh.• DESIGN: PROSPECTIVE CLINICAL TRIAL

• INCLUSION CRITERIA: • Newly diagnosed cases of vernal catarrh irrespective of age and sex.• EXCLUSION CRITERIA: • Patients who were already treated for vernal catarrh.

• Atopic conjunctivitis.

• Patients of vernal catarrh having herpes infection.

• Patients with ocular surface disorder.

• Patients having severe systemic allergy requiring treatment at study entry.

SIGNS SCORESIGNS SCORE  0 1 2 3

Conjunctival Hyperemia No   Mild Moderate Severe

Punctate keratitis absent 1 quadrant 2 quadrant 3 or >3 quadrant

Tranta's Spots Absent 1-2 3-4 5 or >5

Limbal oedema absent <90degree >90 <180 degree >180 degree

SYMPTOMS SCORE

Itching, Tearing,Photophobia, Foreign body sensation

0 no symptoms

1 mild symptoms/ discomfort that is just noticeable

2 moderate /discomfort that doesn't interfere with daily routine

3 severe symptoms/disruption of daily routine

GRADING & SCORE

TREATMENT: Topical cyciosporine e/d 0.1% 4 times daily for three months. (cyclomune 0.1%. Benzakonium chloride 0.02% as a preservative)

FOLLOW UP: Patients were reviewed after 7 day, 1 month, and 3months. At every visit patients -progression and regression of initial symptoms.

-through clinical examination with slit lamp. depending upon signs and symptoms noted patients were graded again.

GRADE SCOR

E

MILD 1-10

MODERA

TE

11-20

SEVERE 21-30

• Patient's details, Detailed history, chief complaints were noted & thorough clinical examination with slit lamp were done. Depending upon signs and symptoms noted each patient were graded as mild, moderate and severe according to total score

• FOLLOWING EFFECTS WERE SEEN FOLLOWING EFFECTS WERE SEEN Symptoms Mild Moderate Severe

P-Value % Improvemen

t

P-Value % Improvemen

t

P-Value % Improvement

Itching 0.046 56.7 0.020 46.5 0.301 6.7Tearing 0.013 73.5 0.020 54.0 0.317 15.4

Photophobia 0.034 62.5 0.020 50.3 0.311 8.3Foreign Body Sensation 0.033 73.0 0.009 78.3 0.352 8.3

Palpebral Hyperemia 0.018 59.9 0.024 44.8 0.295 7.1Palpebral Papillae 0.026 66.9 0.034 39.6 0.952 0.0Bulbar Hyperemia 0.025 67.0 0.046 23.1 0.300 8.3

Limbal Edema 0.157 38.9 0.317 48.0 0.517 12.5Tranta’s Spot 0.083 51.9 0.102 28.6 0.410 16.7

Punctate Keratitis 0.014 85.9 0.014 54.3 0.317 6.7Composite Score* 0.007 68.0 0.011 49.7 0.212 7.5

STATISTICALLY SIGNIFICANT IMPROVEMENT WAS OBSERVED STATISTICALLY SIGNIFICANT IMPROVEMENT WAS OBSERVED IN MILD AND MODERATE CASESIN MILD AND MODERATE CASES

Improvement of conjunctival hyperaemia

Improvement of conjunctival papillary hypertrophy Improvement of limbal hypertrophy

Giant Papillae

Punctate Keratitis

severe conjunctival hyperaemia and corneal pannus formation

DISCUSSION• VKC is an allergic type of conjunctivitis which is most common in young males. Visual loss occurs

because of corneal complications from the disease or because of the use or abuse of topical corticosteroids which may lead to steroid induced glaucoma and increased susceptibility to infections.

• Our study was done to observe effect of topical cyclosporine 0.1 % on newly diagnosed VKC. Total 24 patients (48 eyes) were included in this study. Mean age of patients was 7 years (3-13years). Patients were graded as mild, moderate and severe.

• Of the total 24 patients 11 of mild, 8 patients of moderate and 5 of severe grade who were administered topical cyclosporine 0.1 % four times per day and followed for 3 months. Topical cyclosporine was well tolerated by all our patients.

• 2% cyclosporine may cause corneal epitheliopathy and eyelid maceration therefore by using 0.1 % cyclosporine we have tried to prevent such untoward effects in mild to moderate cases.

• Our study has included mild and moderate cases. We have used 0.1 % concentration of cyclosporine. Severe cases had no statistical improvement.

CONCLUSION• Topical 0.1 % cyclosporine Topical 0.1 % cyclosporine is an effective and safe treatment modality for mild

and moderate cases of vernal catarrh when given four times per day for 3 months.

• This dosage is not effective in severe cases of vernal catarrh.

• Cyclosporine 0.1 % can be used as alternate to corticosteroids therapy for mild and moderate cases of vernal catarrh.

• However, a longer duration of study and a large sample size will be more conclusive for defining the treatment course of the cases of vernal catarrh.

- D- Dr r SSaurabh aurabh SShahhah