Treatment of refractory dry eye associated with graft versus host disease with 0.03% tacrolimus eyedrops.
OBJECTIVE
We investigate the efficacy of 0.03% topical tacrolimus eyedrops for the treatment of dry eye in graft versus host disease (GVHD) patients resistant/intolerant to 0.05% topical cyclosporine.


METHODS
Forty-three patients were enrolled in this prospective study. After completing a 1-year run-in period of using artificial tears, 50% autologous serum eyedrops, and punctal plug occlusion, all the symptomatic patients (n=29) were treated with 0.05% topical cyclosporine (Restasis(®); Allergan, Inc.). After 1 month, the patients who presented topical or systemic intolerance to cyclosporine were instructed to instill 0.03% topical tacrolimus once a day for 3 months (n=14). All the patients were allowed to continue with their basal dry eye treatment. Visual acuity, fluorescein staining, Schirmer test, fluorescein tear break-up time, and tear meniscus height measurement were evaluated fortnightly (minimum 3 months). Subjective assessments of symptoms were also reported at the beginning and at the end of the study.


RESULTS
Dry eye symptoms and signs improved statistically (P<0.05) and significantly with tacrolimus and cyclosporine topical treatment. No significant differences were observed between both the groups. The mean follow-up time was 12.14±2.69 months (range 10-18 months).


CONCLUSIONS
The findings of this prospective pilot study suggest that cyclosporine-intolerant patients with dry eye associated with GVHD can be effectively treated with topical tacrolimus.
1 Department of Ophthalmology, La Fe University Hospital of Valencia , Valencia, Spain .
Empar
E
Sanz-Marco
Patricia
P
Udaondo
Salvador
S
García-Delpech
Amparo
A
Vazquez
Manuel
M
Diaz-Llopis
D060433:Administration, Ophthalmic; D000328:Adult; D016026:Bone Marrow Transplantation; D004334:Drug Administration Schedule; D015352:Dry Eye Syndromes / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010865:Pilot Projects; D011446:Prospective Studies; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; D016559:Tacrolimus