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Clinical science
Long-term outcome after topical ciclosporin in severe dry eye disease with a 10-year follow-up
  1. Morgane Straub1,
  2. Alain M Bron2,3,
  3. Aurore Muselier-Mathieu2,
  4. Catherine Creuzot-Garcher2,3
  1. 1Department of Ophthalmology, University Hospital, Lyon Sud, France
  2. 2Department of Ophthalmology, University Hospital, Dijon, France
  3. 3Eye and Nutrition Research Group, CSGA, UMR 1324 INRA, 6265 CNRS, Burgundy, Dijon, France
  1. Correspondence to Professor Catherine Creuzot-Garcher, Department of Ophthalmology, University Hospital, CHU le Bocage, 14 rue Gaffarel Dijon 21000, France; Catherine.creuzot-garcher{at}chu-Dijon.fr

Abstract

Aim To report a 10-year follow-up of patients suffering from severe dry eye syndrome (DES) initially treated with topical ciclosporin A (tCSA) for 6 months.

Methods The charts of 26 patients with severe DES related to keratoconjunctivitis sicca (KCS) and followed for a minimum 10-year follow-up were retrospectively reviewed. All of them were treated initially with tCSA for 6 months. The Schirmer I test, fluorescein and lissamine green staining scores and tear film break-up time (TBUT) were recorded to assess clinical symptoms before, during and after treatment. The subjective signs were evaluated with the ocular surface disease index (OSDI) questionnaire. Prolongation and reintroduction of tCSA after the initial treatment and combined treatments were also noted.

Results Overall the median (IQR) duration of tCSA treatment was 23 (7–51) months after a prolonged induction treatment lasting 20 (8–41) months during the 10-year follow-up. For symptoms, a statistically significant difference in the OSDI between baseline and the end of the 10-year follow-up was not found (p=0.67). We noted a statistically significant improvement in all clinical signs after the initial treatment period, still present at the end of follow-up. Only 6.5% of the patients needed reintroduction of tCSA after their prolonged induction treatment.

Conclusions The improvement observed after an initial tCSA treatment was sustained after a long-term follow-up with few cases requiring additional tCSA treatment. A prolonged induction treatment to decrease initial inflammatory local signs is a promising option in KCS.

  • Ocular surface
  • Inflammation
  • Tears

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bjophthalmol-2015-306930

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    Footnotes

    • Contributors Design and conduct of the study (AMB, CC-G); collection, management, analysis and interpretation of the data (MS, AMB, AM-M, CC-G); preparation, review or approval of the manuscript (MS, AMB, AM-M, CC-G).

    • Competing interests AMB: consultant for Allergan, Bausch Lomb, Théa, research grant Horus; CC-G: consultant for Allergan, Bayer, Bausch Lomb, Novartis, Théa, research grant Horus.

    • Patient consent Obtained.

    • Ethics approval Local institutional review board (CPP Est).

    • Provenance and peer review Not commissioned; externally peer reviewed.

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