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Abstract
To evaluate the therapeutic effects of 0.05% cylosporine A eyedrops (Restasis, Allergan Inc., Irvine, CA, USA.) in patients with dry eye syndrome, one hundred thirty-five patients (270 eyes) with dry eye syndrome were treated with 0.05% cylosporine A (CsA) and lubrication eyedrops for 12 months. Before and 1, 3, 6 and 12 months after treatment, symptom score, corneal sensitivity, tear film break-up time (BUT), keratoepitheliopathy score, basal tear secretion, tear clearance rate were measured. Before and 3 months after treatment, conjunctival impression cytology were done. One month after treatment, symptom score (2.38±0.80), basal tear secretion (6.34±3.26 mm), and keratoepitheliopathy score (1.10±1.54) were improved from 2.87±0.62 (p〈0.01), 5.89±2.72 mm (p〈0.01) and 1.50±1.82 (p〈0.01), respectively. Three months after treatment, tear film break-up time (5.70±1.76 sec) and tear clearance test (13.52±11.0) were improved from 5.24± 2.01 sec (p=0.01) and 10.74±8.48 (p=0.02), respectively. Six months after treatment, corneal sensitivity were improved from 57.85±4.27 mm to 57.57±6.24 mm (p=0.01) during the follow up period. Treatment of dry eye syndrome with topical CsA resulted in an increase in goblet cell numbers and decrease in conjunctival keratinization. Fourteen patients (10.4%) were discontinued instillation of topical CsA due to burning sensation and pain. Use of 0.05% topical CsA emulsion is effective for dry eye syndrome in helping to improve ocular symptom, and parameters of tear film and ocular surface during the follow-up period of 12 months.
Figures and Tables
Fig. 1
Tear film and ocular surface changes after treatment with topical 0.05% cyclosporine A in patients with severe dry eye. (A) symptom score, (B) corneal sensitivity, (C) basal secretion test, (D) tear film break-up time, (E) keratoepitheliopathy score, (F) tear clearance rate. *p <0.05 compared with baseline.
Fig. 2
Slit lamp photographs with fluorescein staining in dry eye syndrome patient before (A) and after (B)topical 0.05% cyclosporine A therapy. Note the marked improvement in the corneal epithelium.
Fig. 3
Impression cytologic finding (PAS, × 400). (A) Specimen from a patients with dry eye before treatment of 0.05% topical cyclosporin application shows a goblet cell loss and large, polygonal epithelial cells with a nucleocytoplasmic ratio of 1 : 3. (B) Specimen at three months after 0.05% topical cyclosporine application show many periodic acid-schiff positive goblet cells and round epithelial cells with a nucleocytoplasmic ratio of 1 : 1.
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