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Abstract
Purpose
To analyze the effects of topical 10% N-acetylcysteine on patients with refractory filamentary keratitis.
Methods
The present study included 29 eyes from 20 patients diagnosed with filamentary keratitis. We analyzed the cause of filamentary keratitis, types of treatments, symptom scores, number of filaments, fluorescein staining, degrees of remission, and recurrence of the disease.
Results
A total of 19 eyes treated with filament removal, therapeutic contact lenses, topical antibiotics, topical steroids, topical 0.05% cyclosporine, artificial tears, and punctal plugs showed improvements. Topical 10% N-acetylcysteine was added to 10 patients who did not respond to the usual treatment for more than 1 month. Seven eyes showed a complete remission of disease at an average of 56.22 ± 24.52 days. Two eyes showed a partial remission with less than 1–2 fillaments. One eye stopped 10% N-acetylcysteine treatment because of an irritable sensation.
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Figure 1.
Anterior segment sectioning for fluorescein staining scores. Each compartment was graded on a scale of 0 (no staining) to 3 (intense staining). (A) Superior cornea (B) mid cornea (C) inferior cornea.
Figure 2.
Slit-lamp photograph of two patients with refractory filamentary keratitis. (A, B) The left eye of 42-year-old woman with Sjögren's syndrome, 62 filaments were observed in the entire area. After 90 days of 10% N-acetylcysteine treatment, complete remission was observed. (C, D) The left eye of 39-year-old woman with dry eye syndrome, 36 filaments were observed in especially interpalpebral area. After 48 days of 10% N-acetylcysteine treatment, complete remission was observed.
Figure 3.
Transition of filament numbers after using topical 10% N-acetylcysteine eyedrop. There were statistically significant decrease of filament numbers in each period. NAC = N-acetylcysteine. * Wilcoxon signed rank test.
Figure 4.
Transition of fluorescein staining score after using topical 10% N-acetylcysteine eyedrop. There were statistically significant decrease of fluorescein staining score in each period except between 2 week and 1 month. NAC = N-acetylcysteine. * Wilcoxon signed rank test.
Figure 5.
Transition of symptom scores after using topical 10% N-acetylcysteine eyedrop. There were statistically significant decrease of symptom scores in each period. NAC = N-acetylcysteine. * Wilcoxon signed rank test.
Table 1.
Demographics of the filamentary keratitis patients
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