Cyclosporine may be new treatment option for ptergyia

Topical cyclosporine ophthalmic emulsion 0.05% may be a new treatment option for patients with inflamed pterygia that are refractory to conventional therapy of topical steroids and emollients. The modulating effect of the drug also may reduce or delay the need for excision of pterygia.

Elastoic degeneration of collagen and fibrovascular proliferation with an overlying cover of epithelium is the characteristic finding in patients with pterygia.

The incidence of pterygia varies, and they may occur more frequently in the lower latitudes in the United States.

Symptoms vary substantially and can range from none to substantial redness, swelling, itching, irritation, and blurring of vision, Dr. Schechter explained.

Treatment of pterygia is either surgical or medical; however, even after surgery, recurrences are possible. Artificial tears, non-preserved ointments, and short-term use of topical corticosteroid drops may reduce intense symptoms during flare-ups.

"These treatments, however, provide palliative relief of symptoms and do not address the underlying inflammatory mechanism usually associated with pterygia. The presence of inflammatory cells such as CD-4 and CD-8 subpopulations of T-lymphocytes may play a role in the pathogenesis of moderate to severe pterygia," Dr. Schechter pointed out.

He conducted a prospective, open-label 4-month study of patients with symptomatic pterygia that had not responded to the conventional medical therapy. Forty-one eyes of 26 patients were included; patients instilled one drop of cyclosporine 0.05% twice daily into the affected eye. Eleven eyes of eight patients served as controls; they received the lubricant eye drops (Refresh Endura, Allergan).

Participants were evaluated monthly for 4 months.

The study outcome measures included the ocular surface disease index (OSDI), the size of the pterygia, tear film break-up time, staining with lissamine green, and a subjective evaluation of patient pain using a scale of 0 to 4, with 0 indicating no pain and 4 indicating severe pain.

Dr. Schechter reported that by 1 month after the onset of treatment with cyclosporine, the mean OSDI scores improved by 8.6 points (p ≤ 0.012), and Schirmer's scores also improved (p ≤ 0.015). Cyclosporine also significantly reduced pain and staining (p < 0.001), and tear breakup time increased. The control patients did not show any significant differences from baseline.

"In addition, there was no progression of pterygia growth or change in the lesion size in patients treated with cyclosporine. This lack of progression, however, is likely due to the short-term follow-up period," he said.

One patient who received cyclosporine scheduled surgery as compared with seven of the eight patients who were treated with the lubricant eye drops.