title: [Local cyclosporin A therapy of nummuli after epidemic keratoconjunctivitis--case report].
abstract: BACKGROUND
  Steroid therapy for persistent or recurrent nummular adenoviral keratoconjunctivitis (AK) has little benefit because of the frequent recurrences, and mostly "offers" only serious steroid side effects. Since January 1995, we have treated different patients with nummuli after AK with topical Ciclosporin A (CSA) in an attempt to achieve at least the same symptomatic effect as with steroids, however, without side effects. Here, we report about our experiences in a very severe case with longterm treatment.
  
  
  METHODS
  The patient was sent to our clinic 4 months after AK with confluent nummuli and Descemet folds, more severe in the right than in the left eye. Best corrected visual acuity was 0.05 in the right and 0.5 in the left eye. Topical CSA 2% 4 times daily was first administered only in the right eye. When after 6 weeks a reduction of nummuli was noted in the right eye, the left eye, which had not improved, was started on the same regime. Therapy was tapered and finally stopped after 12 months in the right and 10 months in the left eye, when only minor changes were left in the corneae. A prompt recurrence of nummuli in both eyes within 4 weeks forced us to resume CSA therapy. At present, both corneae are clear with full vision, and this result is stable with 1 drop of CSA daily. No side effects of CSA therapy have been noted.
  
  
  CONCLUSIONS
  The disappearance of nummuli with topical CSA and even more the reappearance of nummuli after cessation of CSA therapy show that topical CSA is about as effective as topical steroids in the symptomatic treatment of non-scarred nummuli after KE without the serious steroid side effects. Topical CSA treatment of nummuli after KE is, therefore, a very recommendable alternative for the potentially dangerous steroid therapy. Generally valid data on risk of recurrences, dosage and general effectiveness could only be learned from prospective studies with large numbers of AK patients, which, however, are not available outside epidemics.
authors.affiliation: Augenklinik der Heinrich-Heine-Universität, Düsseldorf.
authors.forename: T
authors.initials: T
authors.lastname: Reinhard
authors.forename: R
authors.initials: R
authors.lastname: Sundmacher
mesh_terms: D000258:Adenovirus Infections, Human / Q000188:drug therapy*; D016572:Cyclosporine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007637:Keratoconjunctivitis / Q000188:drug therapy*; D008875:Middle Aged; D009883:Ophthalmic Solutions; D012008:Recurrence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; D016572:Cyclosporine