Purpose: To compare the efficacy of topical cyclosporine 0.05% (tCsA) and combined treatment with 1% methylprednisolone acetate for the treatment of moderate-to-severe chronic dry eye.
Patients and Methods: Forty-four patients with moderate-to-severe dry eye who had not responded to conventional treatment were treated with tCsA for 3 months. Twenty-one subjects (Group 1) were treated with 1% methyl prednisolone acetate and tCsA for the initial 3 weeks, and treated with tCsA only thereafter, and 23 subjects (Group 2) were treated with tCsA only. Symptom scores, tear break-up time (TBUT), Schirmer score, and corneal and conjunctival fluorescein staining were evaluated before and at 1, 2, and 3 months after treatment. Proinflammatory factors, interleukin-6 (IL-6), and interleukin-8 (IL-8) tear concentration were measured before treatment and at 3 months.
Results: Symptom scores, Schirmer scores, TBUT score, corneal fluorescein, and conjunctival staining showed significant improvement at 1 month compared to baseline in group 1 (all P < 0.001), and all the same but few exceptions in group 2 (P = 0.002 on Schirmer, P = 0.267 on cornea stating). In symptom scores, Schirmer scores, and corneal staining, greater improvements were observed for group 1 at 1 month compared to group 2 (P < 0.001, P = 0.039, P = 0.01, respectively). However, in TBUT score and conjunctival staining, there were no between-group differences (P = 0.277, P = 0.254, respectively). The time interval from treatment initiation to symptom relief was shorter for group 1 than group 2. Both groups showed decreased tear IL-6 and IL-8 concentrations at 3 months compared to baseline levels (P < 0.05). However, no between-group differences were noted in mean concentrations of IL-6 and IL-8 at baseline and at 3 months.
Conclusions: Treatment with tCsA appears to be safe and effective in moderate-to-severe chronic dry eye. Additional short-term use of a topical steroid had the benefit of providing faster symptom relief and improvement of ocular sign without serious complications.
*Vision Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
†Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
‡Department of Ophthalmology, Soonchunhayng University College of Medicine, Bucheon, Korea.
The first two authors contributed equally to this study.
The authors have no proprietary interests in any of the products discussed in this manuscript.
Supported by the Dong-A University Research Fund in 2007 and partially supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST No. 2009-0066392).
Reprints: Woo Chan Park, Department of Ophthalmology, Dong-A University College of Medicine, 3-1 Dongdaesin-dong, Seo-gu, Busan, 602-714, South Korea (e-mail: firstname.lastname@example.org).
Received April 24, 2008
Accepted August 21, 2008