Topical tacrolimus shows promise against persistent subepithelial infiltrates

This case series assessed the efficacy and safety of topical tacrolimus for subepithelial infiltrates due to adenoviral keratoconjunctivitis (AKC) persisting at least 2 years after treatment.

Study design

Researchers assessed 15 eyes with corneal subepithelial infiltrates and 16 healthy eyes. After being resistant to topical steroid and cyclosporine for at least 2 years, eyes in the study arm were treated with topical 0.03% tacrolimus ointment for 12 months. Efficacy was measured by BCVA, Fantes corneal haze score, corneal subepithelial infiltrate score, Oxford score, Schirmer score, and tear breakup time.

Outcomes

The corneal subepithelial infiltrate score began decreasing after 3 months and by 12 months had reduced from 2 to 0.8. Improvements in BCVA, Fantes, and Schirmer scores followed similar trends while Oxford scores did not improve until 6 months; tear breakup time did not show any change. One patient could not tolerate the treatment.

Limitations

The authors included dry eye parameters (Oxford, Schirmer, tear breakup time) because goblet cell loss is associated with adenoviral infection, but they did not include subjective questionnaires assessing dry eye symptoms.

Clinical significance

Topical 0.03% tacrolimus shows promise for managing subepithelial infiltrates that previously failed to respond to corticosteroid and/or cyclosporine treatment without inducing significant side effects. Based on these findings, the authors note that it may take at least 3 months for an improvement in BCVA.