[0.05% cyclosporine a for treatment of chronic severe ocular surface disease]

To evaluate the effects of topical cyclosporin A on severe and corticodependent chronic ocular surface disorders (OSD), in immune inflammatory disease.

Experimental study, Centre hospitalier universitaire (CHU) Bretonneau, Tours, France.

Twenty-one patients diagnosed with dry eye syndrome secondary to vernal keratoconjunctivitis (7 cases), atopic keratoconjunctivitis (8 cases), and ocular rosacea (6 cases) were treated twice a day with a 0.05% cyclosporin ophthalmic emulsion.

Corneal and conjunctival staining, Oxford score, and symptoms severity assessment (OSDI score) were conducted from the beginning of the cyclosporin treatment up to the end of study. Other collected data included visual acuity, intraocular pressure measurements, an adverse effects questionnaire, and evaluation of the use of adjunctive corticosteroids therapy.

Topical cyclosporin 0.05% gave significant long-term improvement of visual acuity (p = 0.018), symptoms severity (OSDI score, p = 0.001), corneal and conjunctival staining (van Bijesterveld score, p = 0.0003), and Oxford score (p = 0.0002). Topical cyclosporin allowed for less corticosteroid treatment in all cases (p = 0.04), and broke it off with no long-term recurrence in 15 cases (71%). No severe adverse effect occurred, but 3 patients (14%) stopped cyclosporin treatment because of increasing ocular symptoms.

Given our results, topical cyclosporin represents a new well-tolerated treatment for severe and corticodependent chronic ocular surface disorders. In monotherapy or in association with a corticotherapy, topical cyclosporin could be efficient in any OSD involving immune-based inflammation.