Transcript Topical Tacrolimus 0.03% for Refractory Allergic Conjunctivitis

Topical Tacrolimus 0,03% for Treatment
of Refractory Allergic Conjunctivitis
Diane Marinho, Andréia Ferreira Laranjeira ,
Sérgio Kwitko, Samuel Rymer
Hospital de Clínicas de Porto Alegre
Federal University of Rio Grande do Sul - Porto Alegre - Brazil
The authors have no financial interest in the subject matter of this poster
Topical Tacrolimus for Allergic Conjunctivitis
Treatment of severe allergic conjuntivitis is a big
challenge,
since
eyedrops
containing
antihistamines or sodium chromoglycate and its
derivates are often insufficient. The addition of
corticoids is often required, but the risk of
glaucoma, cataract or atrophy of the skin limits the
use of corticoids to short courses.
• Purpose
To evaluate the efficacy of topical tacrolimus
0,03% in the treatment of allergic conjunctivitis
refractory to conventional treatment or dependent
of corticosteroids.
1.
2.
Virtanen H et al. Effect of 0,03% tacrolimus ointment on conjunctival cytology in patients with severe atopic blepharoconjunctivitis: a retrospective
study. Acta Ophthalmol. Scand 2006;84: 693-695.
Tacrolimus Ointment 0,03% in the Eye for Treatment of Giant Papillary Conjunctivitis Cornea 2008; 27: 228-229.
Topical Tacrolimus for Allergic Conjunctivitis
Methods
•
13 patients with ocular allergy
9 vernal conjunctivitis
3 chronic atopic conjunctivitis
1 allergic dermatoconjunctivitis
•
Topical tacrolimus 0,03% twice daily
• Clear of topical antihistamines and corticoids for
at least one week
• Follow-up between 6-16 months
• Ophthalmological examination in days 15th, 30ty and
monthly after
Topical Tacrolimus for Allergic Conjunctivitis
• Results
Patients referred total symptoms relief after a
mean follow-up time of 2 weeks. Two patients
referred burning sensation and interrupted the
eyedrops in the first two weeks of treatment. No
other medications were necessary for ocular allergy
control. One patient showed ponderal gain of 12
pounds and school improvement since tacrolimus
introduction. No one restarted with corticoids or
antihistamines eyedrops during treatment with
tacrolimus. After two weeks of the begining, seven
patients related reduced burning sensation with
topical tacrolimus. No adverse event due to local
imunossupression, in visual acuity or in refraction
was observed.
Topical Tacrolimus for Allergic Conjunctivitis
Table 1: Patients caracteristics and follow-up
Patients
1
2
3
4
5
6
7
8
9
10
11
12
13
Age(Yrs) Gender
6
8
16
24
22
18
11
8
18
19
16
9
7
M
M
M
M
F
M
F
M
M
M
M
M
M
Conjunctivitis
VERNAL
VERNAL
VERNAL
ALLERGIC
ATOPIC
VERNAL
VERNAL
VERNAL
ATOPIC
ATOPIC
VERNAL
VERNAL
VERNAL
Previous history
1,2,4,5,6
1,2,4,5
1,3,5,7
1,2,3,4,5
1,4,5,6
1,2,3,4,5
1,2,4,5
3,4,5,6
1,2,3,5
1,2,3,4,5,6,7
1,3,4,5,6
2,4,5
1,3,4,5
Follow-up (months) Incident or Adverse event
16
16
16
14
14
11
8
10
9
9
-
Burning sensation 1st week
Tacrolimus sttoped for 2 months: new crisis
Burning sensation for 2 weeks
Sttoped in 2 weeks (burning)
Burning sensation 1st week
Burning sensation for 3 weeks
Sttoped in the first week (burning)
Burning sensation 1st week
Burning sensation for 2 weeks
1- Rinitis 2- Asthma 3- Atopic dermatitis 4- Corticoid use >3 times/year 5- Cronic use of antihistamines or mast cells stabilizers eyedrops
6- Corneal ulcer 7- Cataract Yrs= years M=male F=female
Topical Tacrolimus for Allergic Conjunctivitis
Figures 1. Patient 3 30 and 120 days pos treatment
Topical Tacrolimus for Allergic Conjunctivitis
Figures 2: Patient 2 pre treatment and 15 days pos treatment
Figures 3: Patient 2 pre treatment and 30 days pos treatment
Topical Tacrolimus for Allergic Conjunctivitis
• Conclusion:
The tacrolimus 0,03% eyedrops appears to
be an effective and safe alternative for
allergic conjunctivitis refractory to traditional
treatment or corticoid dependent.