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Topical Treatment With 1% Cyclosporine for Subepithelial Infiltrates Secondary to Adenoviral Keratoconjunctivitis

Levinger, Eliya MD; Slomovic, Alana; Sansanayudh, Wiwan MD; Bahar, Irit MD; Slomovic, Allan R MA, MD, FRCSC

doi: 10.1097/ICO.0b013e3181c33034
Clinical Science

Purpose: To evaluate the treatment with topical 1% cyclosporine A (CsA) in patients with subepithelial corneal infiltrates (SEIs).

Methods: We retrospectively reviewed the records of 9 patients (12 eyes) before and after the treatment with CsA 1% eyedrops twice daily. All patients had been treated with topical corticosteroids previously without improvement or had to stop the medication secondary to intraocular pressure elevation. The objective data recorded included best-corrected Snellen visual acuity, intraocular pressure, number of medications in use, and evaluation of severity of SEIs (improved, stable, or worse). For their subjective evaluation, patients were asked to complete a questionnaire based on the last follow-up visit.

Results: Five males (56%) and 4 females (44%), mean age of 47 ± 13 years, were included. Mean follow-up on CsA was 13 ± 7 months. The mean best-corrected Snellen visual acuity (logarithm of the minimum angle of resolution) before and after treatment was 0.42 ± 0.40 and 21 ± 0.28, respectively, with no statistically significant improvement. There was statistically significant reduction in the number of medications before and after treatment from 1.88 ± 1.05 to 1.22 ± 0.44, respectively (P = 0.049). Six patients (66%) showed clinical improvement, and 3 (34%) were stable during the treatment period. Patients reported statistically significant reduction in the severity of symptoms before and after the treatment. Most of the patients reported no foreign body sensation, glare, or other side effects with topical CsA treatment. Overall, patients noted an improvement in vision and satisfaction with CsA treatment.

Conclusions: Topical CsA 1% is a safe and effective alternative treatment in patients with SEIs who do not respond to other treatment modalities or have unwanted side effects from topical steroids.

From the Department of Ophthalmology, Donald K. Johnson Eye Center, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.

Received for publication April 20, 2009; revision received August 7, 2009; accepted August 21, 2009.

Reprints: Eliya Levinger, Department of Ophthalmology, Toronto Western Hospital, 399 Bathurst St, Ontario, Canada M5T2S8 (e-mail:

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