Comparative study of efficacy and safety of topical cyclosporine 0.1% and tacrolimus ointment 0.1% therapy with fluorometholone 0.1% for vernal keratoconjunctivitis

Aim: To evaluate and compare the efficacy and safety of eyedrop cyclosporine (CsA) 0.1%, eye ointment tacrolimus (TCA) 0.1% and eyedrop fluorometholone (FML) 0.1% in patients of VKC. Methods: Prospective and Interventional Randomised Comparative Double Blinded Study conducted at Baba Saheb Ambedkar Hospital, New Delhi during August 2017 to December 2018.All 60 patients of 5 to 20 years age with moderate to severe VKC randomly divided into three groups A,B and C of 20 patients each and were treated with cyclosporine 0.1% eyedrops, tacrolimus 0.1% ointment and flurometholone 0.1% eye drops respectively. Patients were followed up after 7,14,30,60 and 90 days. Quantitative variables were compared using ANOVA/Kruskal Wallis Test and paired t test/Wilcoxon. Qualitative variables were correlated using Chi-Square test /Fisher’s exact test. Results: In CsA group symptoms and signs except except foreign body sensation and papillary hypertrophy were decreased earliest at 7 days and these two started improving by 1 month. TCLand FML group showed improvement in all symptoms and signs except papillary hypertrophy after 7 days of treatment. Later started improving by 14 day with FML while it took 60 days with TCA. No changes in fundus and IOP with CsA and TCA was noted whereas, Significant rise in IOP was seen in three patients withFML but no fundus changes. Conclusion: FML has early and maximum effect than others, but considering IOP rise seen with it, TCA and CsA can be safely used as an alternative to topical fluorometholone.