title: High-frequency topical cyclosporine 0.05% in the treatment of severe dry eye refractory to twice-daily regimen.
abstract: OBJECTIVE
  The purpose of this study was to report the efficacy of topical cyclosporine 0.05% at a frequency of 3 to 4 times daily in severe dry eye disease.
  
  
  METHODS
  We retrospectively identified a cohort of patients with severe dry eye disease who had shown inadequate response to at least a 4-month course of treatment with twice-daily use of topical cyclosporine 0.05% but who showed significant improvement to more frequent dosing.
  
  
  RESULTS
  Twenty-two patients, including 13 patients with ocular graft-versus-host disease and 9 patients with primary or secondary Sjögren's syndrome, were included. After a minimum of a 2-month course of treatment with more frequent dosing of cyclosporine 0.05% (3 times a day in 7 patients and 4 times a day in 15 patients), overall dry eye symptoms were improved in 15 (68.2%) patients (9 patients with ocular graft-versus-host disease and 6 patients with Sjögren's syndrome). Mean corneal fluorescein staining scores (National Eye Institute scale of 0-15) improved (decreased) from the baseline (precyclosporine use) by -3.5 (range, 0 to -7) in patients with ocular graft-versus-host disease (P < or = 0.0008) and -2.8 (range, 0 to -5) in patients with Sjögren's syndrome (P < or = 0.001). After treatment with high-frequency use of cyclosporine 0.05%, the global physician assessment of dry eye status was favorable (improved) in 16 (72.7%) patients. Three (13.6%) patients reported new-onset symptoms of burning or irritation with the use of high-frequency dosing of topical cyclosporine. No other associated adverse effect was reported.
  
  
  CONCLUSIONS
  These data suggest that patients with severe dry eye may require more frequent dosing of topical cyclosporine 0.05% than twice daily.
authors.affiliation: Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Dastjerdi
authors.forename: Pedram
authors.initials: P
authors.lastname: Hamrah
authors.forename: Reza
authors.initials: R
authors.lastname: Dana
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D006086:Graft vs Host Disease / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000150:complications; D013194:Staining and Labeling; D014985:Xerophthalmia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*
chemical_list: D005456:Fluorescent Dyes; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D019793:Fluorescein