Recurrence after topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjögren's syndrome.
BACKGROUND
The aim of this study was to evaluate the prevalence of long-term recurrence after topical nonpreserved methylprednisolone pulse therapy for the treatment of keratoconjunctivitis sicca (KCS) with Sjögren's syndrome.


METHODS
A total of 106 eyes of 53 Sjögren's syndrome patients were included in the study. All patients were treated with topical nonpreserved 1% methylprednisolone solution. Initial therapy consisted of eyedrops 4 times a day for 2 weeks, and then patients were reevaluated and tapered off the medication every 2 weeks until discontinuation. Tear film breakup time (TBUT), Schirmer test, corneal fluorescein staining, and subjective symptom scores were measured. Additionally, impression cytology of the bulbar conjunctiva was performed. The over-all success rates and success period were determined using the Kaplan-Meier survival curve.


RESULTS
A reduction in subjective symptoms and fluorescein staining, and an improvement in TBUT and Schirmer test results, was observed after treatment (P<0.001). Impression cytology specimens revealed a significantly increased number of periodic acid-Schiff-positive cells after treatment. After the first pulse therapy, mean survival was 56.6 weeks and 11 (20.8%) patients recurred. After the second pulse therapy, mean survival was 72.4 weeks and only 1 patient recurred. No serious complications, including intraocular pressure elevation and cataract formation, were encountered during the entire follow-up period.


CONCLUSIONS
Topical nonpreserved methylprednisolone pulse therapy proved to be a safe, effective long-term treatment of improving subjective and objective dry eye factors in KCS patients with Sjögren's syndrome.
Hong
Samin
S
Department of Ophthalmology, Yonsei Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
Kim
Terry
T
Chung
So-Hyang
SH
Kim
Eung Kweon
EK
Seo
Kyoung Yul
KY
D000287:Administration, Topical; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011310:Preservatives, Pharmaceutical; D020551:Pulse Therapy, Drug; D012008:Recurrence; D012859:Sjogren's Syndrome / Q000150:complications / Q000188:drug therapy*; D013666:Tears / Q000378:metabolism; D016896:Treatment Outcome
D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D011310:Preservatives, Pharmaceutical; D008775:Methylprednisolone