title: Topical cyclosporine A in severe steroid-dependent childhood phlyctenular keratoconjunctivitis.
abstract: OBJECTIVE
  To assess the efficacy of topical cyclosporine A (CsA) in children with phlyctenular keratoconjunctivitis associated with severe steroid-dependent corneal inflammation.
  
  
  METHODS
  Prospective, noncomparative, interventional case series.
  
  
  METHODS
  patients: Children with phlyctenular keratoconjunctivitis associated with severe steroid-dependent corneal inflammation and not responding to oral antibiotics (cyclines or erythromycin). intervention: Topical CsA 2% four times daily, initially combined with topical dexamethasone for the first week. main outcome measures: Efficacy was judged by the patients (symptoms and ocular redness) and by the ophthalmologist (ocular redness and corneal inflammation). The patients were monitored for adverse effects, and cyclosporinemia was determined every 3 months.
  
  
  RESULTS
  We studied 11 children (13 eyes) with a mean age of 9 years (range, 4 to 15 years). Inflammation was controlled in all the eyes within 14 days. Inflammation did not recur during CsA monotherapy, during a mean follow-up of 12 +/- 8 months (range, 6 to 31 months). CsA therapy was stopped in eight patients (10 eyes) after a mean treatment duration of 13 +/- 9 months (range, 6 to 31 months), and no recurrences occurred during 10 +/- 3 months of follow-up (range, 6 to 12 months). Local tolerance of CsA was good. None of the patients had detectable CsA blood levels. CsA was withdrawn in one case after 6 months, because of generalized skin rash.
  
  
  CONCLUSIONS
  Long-term topical CsA 2% therapy is safe and effective in children with phlyctenular keratoconjunctivitis associated with severe steroid-dependent corneal inflammation.
authors.affiliation: Service d'ophtalmologie, Hôpital Bichat, Fondation A. de Rothschild, 46 rue Henri Huchard, 75018 Paris, France. serge.doan@noos.fr
authors.forename: Serge
authors.initials: S
authors.lastname: Doan
authors.forename: Eric
authors.initials: E
authors.lastname: Gabison
authors.forename: Damien
authors.initials: D
authors.lastname: Gatinel
authors.forename: Minh-Hanh
authors.initials: MH
authors.lastname: Duong
authors.forename: Olivia
authors.initials: O
authors.lastname: Abitbol
authors.forename: Thanh
authors.initials: T
authors.lastname: Hoang-Xuan
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007637:Keratoconjunctivitis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; D003907:Dexamethasone; D016572:Cyclosporine