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. 2025 Jan 9;44(9):1078-1083.
doi: 10.1097/ICO.0000000000003786.

Oral Cyclosporine in Vernal Keratoconjunctivitis: Indications, Outcomes, and Effect on Corticosteroid Use

Anahita Kate  1 , Haritha Goud Tallapelly  1   2 , Neha Jain  3 , Kumari Yukti  1 , Sayan Basu  3   4
Affiliations

Oral Cyclosporine in Vernal Keratoconjunctivitis: Indications, Outcomes, and Effect on Corticosteroid Use

Anahita Kate et al. Cornea. .

Abstract

Purpose: The purpose of this study was to report the indications and outcomes of oral cyclosporine A (oCsA) use in vernal keratoconjunctivitis (VKC) and to assess its effect on corticosteroid use.

Methods: This retrospective review of VKC cases included patients who were prescribed oCsA. Data on clinical characteristics, demographic profile, and treatment were collected. An acute episode was defined as one requiring oral/topical corticosteroids. The outcome measure was the difference in the number of acute episodes before and after oCsA use.

Results: The study included 27 cases (54 eyes) of VKC from 2016 to 2024. The median age was 20 years. Thirty eyes had sequelae due to VKC, the most common of which was limbal stem cell deficiency (46%). The median duration of follow-up was 11 months. Indications for oCsA were recalcitrant disease (23/27, 85%) and severe active allergy in steroid-induced glaucoma/steroid responders (4/27, 15%). None of the cases experienced progression of sequelae with oCsA use. Forty-two acute episodes were observed before oCsA initiation over 403 person-months, which reduced to 10 episodes over 250 person-months with oCsA use. Without oCsA use, the odds of developing an acute exacerbation of the ocular allergy were 2.6 times (95% confidence interval: 1.3-5.2) higher compared with that with oCsA usage.

Conclusions: Oral cyclosporine reduces corticosteroid use in VKC and can be considered in recalcitrant disease or in eyes with steroid-induced glaucoma and active allergy. Oral cyclosporine significantly reduced the risk of acute exacerbations, proving to be an effective modality for controlling inflammation in VKC.

Keywords: calcineurin inhibitors; cornea; corticosteroids; cyclosporine; systemic immunosuppression; vernal keratoconjunctivitis.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

References

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    1. Sangwan VS, Jain V, Vemuganti GK, et al. Vernal keratoconjunctivitis with limbal stem cell deficiency. Cornea. 2011;30:491–496.
    1. Kate A, Basu S. Systemic immunosuppression in cornea and ocular surface disorders: a ready reckoner for ophthalmologists. Semin Ophthalmol. 2022;37:330–344.
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