title: Topical calcineurin inhibitors in the treatment of steroid-dependent atopic keratoconjunctivitis.
abstract: OBJECTIVE
  To evaluate the long-term effectiveness of the combination of topical cyclosporine drops and tacrolimus ointment in the treatment of steroid-dependent atopic keratoconjunctivitis (AKC).
  
  
  METHODS
  Ten patients with moderate to severe AKC participated in the study. Topical cyclosporine 0.05% was used, as a monotherapy, 6 times daily during the first month of the study, followed by 4 times daily during the second month. The patients were then instructed to self-treat with topical cyclosporine at a dose ranging from 2 to 6 times daily depending on the severity of the disease. Tacrolimus ointment 0.03% was applied on the lid skin. Follow-up examinations were performed approximately every 3 months. Each patient completed a follow-up period of at least 12 months. Symptoms and signs of AKC were assessed on the day of enrollment, on days 28, 56, and 63, and at subsequent follow-up visits. Flare-ups of AKC requiring steroid use and progression of the disease findings were also recorded.
  
  
  RESULTS
  All patients experienced significant improvement of their symptoms and signs during the first 2 months of the study. Two patients were lost to follow-up after the initial 2 months. One patient was noncompliant and continued the treatment only for 7 months. During the median treatment period of 21.5 months for the 7 continuing patients, a total of only 2 flare-up episodes were noted requiring topical steroids.
  
  
  CONCLUSIONS
  Adequate topical immunomodulation using topical calcineurin inhibitors may eliminate the need for steroids and favorably alter the long-term prognosis of patients with AKC.
authors.affiliation: Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21237, USA.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Tzu
authors.forename: Canan Asli
authors.initials: CA
authors.lastname: Utine
authors.forename: Michael E
authors.initials: ME
authors.lastname: Stern
authors.forename: Esen Karamursel
authors.initials: EK
authors.lastname: Akpek
mesh_terms: D000287:Administration, Topical; D000328:Adult; D065095:Calcineurin Inhibitors; D003233:Conjunctivitis, Allergic / Q000188:drug therapy* / Q000503:physiopathology; D016572:Cyclosporine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009824:Ointments; D009883:Ophthalmic Solutions; D011239:Prednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D011446:Prospective Studies; D016559:Tacrolimus / Q000008:administration & dosage*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D004791:Enzyme Inhibitors; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009824:Ointments; D009883:Ophthalmic Solutions; D016572:Cyclosporine; C009935:prednisolone acetate; D011239:Prednisolone; D016559:Tacrolimus