Efficacy of Topical Tacrolimus 0.05% Suspension on Treatment of Steroid Resistant Refractory Vernal Keratoconjunctivitis

To evaluate the efficacy and safety of topical tacrolimus 0.05% suspension for the treatment of long standing steroid resistant vernal keratoconjunctivitis (VKC). In this interventional case series, patients with refractory VKC were included. All patients had active symptomatic disease despite conventional medical therapy including topical steroids. After discontinuation of all the medications, patients were treated with topical 0.05% tacrolimus eye drop four times a day for at leastr 6 months. Changes in subjective symptoms and objective signs scores after treatment were evaluated one week, one month and 6 months after treatment. Development of possible ocular and systemic complications were also assessed. Twenty-eight eyes of 14 patients, 11 male and 4 female were included. Mean age of the patients was 22±8 years (11 to 38 years). Mean duration of VKC was12±6 years (5 to 23 years). Patients were followed for 10±2 months (6-12 months). All symptoms including itching, redness, photosensitivity, foreign body sensation and mucus discharge improved in all follow-up periods (P<.001). Conjunctival hyperemia was the first sign, which improved 1 week after treatment. Other objective signs including conjunctival papillary hypertrophy, limbal hypertrophy (including Horner-Trantas dots), corneal punctate epithelial erosions and corneal pannus decreased at least one month after treatment. There was no changes in corneal opacity during follow-up period (p> 0.05). No ocular or systemic complications was observed. Topical 0.05% tacrolimus is a safe and effective medication for steroid resistant refractory VKC. It might be better to apply it earlier in these cases before occurance of the complications including irreversible limbal stem cell deficiency and corneal opacity and steroid-induced complications. However, long-term use was needed to control the disease.