Comparison of the safety and efficacy of topical Tacrolimus (0.03%) versus dexamethasone (0.05%) for subepithelial infiltrates after adenoviral conjunctivitis

• Published in: Indian journal of ophthalmology 2019-05, Vol.67 (5), p.594-598
• Main Authors: Bhargava, Rahul, Kumar, Prachi
• Format: Article
• Language: English
• Subjects: Acuity; Adenoviral keratoconjunctivitis; Adenovirus Infections, Human - diagnosis; Adenovirus Infections, Human - drug therapy; Adenovirus Infections, Human - virology; Administration, Topical; Adult; Burning; Cataracts; Conjunctivitis; Conjunctivitis - diagnosis; Conjunctivitis - drug therapy; Conjunctivitis - virology; Cornea; Dexamethasone; Dexamethasone - administration & dosage; Dose-Response Relationship, Drug; Double-Blind Method; Drug dosages; Dual energy X-ray absorptiometry; Epidemics; Eye Infections, Viral - diagnosis; Eye Infections, Viral - drug therapy; Eye Infections, Viral - virology; Female; Follow-Up Studies; Glaucoma; Glucocorticoids - administration & dosage; Humans; Immunosuppressive Agents; Infections; Keratoconjunctivitis; Male; Ophthalmology; Original; Patients; Slit Lamp Microscopy; Steroids; subepithelial infiltrates; Tacrolimus; Tacrolimus - administration & dosage; Time Factors; Vision; Visual Acuity; Young Adult
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_1352_18

Purpose: To compare the safety and efficacy of tacrolimus 0.03% ointment with dexamethasone 0.05% ointment for subepithelial infiltrates (SEIs) following adenoviral keratoconjunctivitis (AK). Methods: A randomized, double blind trial was done. Eligibility criteria was corrected distance visual acuity of 6/9 Snellen or worse for at least 4 weeks with corneal SEIs following AK. The grading of SEIs was done on a scale of 0 to 3; 0, no infiltrates, 1 mild infiltration, 2 moderate infiltration and 3, severe infiltration. Consecutive patients with SEIs following AK were randomized to receive either topical tacrolimus 0.03% or dexamethasone 0.05% ointment twice daily for 6 months. Treatment was successful if there was reduction of SEIs and improvement in vision. Results: A total of 45 patients each were assigned to the Tacro and Dexa groups, respectively. Baseline characteristics of patients did not differ significantly (P > 0.001). There was a significant change in symptoms, vision and SEIs in both the groups. However, the magnitude was greater in tacro group. Treatment was successful in 37 (92.5%) patients in Tacro and 34 (85%) patients in dexa group. In dexa group, after a period of 1.24 ± 0.24 months, 7 (15.6%) patients developed a significant rise in intraocular pressure (IOP). Three (7.5%) eyes in tacro and 6 (15%) eyes in dexa group had recurrence of SEIs after cessation of therapy. Conclusion: Tacrolimus 0.03% is an effective alternative to dexamethasone 0.05% with low recurrence rate, no significant rise in IOP but may cause burning and foreign body sensation in some patients.