[Efficacy of topical 2% cyclosporine A as a steroid-sparing agent in steroid-dependent vernal keratoconjunctivitis]

Abstract

Introduction: Vernal keratoconjunctivitis (VKC) is responsible for severe conjunctival and corneal inflammation that often requires topical steroids. Steroid dependency is not rare and can lead to unacceptable complications. The aim of this study was to analyze the efficacy of 2% cyclosporine eye drops (CsA) as a steroid-sparing agent in steroid-dependent VKC.

Patients and methods: In this noncomparative interventional case series, 18 steroid-dependent VKC patients (17 males, 1 female; mean age, 13 years old) received 2% CsA qid. Topical steroids were associated at decreasing dosage for 1 week and stopped if possible. Efficacy was graded at 1 and 3 months on symptoms, signs and steroid use. Local and systemic tolerability (cyclosporinemia, creatininemia) was also assessed.

Results: After 1 month, inflammation was controlled without steroids in 11 cases (61%). Low-dose steroids were still necessary to control the disease in four cases (22%). In three cases (17%), the disease was not controlled despite high-dose steroids. At 3 months, results were similar. All patients whose inflammation was partially controlled or not controlled by CsA had active extraocular atopic diseases. Local and systemic tolerability was excellent.

Conclusions: Topical 2% cyclosporine is inconstantly effective in steroid-dependent VKC. However, this treatment allows for a partial or total reduction of steroids in most cases.