Cyclosporine in both 0.1% and 2.0% doses demonstrate similar efficacy for reducing clinical and symptom scores and the need for corticosteroids in patients with vernal keratoconjunctivitis (VKC), according to a study published in Clinical Ophthalmology. Cyclosporine 0.1% may be the better alternative due to its widespread availability and ease of handling.
Researchers enrolled 46 children (65% boys; mean age, 8.8 years; mean age at onset, 5.1 years) with severe VKC and randomly assigned them to treatment with 0.1% (n=24) or 2.0% (n=26) cyclosporine. Participants underwent refraction, slit lamp evaluation, quality of life (QOL) assessments, and a systemic allergy workup at baseline and every 3 months spanning a study duration of 12 months. Corticosteroid dependence was present in 52% of the children at baseline.
A symptomatic score was obtained based on the intensity of itching, discomfort, tearing, discharge, and photophobia (scored from 0 to 3 and totaled). A clinical score was based on a slit lamp examination of conjunctival hyperemia, tarsal papillae, limbal involvement, keratitis, and corneal neovascularization (scored 0 to 3).
Investigators report significant improvements in various symptomatic and clinical scores following treatment with both 0.1% and 2.0% cyclosporine with no significant differences between doses at baseline, 3, 6 and 12 months. The use of topical corticosteroid treatment was reduced from 19 drops per month to 4 drops per month at 12 months and both doses demonstrated comparable safety. Common adverse effects were itching, tearing, discomfort and photophobia. Participants treated with 0.1% cyclosporine reported identical symptom scores compared with participants treated with 2.0% cyclosporine at 12 months for each of these variables (0.8, 0.7, 0.8, and 0.6, respectively).
“The reduction in corticosteroid use thus remains the key reason for introducing cyclosporine in severe VKC,” according to the investigators. “Cyclosporine at 0.1% or 2% can limit the use of topical corticosteroids during recurrence of inflammation, and is an important addition to the range of treatments available for this allergic pathology, in particular in severe cases of VKC.”
Study limitations include a small sample size and short duration.
Bourcier T, Dory A, Dormegny L, Alcazar J, Gaucher D, Sauer A. Efficacy and safety of 0.1% cyclosporine versus 2% cyclosporine in the treatment of severe vernal keratoconjunctivitis in children. Clin Ophthalmol. Published online October 26, 2022. doi:10.2147/OPTH.S370414