Efficacy of cyclosporine eyedrops combined with anti-infectious drugs for moderate/severe suppurative keratitis
Hu Xiaodan, Li Siyuan, Zhang Yang, Zhu Lei, Jie Ying
2020, 29(6):
431-437.
doi:10.13281/j.cnki.issn.1004-4469.2020.06.005
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Objective To evaluate the efficacy of cyclosporine eyedrops combined with anti-infectious drugs for moderate/severe suppurative keratitis. Design Retrospective cases series. Participants 20 patients (20 eyes) who were diagnosed as moderate/severe suppurative keratitis from October 2018 to November 2019 in Beijing Tongren Eye Center. Methods All patients received topical application of cyclosporine eyedrops and anti-infectious drugs. Therapeutic method: 1% cyclosporin eyedrops 4 times a day; at the same time, an empirical anti-infection treatment was performed according to the type of keratitis. Then the drug can be adjusted according to the microbial culture results or drug sensitivity results. If anterior chamber inflammation appears (e.g. keratic precipitate, lots of anterior chamber cells, hypopyon), atropine sulfate eye gel will be applied. Follow-up time ≥6 months after drug withdrawal. Patient's general condition, etiology, medical history, degree of corneal infection, type of keratitis, visual acuity, intraocular pressure, adverse drug reactions, and recurrence after drug withdrawal were recorded. Conjunctival congestion and corneal edema were graded according to the anterior segment photographs at the first visit, 1 week, 1, 2, and 3 months after treatment. Corneal ulcer area and hypopyon height were measured at the same time. Criteria for evaluation of efficacy: Effective: relief or disappearance of pain, partial or complete healing of corneal ulcer, fluorescein staining (±), significant reduction or disappearance of Descemet's membrane striae and edema, reduction or disappearance of hypopyon, no change or improvement of visual acuity; Noneffective: no obvious improvement of symptoms, no change or expansion of lesions, no disappearance of hypopyon or complications occurred. Main Outcome Measures Visual acuity, intraocular pressure, grading of conjunctival congestion and corneal edema, corneal ulcer area, hypopyon height, adverse drug reactions, and recurrence after drug withdrawal. Results Conjunctival congestion score（M，Q25~Q75) was 2.50, 2.00~3.00 at the first visit; and 2.00, 2.00~3.00; 1.50, 1.00~2.00; 1.00, 0~1.00; 0, 0~1.00 at 1 week, 1, 2 and 3 months after treatment respectively (all P<0.05). Corneal edema score was 2.00, 2.00~3.00 at the first visit; and 1.50, 1.00~2.75; 1.00, 0~1.75; 0, 0~0; 0, 0~0 at 1 week, 1, 2 and 3 months after treatment respectively (all P<0.05). Corneal ulcer area was 7.63 mm2, 6.00～29.81 mm2 at the first visit; 4.50 mm2, 3.00~21.88 mm2; 0 mm2, 0~4.88 mm2; 0 mm2, 0~0 mm2; 0 mm2, 0~0 mm2 at 1 week, 1, 2 and 3 months after treatment respectively (all P<0.05). Hypopyon height was 0.25mm, 0～1.88 mm at the first visit; 0 mm, 0～0.95 mm; 0 mm, 0～0 mm; 0 mm, 0～0 mm; 0 mm, 0～0 mm at 1 week, 1, 2 and 3 months after treatment respectively (all P<0.05). At the first visit, visual acuity of 12 cases was < 0.05, 6 cases was between 0.05 and 0.3, and 2 cases was > 0.3. After treatment, the visual acuity of 6 cases was < 0.05, 8 cases was between 0.05 and 0.3, and 6 cases was > 0.3. Visual acuity improved in all cases after treatment, but the difference was not statistically significant (χ2=4.286，P=0.134). Only one case had elevated intraocular pressure during the treatment. All the cases were effectively treated, and no drug irritation symptoms or adverse reactions occurred. No recurrence occurred within 6 months after drug withdrawal. Conclusion Topical application of cyclosporine eyedrops combined with anti-infectious drugs is an effective and safe modality for treatment of moderate/severe suppurative keratitis.