Immunosuppression in atopic keratoconjunctivitis: experience from a single centre

Session Details

Session Title: Inflammation and Pathology

Session Date/Time: Sunday 11/09/2016 | 14:30-16:00

Paper Time: 15:42

Venue: Hall C2

First Author: : K.Darcy UK

Co Author(s): :    C. Chu   M. Buckle   D. Tole              

Abstract Details

Purpose:

To describe the long-term outcomes of patients with severe atopic keratoconjunctivitis (AKC) requiring systemic immunosuppression.

Setting:

Bristol Eye Hospital is the tertiary referral centre for the South-West region of the United Kingdom.

Methods:

A retrospective notes audit of all AKC patients treated with systemic immunosuppression in a single tertiary referral centre. Eligible patients were identified using a single patient record database used by the corneal service.

Results:

26 patients (mean age 35 years, 20 Caucasian, 6 Asian origin) followed between 1986 and 2016, with a median follow-up of 12 years (range 3 – 30). Visual acuity was maintained, with a median visual outcome of 0.2 logMAR at 10 years (-0.1 to 0.8). The median time on immunosuppression was 6.2 years. Tacrolimus was the most commonly used first line immunosuppressive agent (21/26) and achieved clinical quiescence in 10/25 (40%). During follow-up 8 eyes developed shield ulcers (15.4%) and 15 eyes (28.8%) were treated for microbial keratitis. 18 eyes (34.6%) required penetrating keratoplasty with 14 eyes (26.9%) undergoing cataract extraction.

Conclusions:

Good visual outcomes in severe AKC at 10 years are possible using contemporary immunosuppression and surgery. Increasing severity of AKC was associated with an increased requirement for keratoplasty. Patients of Asian origin were observed to have worse visual outcomes and required multiple immunosuppressant usage.

Financial Disclosure:

NONE