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Long-term result of maintenance treatment with tacrolimus ointment in chronic ocular graft-versus-host disease

 Ji Won Jung  ;  Young Ji Lee  ;  Sang Chul Yoon  ;  Tae-im Kim  ;  Eung Kweon Kim  ;  Kyoung Yul Seo 
 AMERICAN JOURNAL OF OPHTHALMOLOGY, Vol.159(3) : 519-527, 2015 
Journal Title
Issue Date
Adolescent ; Adult ; Child, Preschool ; Chronic Disease ; Conjunctivitis/diagnosis ; Conjunctivitis/drug therapy* ; Conjunctivitis/etiology ; Female ; Follow-Up Studies ; Graft vs Host Disease/diagnosis ; Graft vs Host Disease/drug therapy* ; Graft vs Host Disease/etiology ; Hematopoietic Stem Cell Transplantation/adverse effects ; Humans ; Immunosuppressive Agents/adverse effects ; Immunosuppressive Agents/therapeutic use* ; Keratitis/diagnosis ; Keratitis/drug therapy* ; Keratitis/etiology ; Leukemia/therapy ; Male ; Middle Aged ; Ointments ; Retrospective Studies ; Tacrolimus/adverse effects ; Tacrolimus/therapeutic use* ; Treatment Outcome ; Visual Acuity ; Young Adult
PURPOSE: To investigate the efficacy and safety of long-term maintenance treatment with tacrolimus ointment in chronic ocular graft-vs-host disease (GVHD) with ocular surface inflammation.

DESIGN: A retrospective interventional consecutive case series.

METHOD: Long-term maintenance treatment (≥6 months) with topical 0.02% tacrolimus ointment was applied to patients with chronic ocular GVHD with ocular surface inflammation (at least grade 2 inflammatory score). We evaluated the inflammatory score, steroid score and steroid use period of total duration, and numbers of inflammatory aggravations before and after tacrolimus treatment. The clinical outcomes were assessed by symptom score, ocular surface staining, Schirmer I test, tear break-up time (TBUT), and classification of chronic GVHD conjunctivitis at the initial and final examinations.

RESULTS: Thirteen patients (24 eyes) were treated with tacrolimus ointment for up to 20 months (average 12.2 months). The ocular surface inflammatory score decreased from 2.8 to 0.6 (P = .001) within 2-8 weeks after starting tacrolimus ointment treatment. The numbers of inflammatory aggravation and the need for steroid treatment also decreased after initiating tacrolimus treatment. At the final follow-up, all patients reported improvement in clinical outcomes, compared to initial findings. Except for blurred vision or mild burning sensation, there were no reported side effects.

CONCLUSION: Considering the chronic course of GVHD, long-term maintenance treatment with tacrolimus ointment could be useful and safe to locally treat ocular surface inflammation in chronic ocular GVHD.
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1. College of Medicine (의과대학) > Dept. of Medical Humanities and Social Sciences (인문사회의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Eung Kweon(김응권) ORCID logo https://orcid.org/0000-0002-1453-8042
Kim, Tae-Im(김태임) ORCID logo https://orcid.org/0000-0001-6414-3842
Seo, Kyoung Yul(서경률) ORCID logo https://orcid.org/0000-0002-9855-1980
Yoon, Sang Chul(윤상철) ORCID logo https://orcid.org/0000-0003-0454-9597
Jung, Ji Won(정지원)
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