title: Long-term result of maintenance treatment with tacrolimus ointment in chronic ocular graft-versus-host disease.
abstract: OBJECTIVE
  To investigate the efficacy and safety of long-term maintenance treatment with tacrolimus ointment in chronic ocular graft-vs-host disease (GVHD) with ocular surface inflammation.
  
  
  METHODS
  A retrospective interventional consecutive case series.
  
  
  METHODS
  Long-term maintenance treatment (≥6 months) with topical 0.02% tacrolimus ointment was applied to patients with chronic ocular GVHD with ocular surface inflammation (at least grade 2 inflammatory score). We evaluated the inflammatory score, steroid score and steroid use period of total duration, and numbers of inflammatory aggravations before and after tacrolimus treatment. The clinical outcomes were assessed by symptom score, ocular surface staining, Schirmer I test, tear break-up time (TBUT), and classification of chronic GVHD conjunctivitis at the initial and final examinations.
  
  
  RESULTS
  Thirteen patients (24 eyes) were treated with tacrolimus ointment for up to 20 months (average 12.2 months). The ocular surface inflammatory score decreased from 2.8 to 0.6 (P = .001) within 2-8 weeks after starting tacrolimus ointment treatment. The numbers of inflammatory aggravation and the need for steroid treatment also decreased after initiating tacrolimus treatment. At the final follow-up, all patients reported improvement in clinical outcomes, compared to initial findings. Except for blurred vision or mild burning sensation, there were no reported side effects.
  
  
  CONCLUSIONS
  Considering the chronic course of GVHD, long-term maintenance treatment with tacrolimus ointment could be useful and safe to locally treat ocular surface inflammation in chronic ocular GVHD.
authors.affiliation: Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Jung
authors.affiliation: Yonsei Plus Eye Center, Kyonggido, South Korea.
authors.forename: Young Ji
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Sang Chul
authors.initials: SC
authors.lastname: Yoon
authors.affiliation: Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Tae-Im
authors.initials: TI
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Institute of Vision Research, Severance Biomedical Science Institute, Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eung Kweon
authors.initials: EK
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: seoky@yuhs.ac.
authors.forename: Kyoung Yul
authors.initials: KY
authors.lastname: Seo
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D002908:Chronic Disease; D003231:Conjunctivitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009824:Ointments; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D009824:Ointments; D016559:Tacrolimus