Topical Application of 0.05% Cyclosporine for the Treatment of Neurotrophic Keratopathy Secondary to Herpes Simplex Keratitis

IF 3.2 4区医学 Q2 PHARMACOLOGY & PHARMACY

Clinical therapeutics Pub Date : 2024-11-01 DOI:10.1016/j.clinthera.2024.09.001

Ruochen Liao , Juan Li , Yuqi Su , Yu Tao , Ruifeng Su , Xiaobo Tan

{"title":"Topical Application of 0.05% Cyclosporine for the Treatment of Neurotrophic Keratopathy Secondary to Herpes Simplex Keratitis","authors":"Ruochen Liao , Juan Li , Yuqi Su , Yu Tao , Ruifeng Su , Xiaobo Tan","doi":"10.1016/j.clinthera.2024.09.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to assess the effectiveness and tolerability of 0.05% cyclosporine A (CsA) eye drops for neurotrophic keratopathy (NK) secondary to herpes simplex keratitis (HSK).</div></div><div><h3>Methods</h3><div>Fifteen patients (15 eyes) with prior HSK and secondary NK, classified as stage 2 or 3 on the basis of the Mackie classification, were enrolled. All patients received a combined treatment regimen of 0.05% CsA eye drops (1 drop 4 times daily), a silicone hydrogel bandage contact lens, and 0.15% ganciclovir ophthalmic gel (1 drop 3 times daily). For patients achieving corneal healing, CsA was continued at a reduced dosage of twice daily for an additional 2 months and other treatments were discontinued. Follow-ups were scheduled at weeks 1, 2, 3, and 4 and at months 2 and 3 after treatment initiation, followed by a 3-month follow-up period. Key outcomes, including best-corrected visual acuity, Schirmer I test, and corneal sensitivity, were assessed at each visit before and after treatment.</div></div><div><h3>Findings</h3><div>Significant reductions were observed in the area of corneal defects, expressed as proportion of total corneal area, throughout follow-up period. Complete corneal healing was achieved by 13.3% of patients by week 2, 60.0% by week 3, 86.7% by week 4, and 100.0% by week 8, with the mean (SD) time to healing being 3.8 (1.8) weeks (range, 2–8 weeks). Additionally, significant improvements were noted in diseased eyes for best-corrected visual acuity, tear secretion (Schirmer I test values), and corneal sensitivity after treatment.</div></div><div><h3>Implications</h3><div>CsA eye drops, with bandage lenses and ganciclovir, effectively resolve NK from HSK, without adverse effects. This combination therapy shows promise for future clinical use and research.</div></div><div><h3>Clinical trial registration</h3><div>Our study is a retrospective observational study because it involves the analysis of previously collected data, so the study was not registered prior to its commencement. However, if it is necessary for publication, we are willing to proceed with retrospective registration.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"46 11","pages":"Pages 900-904"},"PeriodicalIF":3.2000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical therapeutics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0149291824002625","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

The purpose of this study was to assess the effectiveness and tolerability of 0.05% cyclosporine A (CsA) eye drops for neurotrophic keratopathy (NK) secondary to herpes simplex keratitis (HSK).

Methods

Fifteen patients (15 eyes) with prior HSK and secondary NK, classified as stage 2 or 3 on the basis of the Mackie classification, were enrolled. All patients received a combined treatment regimen of 0.05% CsA eye drops (1 drop 4 times daily), a silicone hydrogel bandage contact lens, and 0.15% ganciclovir ophthalmic gel (1 drop 3 times daily). For patients achieving corneal healing, CsA was continued at a reduced dosage of twice daily for an additional 2 months and other treatments were discontinued. Follow-ups were scheduled at weeks 1, 2, 3, and 4 and at months 2 and 3 after treatment initiation, followed by a 3-month follow-up period. Key outcomes, including best-corrected visual acuity, Schirmer I test, and corneal sensitivity, were assessed at each visit before and after treatment.

Findings

Significant reductions were observed in the area of corneal defects, expressed as proportion of total corneal area, throughout follow-up period. Complete corneal healing was achieved by 13.3% of patients by week 2, 60.0% by week 3, 86.7% by week 4, and 100.0% by week 8, with the mean (SD) time to healing being 3.8 (1.8) weeks (range, 2–8 weeks). Additionally, significant improvements were noted in diseased eyes for best-corrected visual acuity, tear secretion (Schirmer I test values), and corneal sensitivity after treatment.

Implications

CsA eye drops, with bandage lenses and ganciclovir, effectively resolve NK from HSK, without adverse effects. This combination therapy shows promise for future clinical use and research.

Clinical trial registration

Our study is a retrospective observational study because it involves the analysis of previously collected data, so the study was not registered prior to its commencement. However, if it is necessary for publication, we are willing to proceed with retrospective registration.

查看原文本刊更多论文

局部应用 0.05% 环孢素治疗继发于单纯疱疹性角膜炎的神经营养性角膜病。

目的：本研究旨在评估 0.05% 环孢素 A（CsA）滴眼液治疗继发于单纯疱疹性角膜炎（HSK）的神经营养性角膜病（NK）的有效性和耐受性：方法：15 名患者（15 只眼）曾患有 HSK 和继发性 NK，根据麦基分类法被划分为 2 期或 3 期。所有患者均接受了 0.05% CsA 滴眼液（每天 4 次，每次 1 滴）、硅水凝胶绷带接触镜和 0.15% 更昔洛韦眼用凝胶（每天 3 次，每次 1 滴）的综合治疗方案。对于角膜愈合的患者，继续减少 CsA 的用量，每天两次，持续 2 个月，并停止其他治疗。在治疗开始后的第 1、2、3 和 4 周以及第 2 和 3 个月进行随访，然后进行为期 3 个月的随访。在治疗前后的每次就诊时，都会对包括最佳矫正视力、Schirmer I 测试和角膜敏感度在内的主要结果进行评估：结果：在整个随访期间，以占角膜总面积的比例表示的角膜缺损面积显著减少。有 13.3% 的患者在第 2 周、60.0% 的患者在第 3 周、86.7% 的患者在第 4 周、100.0% 的患者在第 8 周实现了角膜完全愈合，平均（标度）愈合时间为 3.8 (1.8) 周（范围为 2-8 周）。此外，治疗后病变眼的最佳矫正视力、泪液分泌（Schirmer I 测试值）和角膜敏感性也有明显改善：意义：CsA 滴眼液、绷带镜片和更昔洛韦可有效解决 HSK 中的 NK 问题，且无不良反应。这种联合疗法为未来的临床应用和研究带来了希望：我们的研究是一项回顾性观察研究，因为它涉及对以前收集的数据进行分析，所以在研究开始前没有进行注册。不过，如果需要发表，我们愿意进行回顾性注册。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical therapeutics 医学-药学

CiteScore

6.00

自引率

3.10%

发文量

154

审稿时长

9 weeks

期刊介绍： Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.