Therapeutic effects of tacrolimus ointment for refractory ocular surface inflammatory diseases.
OBJECTIVE
To investigate the therapeutic effects of topical tacrolimus ointment on refractory ocular surface inflammatory diseases.


METHODS
Retrospective interventional consecutive case series.


METHODS
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.


METHODS
The clinical findings and therapeutic responses after treatment with 0.02% topical tacrolimus ointment were determined by conventional ophthalmological examinations.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Miyazaki
Dai
D
Division of Ophthalmology and Visual Science, Tottori University Medical School, Yonago, Japan. dm@grape.med.tottori-u.ac.jp
Tominaga
Takeshi
T
Kakimaru-Hasegawa
Akiko
A
Nagata
Yuiko
Y
Hasegawa
Jiro
J
Inoue
Yoshitsugu
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003233:Conjunctivitis, Allergic / Q000188:drug therapy*; D003320:Corneal Ulcer / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009824:Ointments; D012189:Retrospective Studies; D015423:Scleritis / Q000188:drug therapy*; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D009824:Ointments; D016559:Tacrolimus