title: Therapeutic effect of 0.1% Tacrolimus Eye Ointment in Allergic Ocular Diseases.
abstract: BACKGROUND
  Allergic Ocular Diseases (AODs) like Atopic Keratoconjunctivitis (AKC) and Vernal Keratoconjunctivitis (VKC) are chronic forms of ocular allergy that can cause severe visual complications. Pathogenesis of AODs is uncertain and treatment has been a challenge for ophthalmologists. Tacrolimus, a 23-member cyclic macrolide lactone derived from [streptomyces tsukubaensis] now in ointment form has been successfully used in AODs.
  
  
  OBJECTIVE
  To study the therapeutic effect of 0.1% Tacrolimus eye ointment in patients with Allergic Ocular Diseases (AODs).
  
  
  METHODS
  This prospective observational study was conducted on 36 patients with severe AOD and moderate cases not responding to conventional treatment. They were treated with 0.1% tacrolimus eye ointment twice daily for minimum three months in addition to conventional treatment and observed for a period of 6 months. Symptoms and signs after treatment were evaluated. Grades of clinical signs were assessed based on slit lamp clinical photographs; development of possible complications was assessed and analysed by Wilcoxon signed rank test.
  
  
  RESULTS
  Mean age of patients was 9.3±4.3 years and mean duration of AODs was 3.1±1.8 years. The scores on both the four point scales for signs and symptoms decreased significantly (p<0.0001) after 1 month of 0.1% Tacrolimus eye ointment treatment. Itching was the first symptom to show dramatic relief and conjunctival hyperaemia was the first sign to show improvement. 88.88% of patients were successfully weaned off topical steroids in 6 months into Tacrolimus treatment. Even in patients unresponsive to 0.1% topical Cyclosporine, symptoms and signs scores decreased significantly (p<0.0001). The most common adverse reaction was a transient burning sensation (36.11%).
  
  
  CONCLUSIONS
  Topical 0.1% Tacrolimus eye ointment was found to be a safe and effective treatment in cases of AODs and also worked as steroid sparing and replacing agent. It was also found effective in patient's refractory to topical Cyclosporine.
authors: Associate Professor, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH , Kalwa, Thane, Maharashtra, India .
authors: Rakesh K
authors: RK
authors: Barot
authors: Assistant Professor, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH , Kalwa, Thane, Maharashtra, India .
authors: Satish C
authors: SC
authors: Shitole
authors: Resident, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH , Kalwa, Thane, Maharashtra, India .
authors: Nupur
authors: N
authors: Bhagat
authors: Resident, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH , Kalwa, Thane, Maharashtra, India .
authors: Deepak
authors: D
authors: Patil
authors: Resident, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH , Kalwa, Thane, Maharashtra, India .
authors: Pawan
authors: P
authors: Sawant
authors: Resident, Department of Ophthalmology, Rajiv Gandhi Medical College and CSMH , Kalwa, Thane, Maharashtra, India .
authors: Kalpita
authors: K
authors: Patil
keywords: Atopic keratoconjunctivitis; Steroid sparing and replacing agent; Vernal keratoconjunctivitis