Comparative Efficacy and Safety of Topical Cyclosporine, Dexamethasone and Loteprednol in Vernal Keratoconjunctivitis

Introduction: Vernal keratoconjunctivitis is a chronic, severe, recurrent and bilateral seasonal allergic conjunctivitis causing vision threatening complications for which drugs like topical corticosteroids and cyclosporine are required for severe inflammation. Aims &Objectives: To compare the efficacy and safety of topical cyclosporine, dexamethasone and loteprednol in vernal keratoconjunctivitis. Place and Duration of Study: Department of Ophthalmology, Shaikh Zayed Hospital, Lahore from 1st December 2019 to 30th June 2020. Materials & Methods: A randomized controlled trial in which one hundred and fifty patients of VKC (vernal keratoconjunctivitis) were enrolled in which 50 were from cyclosporine group, 50 were from dexamethasone group and 50 were from loteprednol group. Detailed ocular and systemic histories were recorded followed by ocular examination including recording of visual acuity, intraocular pressure (IOP) measurements, slit lamp examination of anterior segment and fundoscopy. Results: The mean ages of the patients were 18.12±7.76 years, 17.02±7.22 years and 17.50±7.22 years in cyclosporine, dexamethasone and loteprednol groups respectively. At 1st week, in cyclosporine, dexamethasone and loteprednol groups the mean intraocular pressures of patients were 16.09±1.44 mmHg, 16.39±1.37 mmHg and 16.69±1.46 mmHg respectively (P=0.114). Similarly at 6th months follow-up in cyclosporine, dexamethasone and loteprednol groups, the mean intraocular pressure of patients was 16.09±1.44 mmHg, 17.26±1.13 mmHg and 16.67±1.44 mmHg respectively (P=0.000). Posterior subcapsular opacity of lens was observed in one case in dexamethasone group while in both other groups no posterior subcapsular opacity of lens occurred. Conclusion: Cyclosporine is a safe and effective drug as compared to dexamethasone and loteprednol in treating vernal keratoconjunctivitis.