Objective To evaluate the efficacy of using 0.1% tacrolimus eye drops in the treatment of refractory immunologic keratitis.Methods In a retrospective study, 13 patients (20 eyes) diagnosed as refractory immunologic keratitis between March 2014 and October 2015 at Shandong Eye Hospital were included.Eight patients (10 eyes) had been treated with glucocorticoid and cyclosporin eye drops for 3~6 months after lamellar keratoplasty and suffered Mooren''s ulcer.They received lamellar keratoplasty again and were given tacrolimus eye-drop 0.1% immediately after the re-epithelialization of the cornea.Five patients (10 eyes) had limbal form of seasonal keratoconjunctivitis that were refractory to conventional topical glucocorticoid and cyclosporin treatments.Three patients (6 eyes) had ocular inflammation and persistent corneal limbus nodules.Two patients (4 eyes) discontinued topical medication because of intolerance.In these patients, tacrolimus was replaced by cyclosporin eye drops.All patients were followed for 1 year.Results After application of 0.1% tacrolimus eye-drop, 8 cases (10 eyes) of recurrent Mooren?s ulcer were all cured.Of these 10 eyes, 4 were treated with partial lamellar keratoplasty, 3 eyes were treated with total lamellar keratoplasty, and the other 3 were treated with lamellar keratoplasty combined with corneal perforation repair.Of all the limbal form of seasonal keratoconjunctivitis patients, symptoms and signs significantly improved in the first week of topical 0.1% tacrolimus eye-drop therapy.Two eyes felt minor, temporary irritation when using tacrolimus.No other adverse effects were observed.Two eyes showed recurrent symptoms after cessation of tacrolimus, but symptoms were relieved after resume tacrolimus.No recurrence and complications were found during the treatment and follow-up period.Conclusions 0.1% tacrolimus is effective in patients with refractory immunologic keratitis.Combined with corneal transplantation surgery, it is particularly effective in preserving eyes and visual acuity and reducing recurrence.%目的 探讨0.1%他克莫司滴眼液治疗难治性免疫相关性角膜病的疗效. 方法 回顾性系列病例研究.山东省眼科医院2014年3月至2015年10月诊治的难治性免疫相关性角膜病13例(20只眼).其中蚕蚀性角膜溃疡行板层角膜移植术后常规使用糖皮质激素和环孢素滴眼液治疗3~6个月后复发8例(10只眼),再次给予板层角膜移植术,待术后角膜植片上皮愈合后立即给予0.1%他克莫司滴眼液局部点眼治疗,观察其疗效.春季角结膜炎角膜缘型常规应用糖皮质激素和环孢素滴眼液治疗效果不理想5例(10只眼),其中眼部炎症持续存在、角膜缘结节未见消失3例(6只眼),无法耐受环孢素局部刺激症状而致停药2例(4只眼),对于此类患者给予他克莫司滴眼液替换环孢素滴眼液治疗,观察其疗效.所有患者随访1年.结果 蚕蚀性角膜溃疡再次行部分板层角膜移植术4只眼,全板层角膜移植术3只眼,穿孔修补联合部分板层角膜移植术3只眼,术后联合应用0.1%他克莫司滴眼液治疗后,角膜溃疡均愈合.所有春季角结膜炎角膜缘型患者在用药1周后症状和体征均有不同程度改善.2只眼出现一过性轻微刺激症状,未发现其它眼表毒副作用;2只眼在停药4 d后症状复发,重新用0.1%他克莫司滴眼液后可迅速控制症状.所有患者随访期间病情均无复发,部分患者视力较治疗前提高,治疗中及随访期间未见特殊并发症.结论 局部应用0.1%他克莫司滴眼液治疗难治性免疫相关性角膜病有效;对于部分患者联合手术治疗并密切随访,有助于提高视力、保存眼球,在一定程度上减少复发.
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