Topical 0.03% tacrolimus ointment in the management of ocular surface inflammation in chronic GVHD.

摘要

We present a case in which topical tacrolimus 0.03% was used successfully in the management of ocular surface inflammation from chronic GVHD. Dry eye is the most common complication of chronic GVHD, occurring in 40-76% of patients. Inflammation of the ocular surface leads to aqueous deficiency and tear film instability; blindness could ensue from conjunctival cicatrization and corneal epithelial breakdown. The mainstay of treatment for ocular surface GHVD consists of lubrication and topical steroid, but the long-term use of the latter is limited by complications, such as cataract and glaucoma. Protopic (Tacrolimus 0.03%, Astellas Pharma, Tokyo, Japan) is a dermatological ointment approved by the US Food and Drug Administration for atopic eczema. Off-label ophthalmic use has emerged for eczematous eyelid disease, atopic keratoconjunctivitis and various other anterior segment inflammations with promising results. Its twice-daily regimen, higher potency than commercially available calcineurin inhibitor (CYA 0.05%), lack of serious side effects and steroid sparing properties have made it ideal for at least short-term use when other modalities fail.