ОСОБЕННОСТИ ПРИМЕНЕНИЯ 0,05%-НОГО ЦИКЛОСПОРИНА (РЕСТАСИС) ПРИ ЛЕЧЕНИИ РЕЦИДИВИРУЮЩЕЙ ИНФИЛЬТРАТИВНОЙ ФОРМЫ АДЕНОВИРУСНОГО КЕРАТОКОНЪЮНКТИВИТА

Oftal mokhirurgiya

О. А. Васильева¹  Д. Ю. Майчук¹ 

[1] МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова, Москва

关键词: adenoviral keratoconjunctivitis;    Cyclosporine;    corneal sub-epithelial infiltrates;    аденовирусный кератоконъюнктивит;    циклоспорин;    роговичные субэпителиальные инфильтраты;   

DOI  :  10.25276/0235-4160-2014-2-66-72

学科分类：眼科学

来源: M H T K Mikrokhirurgiya Glaza

【 摘 要 】

Adenovirus disease is one of the most common eye infections. There are 5 stages for adenovirus keratoconjunctivitis (AVKC): I – acute conjunctival manifestations, II – corneal involvement, III – recovery, IV – stage of secondary dry eye syndrome, V – recurrence of corneal infiltrates. The application of topical corticosteroids is a main method of therapy at the final stage of the disease, including recurrent corneal infiltrates. But they have side effects such as the IOP elevation, the development of cataracts and glaucoma. In this regard, the actual problem consists in a search of effective therapy without side effects of corticosteroids. One of the promising anti-inflammatory drugs in ophthalmology is 0.05% Cyclosporine A (Restasis). Purpose.To study an effect of the therapy 0,05% Cyclosporine A on the condition of recurrent subepithelial corneal infltrates after avkc .  Material and methods.The study was performed in 87 eyes of 49 patients who had corneal infiltrates following the AVKC 3 months and more after the acute period: 19 male and 30 female, aged 19-65 years. All patients had a negative result of adenoviral PCR definition in conjunctival smear before the treatment. All patients were divided into 2 equal groups. The therapy of the first group (25 patients – 45 eyes) included Corticosteroids (Dexamethasone 0.1%, 0.02%, 0.01% eye drops) descending for 12 weeks. Topical 0.05% Cyclosporine (Restasis) was additionally included in the second group of the therapy for 6 months. Biomicroscopy, non-contact IOP measurements, visual acuity test were carried out in all patients, the comfort status of patients and the degree of corneal damage were evaluated according to the developed schemes (0 points: no infiltrates, 1: 1-10, 2: 1120, 3: 21-30, 4: more than 31 infiltrates). Results.Before the treatment the best corrected visual acuity (BCVA) was 0.6±0.15. The main complaints were a blurred vision (100%), foreign body sensations (87%), a light aberration (56%), objects distortions (53%). The condition of the cornea was: 4 points – 8 patients, 3 points – 23 patients, 2 points – 12 patients and 1 point – 6 patients. The IOP data was in the normal range in 97.9% of patients during the whole follow-up. Only 1 person had short-term hypertension, which was stopped by a temporary application of 0.25% Timolol 2 times daily. At 3 months after beginning of the therapy the visual acuity was 0.95±0.05. Only 3 patients had a blurred vision. The condition of the cornea was: 0 points – 47 patients, 1 point – 1 patient in each group. At 6 months after the therapy start there were complaints for the blurred vision (88%), the distortion of objects (52%), halo-effects (32%). The condition of the cornea was: 3 points – 3 patients, 2 – 7 patients, 1 point – 13 patients and 0 point – 2 patients. The BCVA among 23 patients with infiltrates averaged 0.75±0.1. The patients’ condition remained stable in the second group. New corneal infiltrates (number of infiltrates from 3 to 6) appeared after the dexamethasone cancellation in 3 patients (12.5%). The average BCVA was 0.9±0.05. Conclusions.Application of 0.05% Cyclosporine (Restasis) in patients with recurrent post-adenoviral corneal infiltrates is justified not only because of the presence of the secondary dry eye syndrome, but also because of the presence of a certain control of the local inflammatory reaction, which leads to a reduction of the corneal infiltrate recurrence risk in these patients.

【 授权许可】

CC BY