Kuru Göz Sendromlu Hastaların Tedavisinde %0.05 Siklosporin A’nın Etkinliği

Kuru göz, yaşlı popülasyonda en sık görülen oküler hastalıklardan biridir ve önemi giderek artmaktadır. Yaşlanma, azalmış hormonlar ve sistemik otoimmünite kuru göz hastalığının yaygın nedenleri arasındadır. Kuru göz etiyolojisi değişebilse de ana nedenin hem lakrimal bezlerde hem de oküler yüzeylerde inflamasyon olduğu bilinmektedir. Kuru gözün tedavisinde immün modülatör bir ajan olan topikal siklosporin A (CsA) % 0,05'in etkinliğini değerlendirmek için toplam 51 kuru göz sendromu hastası çalışmaya dahil edildi. Hastaların 41'i kadın, 5'i erkekti. Hastaların ortalama ilaç kullanım süresi 8.72 ± 3.59 ay (6-16 ay) idi. Tedavi öncesi Schirmer skorları ile Sjögren ve Sjögren olmayan grupların 1., 6. ve son kontrollerinde bulunan Schirmer skorları arasında istatistiksel olarak anlamlı bir fark gözlendi (p<0.05). Sjögren ve Non- Sjögren grupları arasında ise anlamlı fark yoktu (p> 0.05). Sonuç olarak hem Sjögren hem de Sjögren olmayan grupların Schirmer ve floresein TBUT skorlarında ve gözyaşı menisküs yüksekliğinde anlamlı bir artış olduğu bulundu.

Anahtar Kelimeler:

Kuru göz, Siklosporin A, Sjögren sendromu

Efficacy of Cyclosporine A 0.05% in the Treatment of Patients with Dry Eye Syndrome

Dry eye is one of the most common ocular diseases in the elderly population and has increasing importance. Aging, decreased hormones and systemic autoimmunity are among the common causes of dry eye disease. Although the etiology of dry eye can change, it is known that the main cause is the inflammation in both lacrimal glands and ocular surfaces. To evaluate the effectiveness of topical cyclosporine A (CsA) 0.05% which is an immune-modulatory agent in the treatment of dry eyes, total of 51 patients with dry eye syndrome were included in our study. Forty-six of the patients were female while 5 patients were male. The mean duration of medication use of the patients was 8.72 ± 3.59 months (6-16 months). There was a statistically significant difference between the pre-treatment Schirmer scores and Schirmer scores found in 1st, 6 th and last month controls of Sjögren and Non-Sjögren groups (p<0.05) while there was no statistically significant difference between Sjögren and Non-Sjögren groups (p>0.05). In conclusion, it was found that there was a significant increase in Schirmer and fluorescein TBUT scores and tear meniscus height of both Sjögren and and Non- Sjögren groups.

Keywords:

Dry eye, Cyclosporin A, Sjögren syndrome,

PDF

___

Barber, L.D., Pflugfelder, S.C., Tauber, J., Foulks, G.N., 2005. Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years. Ophthalmology 112(10), 1790-1794.
Bozkurt, B., Irkeç, M., 2013. Kuru gözün fizyopatolojisi. Turkiye Klinikleri Journal of Ophthalmol-Special Topics 6(3), 1-7.
Brignole, F., Pisella. P.J., Goldschild, M., De Saint Jean, M., Goguel, A., Baudouin, C., 2000. Flow cytometric analysis of inflammatory markers in conjunctival epithelial cells of patients with dry eyes. Investigative Ophthalmology and Visual Science 41(6), 1356-1363.
De Paiva, C.S., Pflugfelder, S.C., Ng, S.M., Akpek, E.K., 2019. Topical cyclosporine A therapy for dry eye syndrome. Cochrane Database of Systematic Reviews 9(9) 10.1002/14651858.CD010051.
Devecı, H., Kobak, S., 2014. The efficacy of topical 0.05 % cyclosporine A in patients with dry eye disease associated with Sjögren's syndrome. International Ophthalmology 34(5), 1043-1048.
Foulks, G.N., Forstot, S.L., Donshik, P.C., Forstot, J.Z., Goldstein, M.H., Lemp, M.A., Nelson, J.D., Nichols, K.K., Pflugfelder, S.C., Tanzer, J.M., Asbell, P., Hammitt, K., Jacobs, D.S., 2015. Clinical guidelines for management of dry eye associated with sjögren disease. The Ocular Surface 13(2), 118-32.
Guan, Q., Gao, X., Wang, J., Sun, Y., Shekhar, S., 2017. Cytokines in Autoimmune Disease. Mediators of Inflammation 2017, 1-2.
Jain, A.K., Sukhija, J., Dwedi, S., Sood, A., 2007. Effect of topical cyclosporine on tear functions in tear-deficient dry eyes. Annals of Ophthalmology (Skokie) 39(1), 19-25.
Ji, Y.W., Lee, J.L., Kang, H.G., Gu, N., Byun, H., Yeo, A., Noh, H., Kim, S., Choi, E.Y., Song, J.S., Lee, H.K., 2018. Corneal lymphangiogenesis facilitates ocular surface inflammation and cell trafficking in dry eye disease. The Ocular Surface 16(3), 306-313.
Köksoy Vayısoğlu, S., Öncü, E., Dursun, Ö., Dinç, E., 2019. Investigation of dry eye symptoms in lecturers by ocular surface disease index. Turkish Journal of Ophthalmology 49(3),142-148.
Kunert, K.S., Tisdale, A.S., Stern, M.E., Smith, J.A., Gipson, I.K., 2000. Analysis of topical cyclosporine treatment of patients with dry eye syndrome: effect on conjunctival lymphocytes. Archives of Ophthalmology 118(11), 1489-1496.
Lelli, G.J., Much, D.C., Gupta, A., Farjo, Q.A., Nairus, T.M., Mian, S.I., 2006. Ophthalmic cyclosporine use in ocular GVHD. The Journal of Cornea and External Disease 25(6), 635-638.
Perry, H.D., 2008. Dry Eye Disease: Pathophysiology, classification, and diagnosis. The American Journal of Managed Care 14 (3), 79-87.
Perry, H.D., Donnenfeld, E.D., 2004. Dry eye diagnosis and management in 2004. Current Opinion in Ophthalmology 15(4), 299-304.
Pflugfelder, S.C., De Paiva, C.S., 2017. The pathophysiology of dry eye disease: what we know and future directions for research. Ophthalmology 124(11S), 4-13.
Sall, K., Stevenson, O.D., Mundorf, T.K., Reis, B.L., 2000. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA phase 3 study group. Ophthalmology 107(5), 631-639.
Stern, M.E., Gao, J., Schwalb, T.A., Ngo, M., Tieu, D.D., Chan, C., Reis, B.L., Whitcup, S.M., Thompson, D., Smith, J.A., 2002. Conjunctival T-cell subpopulations in Sjogren's and non-Sjogren's patients with dry eye. Investigative Ophthalmology and Visual Science 43(8), 2609-2614.
Stevenson, D., Tauber, J., Reis, B.L., 2000. Efficacy and safety of cyclosporin A ophthalmic emulsion in the treatment of moderate-to-severe dry eye disease: a dose-ranging, randomized trial. The cyclosporin a phase 2 study group. Ophthalmology 107(5), 967-974.
Turner, K., Pflugfelder, S.C., Ji, Z., Feuer, W.J., Stern, M., Reis, B.L., 2000. Interleukin-6 levels in the conjunctival epithelium of patients with dry eye disease treated with cyclosporine ophthalmic emulsion. The Journal of Cornea and External Disease 19(4), 492-496.
White, D.E., Zhao, Y., Jayapalan, H., Machiraju, P., Periyasamy, R., Ogundele, A., 2020. Treatment satisfaction among patients using anti-inflammatory topical medications for dry eye disease. Clinical Ophthalmology 14, 875-883.