Systemic immunomodulatory therapy in severe dry eye secondary to inflammation
Systemic immunomodulatory therapy in severe dry eye secondary to inflammation
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DOI：
10.1080/09273940701299354
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发表时间：
2007-03-01
影响因子：
3.3
通讯作者：
Foster, C. Stephen
中科院分区：
文献类型：
--
作者：
Cordero-Coma, Miguel;Anzaar, Fahd;Foster, C. Stephen
目的：报告4例继发于泪组织和眼表炎症的异常严重的急性干燥性角膜炎患者，最终需要全身免疫抑制治疗。研究方法：4例极重度急性干眼综合征患者的观察性病例系列，尽管进行了积极的常规治疗，但这些患者仍因疼痛和疼痛而严重残疾（达到呆在暗室的程度）。记录临床数据，包括视力、针对干眼给予的其他治疗、全身性疾病、Schirmer和玫瑰红染色结果、结膜充血程度和药物。所有4例患者均接受了全身免疫调节治疗。结果如下：所有4例患者均为女性，平均年龄40岁（范围22-58岁），均患有全身性自身免疫性疾病：系统性红斑狼疮（SLE）和干燥综合征（n = 2），干燥综合征（n = 1），类风湿性关节炎（RA）和银屑病（n = 1）。Schirmer试验值在发病范围为0至2毫米。所有患者都失败了积极润滑，局部环孢素，眼睑护理，泪点塞。在两名患者中，尝试了血清撕裂和泪点阻塞，但没有成功。使用各种全身性免疫抑制剂控制泪腺炎症：甲氨蝶呤和环孢素A（患者1）、环孢素A（患者2）、泼尼松（患者3）和甲氨蝶呤和英夫利昔单抗（患者4）。全身性免疫调节剂治疗导致泪腺急性炎症攻击的决议和干燥性角结膜炎的体征和症状的控制在所有4例患者，视力改善，在所有的。治疗后Schirmer值范围为7至10 mm。结论：全身免疫抑制剂可能需要在治疗原发性和继发性干燥综合征引起的全身性自身免疫条件。我们发现，在这些罕见但严重的病例中，全身免疫调节治疗可显著改善泪液分泌和角膜结膜炎的消退。
Purpose: To report four patients with unusually severe acute keratitis sicca secondary to lacrimal tissue and ocular surface inflammation who eventually required systemic immunosuppressive therapy. Methods: Observational case series of four patients with extremely severe acute dry eye syndrome who were profoundly disabled by pain and photophobla (to the extent of staying in dark rooms) despite aggressive conventional therapy. Clinical data including visual acuities, other treatments administered for dry eye, systemic medical conditions, Schirmer and rose bcngal staining results, degree of conjunctival injection, and medications were recorded. All four patients were treated with systemic immunomodulatory therapy. Results: All four patients were female with a mean age at presentation of 40 years (range 22-58 years), and all had systemic autoimmune diseases: systemic lupus erythematosus (SLE) and Sjogren's syndrome (n = 2), Sjogren's syndrome (n = 1), rheumatoid arthritis (RA) and psoriasis (n = 1). Schirmer test values at onset ranged from 0 to 2 mm. All patients had failed aggressive lubrication, topical cyclosporine, lid care, and punctual plugs. In two patients, serum tears and hyphrecation punctal occlusion were tried without success. Various systemic immunosuppressive agents were used to control inflammation of the lacrimal glands: methotrexate and cyclosporine A (patient 1), cyclosporine A (patient 2), prednisone (patient 3), and methotrexate and infliximab (patient 4). Treatment with systemic immunomodulatory agents resulted in resolution of the acute inflammatory assault on the lacrimal glands and control of signs and symptoms of keratoconjunctivitis sicca in all four patients, and visual acuities improved in all of them. Post-treatment Schirmer values ranged from 7 to 10 mm. Conclusion: Systemic immunosuppressive agents may be required in the treatment of recalcitrant primary and secondary Sjogren's syndrome caused by systemic autolmmune conditions. We show that systemic immunomodulatory therapy leads to significantly improved tear production and resolution of the keratoconjunctivitis in these rare but severe cases.