Topical tacrolimus in ocular Graft Versus Host Disease

Abstract Purpose: To evaluate the safety and efficacy of topical tacrolimus eye drops in the treatment of patients with ocular Graft Versus Host Disease (GVHD).MethodsTen consecutive patients with ocular GVHD were included retrospectively. All patients were treated with topical tacrolimus (0.01% - 0.03%) twice daily. Five patients were given adjunctive topical steroids for 4 to 6 weeks. The outcome measures included improvement of symptoms of photophobia, ocular pain and discharge and signs of superficial punctate keratitis and conjunctival hyperemia. Clinical assessment was carried out before, during and on the last visit after treatment.ResultsThere were 9 males and 1 female patients. The mean age was 30 years (range 5 to 51). All patients had bilateral ocular involvement. Duration of treatment ranged from 2 to 22 months (mean 6.5 months). There was improvement of symptoms in 8/10 (80%), superficial punctate keratitis in 8(40%) out of the 20 eyes and conjunctival hyperemia in 12 (66%) out of 18 eyes. The response to treatment was noted to be late following initiation of therapy (Average 3 weeks; range 1 to 8 weeks). Patients given adjunctive steroids responded faster. The main adverse ocular side effects were burning sensation, redness and swollen lids.ConclusionTopical tacrolimus is a safe and effective long-term therapy in the treatment of patients with ocular GVHD. Adjunctive short-term use of topical steroids may lead to faster response to topical tacrolimus therapy. Patients should be encouraged to continue use of topical tacrolimus as the onset of action may be delayed.