The Dry Eye Zone

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Abstract: The double whammy

Restasis plus steroid, for chronic dry eye.

Efficacy of Combined 0.05% Cyclosporine and 1% Methylprednisolone Treatment for Chronic Dry Eye.
Cornea. 2009 Aug 31. [Epub ahead of print]
Byun YJ, Kim TI, Kwon SM, Seo KY, Kim SW, Kim EK, Park WC.
From the *Vision Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea; daggerDepartment of Ophthalmology, Dong-A University College of Medicine, Busan, Korea; and double daggerDepartment of Ophthalmology, Soonchunhayng University College of Medicine, Bucheon, Korea.

PURPOSE:: To compare the efficacy of cyclosporine 0.05% (tCSA) and combined treatment with 1% methylprednisolone on treatment of moderate-to-severe chronic dry eye.

PATIENTS AND METHODS:: Forty-four patients with moderate-to-severe dry eye who had not responded to conventional treatment were treated with tCSA for 3 months. Twenty-one subjects (Group 1) were treated with 1% methyl prednisolone and tCSA for initial 3 weeks, and treated with tCSA only thereafter and 23 subjects (Group 2) were treated with tCSA only. Symptom scores, Tear break-up time (TBUT), Schirmer score, and corneal and conjunctival fluorescein staining were evaluated before and at 1, 2, and 3 months after treatment. Proinflammatory factors, interleukin-6, and interleukin-8 tear concentration were measured before and at 3 months.

RESULTS:: Symptom scores, Schirmer scores, TBUT score, corneal fluorescein, conjunctival staining showed significant improvement at 1 month compared to baseline in group 1 (all P < 0.001), and all the same but few exceptions in group 2 (P = 0.002 on Schirmer, P = 0.267 on cornea stating). In symptom scores, Schirmer scores and corneal staining, greater improvements were observed for group 1 at 1 month compared to group 2 (P < 0.001, P = 0.039, P = 0.01, respectively). However, in TBUT score and conjunctival staining, there were no between-group differences (P = 0.277, P = 0.254, respectively). The time interval from treatment initiation to symptom relief was shorter for group 1 than group 2. Both groups showed decreased tear IL-6 and IL-8 concentrations at 3 months compared to baseline levels (P < 0.05). However, no between-group differences were noted in mean concentrations of IL-6 and IL-8 at baseline and at 3 months.

CONCLUSIONS:: Treatment with tCSA appears to be safe and effective in moderate-to-severe chronic dry eye. Additional short-term use of a topical steroid had the benefit of providing faster symptom relief and improvement of ocular sign without serious complications.
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