title: Topical ciclosporin in the treatment of vernal keratoconjunctivitis in Rwanda, Central Africa: a prospective, randomised, double-masked, controlled clinical trial.
abstract: OBJECTIVE
  To compare the short-term efficiency and safety of topical ciclosporin A (CsA) 2% with dexamethasone 0.1% in the treatment of predominantly limbal vernal keratoconjunctivitis (VKC) in Rwanda, Central Africa.
  
  
  METHODS
  Consecutive patients with VKC were randomised in a prospective, double-masked, clinical trial to receive either topical CsA 2% dissolved in olive oil vehicle or dexamethasone 0.1% drops for 4 weeks. Both groups then received sodium chromoglycate 2% drops for maintenance therapy for a further 4 weeks. The primary outcome was the reduction in composite score for VKC-related symptoms and signs at 4 weeks. Secondary outcomes included side effects, best-corrected visual acuity, comfort rating of the trial drops during 4 weeks' test medication and relapse rate thereafter.
  
  
  RESULTS
  The 366 participants recruited had the limbal (91.5%) or mixed form of VKC. At the end of the 4-week treatment period, the composite score had decreased significantly (p<0.001) from baseline without any significant difference between CsA and dexamethasone (p=0.20). There were no severe adverse reactions, but CsA drops caused more stinging than the oil placebo and dexamethasone (p<0.001). In both treatment groups, the visual acuity had improved at 4 weeks compared with baseline (p<0.001) with no significant difference between the treatment arms. The relapse rate following cessation of the trial treatments was similar (p=0.84) in both groups.
  
  
  CONCLUSIONS
  There is no significant difference between the efficiency of topical CsA 2% and dexamethasone 0.1% for the management of acute VKC in Central Africa, but tolerance needs to be improved.
authors: Department of Ophthalmology, Kabgayi Hospital, Muhanga, Rwanda. dr.stefan.desmedt@gmail.com
authors: Stefan
authors: S
authors: De Smedt
authors: John
authors: J
authors: Nkurikiye
authors: Yannick
authors: Y
authors: Fonteyne
authors: Stephen
authors: S
authors: Tuft
authors: Dirk
authors: D
authors: De Bacquer
authors: Clare
authors: C
authors: Gilbert
authors: Philippe
authors: P
authors: Kestelyn
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D002648:Child; D003233:Conjunctivitis, Allergic / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016572:Cyclosporine / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011446:Prospective Studies; D012432:Rwanda / Q000453:epidemiology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; D003907:Dexamethasone; D016572:Cyclosporine