Use of systemic T-lymphocyte signal transduction inhibitors in the treatment of atopic keratoconjunctivitis.
OBJECTIVE
Topical immunomodulators such as tacrolimus have revolutionized the treatment of atopic dermatitis. Because T lymphocytes are integral to the pathogenesis of atopic dermatitis, systemic treatment with T-lymphocyte signal transduction inhibitors should ameliorate both the dermatologic and ocular manifestations. We describe the successful treatment of 6 patients with severe atopic keratoconjunctivitis (AKC) resistant to conventional therapies.


METHODS
Retrospective observational case series. The charts of patients with AKC assessed by 1 of the authors were reviewed to identify those treated with systemic T-cell signal transduction inhibitors. Visual acuities, previous treatments, and the response to systemic signal transduction inhibitors were observed and reported in 6 patients.


RESULTS
The patients had a mean duration of AKC of 21 years. Topical corticosteroids and antihistamines had failed to control signs and symptoms of the disease in all patients, and in some patients, systemic corticosteroids and topical cyclosporine were ineffective. Three patients were treated with systemic cyclosporine, and 3 were treated with systemic tacrolimus. One patient was subsequently treated with daclizumab in addition to tacrolimus. All 6 patients experienced complete remission of their AKC and an increase in visual acuity.


CONCLUSIONS
Selective systemic immunosuppression of T lymphocytes with cyclosporine or tacrolimus has proved effective in the treatment of both atopic dermatitis and atopic keratoconjunctivitis. We advocate the consideration of systemic therapy in cases that are resistant to conventional treatment to resolve inflammation and preserve vision. Further studies in this area are advocated.
Anzaar
Fahd
F
Massachusetts Eye Research and Surgery Institute, Cambridge, MA 02142, USA.
Gallagher
Micheal Joseph
MJ
Bhat
Pooja
P
Arif
Mansoor
M
Farooqui
Saadia
S
Foster
C Stephen
CS
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D003233:Conjunctivitis, Allergic / Q000188:drug therapy*; D016572:Cyclosporine / Q000627:therapeutic use; D000077561:Daclizumab; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015398:Signal Transduction / Q000187:drug effects*; D013601:T-Lymphocytes / Q000187:drug effects*; D016559:Tacrolimus / Q000627:therapeutic use; D014792:Visual Acuity
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000077561:Daclizumab; D016559:Tacrolimus