tacrolimus and Corneal-Ulcer

Ocular graft-versus-host disease (GvHD) following allogeneic blood stem cell transplantation leads to immunologically induced alterations in many ocular tissues, particularly at the ocular surface. Within the framework of the main topic, this article focuses primarily on corneal complications in chronic ocular GvHD.. This article aims to promote understanding of the influencing factors, diagnostics, and therapeutic options pertaining to corneal complications in ocular GvHD. Furthermore, the possibilities for prevention are discussed.. This analysis is based on a literature review as well as on data from the Ophthalmology Clinic at the University Hospital Essen.. Corneal complications often occur secondarily in ocular GvHD, as a consequence of severe inflammatory alterations of the conjunctiva or eyelid. Spontaneous corneal perforations associated with only mild symptoms are less common during the course of disease. From the ophthalmologist's perspective, it is important that the inflammatory activity of all the different ocular tissues is considered. Treatment may follow a stepwise scheme that includes substitution, immunosuppression, and surgical rehabilitation.. Systematic diagnosis of ocular GvHD helps to prevent corneal complications or support early therapeutic intervention. An interdisciplinary approach to diagnosis and treatment planning is recommended, in order to optimize local and systemic immunosuppressive therapy.

Topics: Adrenal Cortex Hormones; Chronic Disease; Combined Modality Therapy; Corneal Diseases; Corneal Ulcer; Cyclosporine; Diagnosis, Differential; Eye Diseases; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Interdisciplinary Communication; Intersectoral Collaboration; Keratoplasty, Penetrating; Limbus Corneae; Ophthalmic Solutions; Tacrolimus

Atopic keratoconjunctivitis (AKC) remains a difficult diagnosis despite advances in imaging technologies. This is a case study of the diagnostic and treatment course for a patient with AKC.. A 15-year-old male complained of progressively increasing pain, redness, watering and blurred vision in the right eye. The medical history showed that the patient suffered from itching on the hands, knees, neck and the eye skin one year before the onset of initial symptoms in the affected eye.. A final diagnosis of stage III AKC with atopic dermatitis (AD) was reached.. The patient was used 0.1% tacrolimus eye drops and 0.3% gatifloxacin eye gel after antimicrobial susceptibility test was performed. In the presence of AD, 0.1% mometasone furoate cream and 0.03% tacrolimus ointment were applied twice daily.. One month after starting treatment, the conjunctivitis and corneal ulcer rapidly improved along with reduced lid papillae. Macular grade corneal opacity was noticed with minimal thinning. The AD also rapidly improved. At the end of two months patient was asymptomatic with a significant improvement in his quality of life.. Proper diagnosis of AKC especially when associated with dermatological signs along with management of AD in conjunction with dermatologist is necessary to prevent corneal involvement which can cause permanent visual disability is of utmost importance. We also noticed that topical tacrolimus is a good option for the treatment of severe AKC with AD along with systemic immunosupressants.

Topics: Administration, Topical; Adolescent; Anti-Allergic Agents; Anti-Bacterial Agents; Conjunctivitis, Allergic; Corneal Ulcer; Dermatitis, Atopic; Fluoroquinolones; Gatifloxacin; Humans; Immunosuppressive Agents; Male; Mometasone Furoate; Ophthalmic Solutions; Tacrolimus; Treatment Outcome

To evaluate the effects of 0.1% topical tacrolimus alone or in combination with steroids for the treatment of shield ulcers and corneal epitheliopathy in patients with refractory allergic ocular diseases.. Open cohort study.. Patients with refractory allergic conjunctivitis epitheliopathy, shield ulcers, or corneal plaques (N = 791).. The 791 patients were treated with topical tacrolimus alone or in combination with topical or oral steroids. The effectiveness of the treatments was determined by a corneal epitheliopathy score during the 3-month follow-up period. The clinical signs were rated on a 4-grade scale. Corneal epitheliopathy with no corneal staining was graded as 0, and shield ulcers or plaques were graded as 3, the highest grade. The effects of tacrolimus with and without topical steroids on the epitheliopathy scores were assessed after adjustments for the severity of the clinical signs and characteristics.. Changes in the corneal epitheliopathy score.. Adjusted mean epitheliopathy score at the baseline was 1.73 (95% confidence interval [CI], 1.65-1.81) for patients treated with tacrolimus alone, and this was significantly reduced by -0.93 at 1 month. The reduction of the score by topical and oral steroids was -0.02 for fluorometholone, 0.02 for betamethasone, and -0.02 for oral steroids, and these reductions were not significant compared with the reduction effect of topical tacrolimus alone at -0.93. The 238 patients with shield ulcer (score 3) were analyzed with adjustments, and the mean epitheliopathy score at 1 month was reduced to 1.38 with tacrolimus alone (95% CI, 1.24-1.51), 1.41 (95% CI, 1.26-1.56) with adjuvant fluorometholone, and 1.46 (95% CI, 1.32-1.61) with adjuvant betamethasone. No significant difference was observed in the adjunctive topical steroids. The presence of severe palpebral conjunctival symptoms, including giant papillae, was a significant resisting factor for topical tacrolimus.. The significant effects of topical tacrolimus alone on shield ulcers and corneal epitheliopathy suggest that it may be used without the need for steroids.

Topics: Administration, Oral; Administration, Topical; Adolescent; Betamethasone; Calcineurin Inhibitors; Child; Cohort Studies; Conjunctivitis, Allergic; Corneal Ulcer; Drug Therapy, Combination; Epithelium, Corneal; Female; Fluorometholone; Glucocorticoids; Humans; Male; Ophthalmic Solutions; Retrospective Studies; Tacrolimus; Young Adult

To investigate risk factors, clinical features, and treatment outcomes of recurrent Mooren ulcers in China.. Medical records of 139 patients (173 eyes) with Mooren ulcers, including 37 patients (38 eyes) with recurrence, were retrospectively reviewed. Clinical features and treatment outcomes were evaluated. The risk factors for ulcer recurrence were analyzed with logistic regression; the cumulative risk of recurrence was assessed with Kaplan-Meier analysis.. The ratio of males to females with Mooren ulcers was 1.62:1. As to age, 32 of 106 patients aged >35 years and 5 of 33 younger patients (28 males and 9 females) had recurrence. Forty-one patients had bilateral disease (7 eyes removed before their visit to our hospital were excluded) and 98 patients had unilateral disease, with recurrence in 10 and 27 patients, respectively. Thirty eyes had recurrence around the primary lesion; 27 eyes had recurrence within 12 months after treatment. Of all eyes, 97.7% were saved and 81.5% retained vision better than 0.05. The cumulative risk of first recurrence at 6, 12, 24, 36, and 48 months was 10.4%, 17.1%, 22.5%, 27.2%, and 28.6%, respectively. Male sex (P = 0.043) and surgical treatment (P = 0.035) were significantly associated with an increased risk of recurrence.. This study provided the clinical characteristics and treatment outcomes of patients with recurrent Mooren ulcers in China. The cumulative risk of first recurrence at 4 years after treatment was 28.6%. Male patients and patients with severe ulcers that required surgery had an increased risk of recurrence.

Topics: Adult; Aged; Aged, 80 and over; China; Corneal Ulcer; Cyclosporine; Dexamethasone; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Ophthalmologic Surgical Procedures; Recurrence; Retrospective Studies; Risk Factors; Tacrolimus; Treatment Outcome; Visual Acuity; Young Adult

To establish polyhexamethylene biguanide (PHMB) as an effective treatment for Aspergillus keratitis in a novel murine model. To determine the ability of the calcineurin inhibitors tacrolimus (FK506) and cyclosporine A (CSA) to enhance the activity of PHMB, amphotericin B (AMB), and voriconazole (VCZ) against Aspergillus keratitis.. Broth antifungal susceptibility tests were performed with PHMB, AMB, VCZ, and FK506, individually and in combination against Aspergillus fumigatus. Minimum inhibitory concentrations (MIC) and fractional inhibitory concentration index (FICI) values were used to analyze antifungal activity. In vivo studies: A novel murine model was created to establish Aspergillus keratitis. Infected mice were randomly assigned to treatment groups receiving saline, CSA, AMB, VCZ, PHMB, AMB+CSA, VCZ+CSA, or PHMB+CSA. An ophthalmologist blinded to the treatment groups assessed disease severity daily based on a grading scale. The mean end change in disease score was compared between groups.. FK506 in combination with PHMB, VCZ, or AMB enhanced fungal growth inhibition. FICI values showed an additive effect between FK506 and PHMB, AMB, or VCZ. PHMB monotherapy eliminated Aspergillus growth starting at 4 μg/mL. In vivo studies: All treatment groups showed a significant improvement in disease score compared to the control group. CSA significantly worsened VCZ activity against Aspergillus keratitis.. PHMB is an effective inhibitor of Aspergillus growth. Further investigation of the role of calcineurin inhibitors in the treatment for Aspergillus keratitis is warranted.

Topics: Amphotericin B; Animals; Aspergillosis; Aspergillus fumigatus; Biguanides; Calcineurin Inhibitors; Corneal Ulcer; Cyclosporine; Disinfectants; Drug Synergism; Eye Infections, Fungal; Immunosuppressive Agents; Male; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Prospective Studies; Pyrimidines; Tacrolimus; Triazoles; Voriconazole

To investigate the therapeutic effects of topical tacrolimus ointment on refractory ocular surface inflammatory diseases.. Retrospective interventional consecutive case series.. Ten consecutive patients with severe ocular surface inflammatory diseases who were suspected to be steroid responders (elevation of intraocular pressure [IOP]) or were refractory to standard steroid therapy were studied. One patient had peripheral ulcerative keratitis with impending corneal perforation, 1 had a Mooren's ulcer, 2 had scleroperikeratitis, 5 had atopic keratoconjunctivitis, and 1 had vernal keratoconjunctivitis.. The clinical findings and therapeutic responses after treatment with 0.02% topical tacrolimus ointment were determined by conventional ophthalmological examinations.. Resolution of the ocular surface diseases (e.g., decrease of hyperemia, ulceration, size of papillae) and IOP. The necessity to use steroids was also assessed.. In all cases, marked to moderate improvement was obtained, including suppression of the melting reaction of the inflamed cornea, remission of scleroperikeratitis, and reduction of a giant papilla and corneal epithelial defect in severe atopic keratoconjunctivitis. The elevated IOP was reduced in steroid responders after successful cessation of steroid therapy. No adverse side effect was noted for 2 to 26 months of continuous treatment.. Topical tacrolimus ointment is effective in treating refractory ocular surface inflammatory diseases and should be considered as an alternative to higher doses, steroid supplementation, or surgical intervention.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Conjunctivitis, Allergic; Corneal Ulcer; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Retrospective Studies; Scleritis; Tacrolimus; Treatment Outcome

To evaluate the efficacy of topical 0.1% FK506 used alone or combined with keratoplasty on patients with recurrent Mooren's ulcer.. This is a retrospective interventional consecutive case series. Nine patients (15 eyes) with recurrent Mooren's ulcer were treated with topical 0.1% FK506 alone or combined with keratoplasty. Two eyes with ulcers involving less than half the corneal limbus were treated with topical 0.1% FK506. Of the other 13 eyes with ulcers involving more than half the limbus, twelve were treated with excision of the ulcer and adjacent conjunctiva combined with lamellar keratoplasty. One eye with a central impending corneal perforation was treated with penetrating keratoplasty. Topical 0.1% FK506 was given post-operatively to all thirteen eyes after re-epithelia-ligation of the cornea. FK506 levels in the surgically resected cornea and conjunctiva of the operated eyes were measured using enzyme immunoassay procedures. Twelve patients (17 eyes) with recurrent Mooren's ulcer treated with lamellar keratoplasty combined with topical 0.1% dexamethasone were taken as the control. The main measure of the outcome was the recurrence of Mooren's ulcer in the patients.. Nine patients (15 eyes) with recurrent Mooren's ulcer were all successfully treated. Vision in 5 eyes improved by two lines or better after treatment. No recurrence was observed during the follow up period of 12 to 22 months. After topical application of 0.1% FK506, concentrations of 30 to approximately 350 ng/g of FK506 were found in the cornea and conjunctiva. Seven eyes of Mooren' s ulcer in the control group recurred during the follow up period.. Topical 0.1% FK506 used alone or combined with keratoplasty is a safe and effective therapy for patients with recurrent Mooren's ulcer.

Topics: Administration, Ophthalmic; Adult; Aged; Corneal Transplantation; Corneal Ulcer; Female; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Corneal Ulcer; Drug Therapy, Combination; Erythromycin; Female; Functional Laterality; Humans; Immunosuppressive Agents; Kidney Transplantation; Lubrication; Middle Aged; Mycophenolic Acid; Tacrolimus

To observe the effect of FK506 eye-drop combined with keratoplasty on recurrent Mooren's ulcer.. 9 cases (15 eyes) of recurrent Mooren's ulcer were treated with topical FK506 eye-drop combined with keratoplasty. Of the 15 eyes, two of Mooren's ulcer smaller than half circle of the limbus were treated with 0.1% FK506 eye-drop. Among the other 13 eyes of the ulcer larger than half the circle of the limbus, 12 eyes were treated with excision of conjunctiva combined with lamellar keratoplasty. One eye with a central corneal perforation was treated with penetrating keratoplasty. FK506 eye-drop 0.1% was given to the 13 operated eyes after the re-epithelialization of the cornea. The effect of FK506 on recurrent Mooren's ulcer was observed. Measurements of FK506 in surgically resected cornea and conjunctiva, and aqueous humor of the operated eyes were performed using enzyme immunoassay procedure. Twelve cases of recurrent Mooren's ulcer treated with lamellar keratoplasty combined with topical 0.1% dexamethasone eye-drop were taken as control.. After application of 0.1% FK506 eye-drop, concentrations of 30 - 350 ng/g of FK506 were found in the cornea and conjunctiva, and no FK506 was measured in the aqueous humor. Nine cases (15 eyes) of recurrent Mooren's ulcer were all cured and no recurrence was observed during the follow-up time of 12 - 17 months. The vision of 5 eyes was improved more than 2 lines after the treatment. Seven eyes of Mooren's ulcer in the control group recurred.. 0.1% FK506 eye-drop combined with keratoplasty is an effective treatment for recurrent Mooren's ulcer.

Topics: Adult; Combined Modality Therapy; Cornea; Corneal Transplantation; Corneal Ulcer; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Middle Aged; Ophthalmic Solutions; Tacrolimus; Treatment Outcome