Format

Send to

Choose Destination
See comment in PubMed Commons below
Trans Am Ophthalmol Soc. 2000;98:81-7; discussion 87-90.

Topical cyclosporin stimulates neovascularization in resolving sterile rheumatoid central corneal ulcers.

Author information

1
Cornea and External Disease Service, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Abstract

OBJECTIVE:

To report the successful use of topical cyclosporin for treatment of central sterile corneal ulcers associated with rheumatoid disease.

DESIGN:

Retrospective, noncomparative case series.

PARTICIPANTS/INTERVENTION:

Five patients (7 eyes) with collagen vascular disorders presented with central, sterile corneal ulcers. An extensive medical evaluation did not reveal active underlying rheumatoid disease in any patient. Inadequate clinical response with use of topical steroids and lubricants led to corneal perforations requiring multiple tectonic procedures. Systemic immunosuppressive therapy either could not be initiated owing to a systemic contraindication or was discontinued owing to intolerance and side effects. The patients were ultimately treated with topical cyclosporin.

RESULTS:

Six of the 7 eyes responded favorably. An intense limbal vascularization began within 48 hours of treatment. The neovascularization progressed centrally with the simultaneous arresting of epithelial and stromal ulceration. Over a 2-week period, re-epithelization occurred with vascularization proceeding throughout the cornea. After several months, the corneal vessels attenuated, and all signs of inflammation subsided. Intrastromal bleeding with corneal blood staining occurred in 1 patient; this resolved over several months. No recurrences of corneal ulceration occurred in a mean follow-up period of 28 months (range, 7 to 60 months). None of the 5 patients have had a reactivation of their rheumatoid disease in the follow-up period.

CONCLUSION:

The clinical response in these patients contrasts with previous animal studies demonstrating an anti-angiogenic property of cyclosporin. We report that an immediate intense neovascularization is the first sign of a favorable clinical response. Treatment with topical cyclosporin alone may be considered in patients with sterile corneal ulcers associated with rheumatoid disease in the absence of systemic activation.

PMID:
11190043
PMCID:
PMC1298214
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for PubMed Central
    Loading ...
    Support Center