Long-term Evaluation After Topical Cyclosporine Treatment in Dry Eye Patients With Graft-Versus-Host Disease

Hyun Lee Seung; Kyu Im Seoung; Woo Je-Moon; Chul Yoon Kyung

doi:10.3341/jkos.2009.50.1.27

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Seung, Seoung, Je-Moon, and Kyung: Long-term Evaluation After Topical Cyclosporine Treatment in Dry Eye Patients With Graft-Versus-Host Disease

Original Article

J Korean Ophthalmol Soc 2009;50(1):27-33.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.1.27

Long-term Evaluation After Topical Cyclosporine Treatment in Dry Eye Patients With Graft-Versus-Host Disease

Hyun Lee Seung, M.D¹, Kyu Im Seoung, M.D¹, Woo Je-Moon, M.D, PhD², Chul Yoon Kyung, M.D, PhD¹

¹Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

²Department of Ophthalmology, Ulsan Hospital, Ulsan University Medical School, Ulsan, Korea

Address reprint requests to Kyung Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Medical School & Hospital #8 Hak-dong, Dong-gu, Gwang-ju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 24 September 2008 Accepted 14 April 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was performed to evaluate the long-term effect of 0.05% cyclosporine A emulsion (Restasis, Allergan Inc. USA.) on dry eye associated with graft-versus-host disease (GVHD).

Methods

Sixteen eyes of 8 patients with severe dry eye associated with GVHD were treated with 0.05% cyclosporine A emulsion twice a day. Tear film parameters were evaluated before treatment and after 1, 3, 6, and 12 months of treatment.

Results

One month after treatment, tear break-up time improved from 3.88±1.78 s to 4.17±1.90 s (P=0.02). Three months after treatment, symptom score and basal secretion improved from 3.00±0.38 and 4.44±1.59 mm to 2.33±0.52 (P=0.04) and 5.42±2.50 mm (P=0.04), respectively. Twelve months after treatment, the keratoepitheliopathy score improved from 2.38±1.31 to 1.13±0.35 (P=0.02).

Conclusions

Use of a 0.05% cyclosporine A emulsion is effective for dry eye associated with GVHD as it helps to increase tear secretion and to relieve symptoms. Treatment with 0.05% cyclosporine A emulsion for longer than 1 year may be necessary to improve keratoepitheliopathy.

Keywords: Cyclosporine, Dry eye syndrome, Graft-versus-host disease

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Figure 1.

Slit lamp photographs with fluorescein staining in GVHD patient with dry eye syndrome before (A) and 1 year after (B) 0.05% cyclosporine A therapy. Note the marked improvement in the corneal epithelium.

Table 1.

Characteristics of patients with severe dry eye associated with GVHD

No.	Age (years)	Sex	Original disease	Stem cell Transplantation	Duration between SCT^∗ and dry eye (months)	GVHD^† other than the eyes	Systemic immunosuppression	Conventional ocular treatment
1	34	M	AML^‡ (M3)	BMT^§	12		Steroid, cyclosporine A	Punctal plug, artificial tears, therapeutic contact lens, amniotic membrane transplantation
2	34	M	AML (M5)	PBSCT^∏	14	Skin, lung	Steroid	Punctal plug, artificial tears
3	41	M	Mantle cell lymphoma	PBSCT	3	Liver, lung oral mucosa	Steroid, cyclosporine A	Punctal plug, artificial tears
4	42	M	NHL^# (diffuselarge B cell)	PBSCT	7	Liver, intestine	Steroid	Punctal plug, artificial tears
5	19	M	AML (M2)	BMT/PBS CT	55	Skin, lung, bone	Steroid	Punctal plug, artificial tears
6	30	M	AML (M2)	BMT	4	Skin, oral mucosa	Steroid, cyclosporine A	Punctal plug, artificial tears Therapeutic contact lens
7	43	M	AML (M3)	BMT	28	Skin, lung, oral mucosa	Steroid, cyclosporine A	Punctal plug, artificial tears, therapeutic contact lens, amniotic membrane transplantation scleral patch graft
8	16	M	AML (M2)	BMT	45	Lung, intestine	Steroid	Punctal plug, artificial tears therapeutic contact lens

^∗ SCT=stem cell transplantation;

^† GVHD=graft-versus-host-disease; marrow transplantation;

^∏ PBSCT=peripheral blood stem cell transplantation;

^# NHL=non-Hodgkin’s lymphoma.

^‡ AML=acute myelogenous leukemia;

^§ BMT=bonemarrow transplantation;

^II PBSCT=peripheral blood stem cell transplantation; # NHL=non-Hodgkin's lymphoma.

Table 2.

Tear film and ocular surface changes after treatment with topical 0.05% cyclosporineA in severe dry eye associated with graft-versus-host disease

	Before treatment	1 month after treatment	3 months after treatment	6 months after treatment	12 months after treatment
Symptom score	3.00±0.38	2.67±0.52	2.33±0.52^∗	1.80±0.33^∗	1.80±0.83^∗
Corneal sensitivity (mm)	58.13±5.12	57.50±5.84	58.33±3.26	58.00±2.58	58.50±2.42
Tear film break up time (s)	3.88±1.78	4.17±1.90^∗	5.25±1.82^∗	8.80±4.13^∗	6.50±2.80^∗
Basal secretion test (mm)	4.44±1.59	4.67±1.72	5.42±2.50^∗	5.80±1.81^∗	6.50±2.50^∗
Tear clearance rate ((log₂)^-1)	2.81±0.83	2.92±0.67	3.00±0.60	2.90±0.57	2.90±0.57
Keratoepitheliopathy score	2.38±1.31	2.25±1.14	2.50±1.62	1.70±1.57	1.13±0.35^∗

^∗ P<0.05 compared with baseline.

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