Abstract

A Comparative Evaluation of Tacrolimus versus Steroids in the Treatment of Vernal Keratoconjunctivitis

Author(s): Sharmiladevi Vadivelu1 , Prasanna Venkat2 , Rajesh Mimmithi3 , Sudarvizhi Arumugam4 , Sivakami Mohan5

BACKGROUND Vernal keratoconjunctivitis (VKC) is a bilateral, chronic, conjunctival inflammatory condition of children and young adults. It is an IgE and T cell mediated disease leading to chronic inflammation in which eosinophil, lymphocyte and structural cell activation are involved. Treatment of VKC requires mast cell stabilisers, antihistamines, steroids and topical immunomodulators. This study was designed to compare topical tacrolimus ointment 0.03% and low potent steroids like Fluorometholone in the treatment of VKC. METHODS In this randomised double masked clinical trial, 60 eyes of 30 patients with VKC were treated in a tertiary referral centre in Chennai. Patients were randomly assigned to receive either 0.03% tacrolimus ointment or low potency topical steroids. Chi-square & t tests were used for comparison of outcomes between the two groups. RESULTS Mean age was 10.2 ± 2 yrs. in study group and 9.2 ± 2 yrs. in control group. The mean duration of disease was 4.2 ± 2.5 years. In this study, signs and symptoms were significantly reduced in patients after treatment in both groups (p=0.0001). Significant improvements in clinical signs and symptoms were achieved in all patients 4 weeks after starting treatment with topical tacrolimus. Significant improvement was noted in the control group too. In the tacrolimus group all patients except one responded to treatment. Side effects in the tacrolimus group were minimal and tolerable. Side effects in the steroids group were slightly severe. CONCLUSIONS Both 0.03% topical tacrolimus ointment and steroids are effective in the treatment of VKC. However, long term complications in the tacrolimus group are fewer and milder when compared with the steroids group.