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To study efficacy of tacrolimus (0.03%) eye ointment, cyclosporine (0.1%) eye drops and fluorometholone (0.1%) eye drops in vernal keratoconjunctivitis

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Original Article

Author Details : Rupali Kashyap*, Tulika Gupta, Rajendra Prakash Maurya, Meghna Roy

Volume : 10, Issue : 3, Year : 2024

Article Page : 454-458

https://doi.org/10.18231/j.ijceo.2024.078

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Abstract

Background: VKC (Vernal keratoconjunctivitis) is a chronic, bilateral ocular inflammatory disorder that primarily impacts young patients. Management of VKC is challenging due to its complex immunological etiology and chronic inflammatory components.

Materials and Methods: This prospective, single-center, randomized study was executed at the Outpatient Department of Ophthalmology, SGT Medical College, Hospital and Research Institute (FMHS), Budhera, Gurugram, for a duration of 18 months. A total of 102 clinically diagnosed VKC patients, aged above 5 years, have been then randomly divided into 3 groups (34 each). Group A received fluorometholone (0.1%) eye drops, Group B received cyclosporine (0.1%) eye drops, and Group C received tacrolimus (0.03%) eye ointment. Patients were evaluated at days 0, 7, 14, 28, 35, and two weeks post-medication using the Clinical Scoring System by Bleik and Tabbara to assess TSSS (Total Subjective Symptom Score) and TOSS (Total Objective Ocular Sign Score).

Results: Most patients were between 6-10 years old, with over 78% being males. Group A showed significant symptom reduction from the first week (mean TSSS reduction from 2.29_0.46 to 0.21_0.41, p<0.0001), while Groups B and C showed significant improvements from the second week (Group B: mean TSSS reduction from 2.5_0.51 to 0.12_0.33, p<0.0001; Group C: mean TSSS reduction from 2.29_0.46 to 1.00_0.00, p<0.0001). Conjunctival hyperemia and tarsal papillae improvements were more pronounced in Group B as compared to Groups A & C. No ocular complications were found, except for dose-dependent irritation in Group C.

Conclusion: While fluorometholone (0.1%) eye drops provided early symptom relief, its effects were not sustained. Cyclosporine (0.1%) eye drops and tacrolimus (0.03%) eye ointment showed delayed but sustained efficacy, making them suitable for long-term treatment of moderate to severe VKC. Fluorometholone may be used initially alongside immunomodulators for rapid symptom relief, followed by tapering as immunomodulators take effect.

Keywords: Vernal keratoconjunctivitis, Tacrolimus, Cyclosporine, Fluorometholone, immunomodulators, Ocular inflammation, Chronic conjunctivitis

How to cite : Kashyap R, Gupta T, Maurya R P, Roy M, To study efficacy of tacrolimus (0.03%) eye ointment, cyclosporine (0.1%) eye drops and fluorometholone (0.1%) eye drops in vernal keratoconjunctivitis. Indian J Clin Exp Ophthalmol 2024;10(3):454-458

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