Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Brief Communication
  • Published:

Topical ciclosporin A for severe ocular surface inflammation: a real-world series of 1221 cases

Eye volume 38, pages 625–627 (2024)Cite this article

Subjects

In 2015, a cationic emulsion of ciclosporin A (CsA) 1 mg/ml (IkervisTM) was launched for use in severe dry-eye-disease (DED [1]) with severe keratitis (defined as a corneal fluorescein staining (CFS) score of 4 on the modified Oxford scale [2]), with a recommended dose of one application a day at bedtime [3]. CsA is used to induce and maintain control of inflammation long-term, reducing the need for topical corticosteroids (tCS). Here we review the steroid-sparing effect of CsA 1 mg/ml and adverse events in our patient population and explore whether CsA is being prescribed for indications other than DED-related keratitis. We defined any reduction and discontinuation of tCS as “success”.

This service evaluation was approved by Moorfields Eye Hospital, registration number 210. We searched electronic medical records and pharmacy prescriptions of patients aged 18 years and older dated between 03/01/2014 and 13/11/2018, using the search terms ciclosporin(e), cyclosporin(e) or Ikervis. Eliminating duplicates, we identified n = 1752 records. As we intended to include only patients using CsA cationic emulsion, we excluded 531 cases after review of individual records, as other preparations of CsA had been used, or as other critical information was not included, principally start date of CsA. We included 1221 records.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15:276–83.

    Article  PubMed  Google Scholar 

  2. Leonardi A, Van Setten G, Amrane M, Ismail D, Garrigue JS, Figueiredo FC, et al. Efficacy and safety of 0.1% cyclosporine A cationic emulsion in the treatment of severe dry eye disease: a multicenter randomized trial. Eur J Ophthalmol. 2016;26:287–96.

    Article  PubMed  Google Scholar 

  3. National Institute For Health And Care Excellence Guidance Executive (GE) Technology Appraisal Review Proposal paper Review of TA369; Ciclosporin for treating dry eye disease which has not improved after treatment with artificial tears. 2018.

  4. Hind J, Macdonald E, Lockington D. Real-world experience at a Scottish university teaching hospital regarding the tolerability and persistence with topical Ciclosporin 0.1% (Ikervis) treatment in patients with dry eye disease. Eye (Lond). 2019;33:685–6.

  5. Deshmukh R, Ting DSJ, Elsahn A, Mohammed I, Said DG, Dua HS. Real-world experience of using ciclosporin-A 0.1% in the management of ocular surface inflammatory diseases. Br J Ophthalmol. 2022;106:1087–92.

    PubMed  Google Scholar 

  6. Pisella PJ, Labetoulle M, Doan S, Cochener-Lamard B, Amrane M, Ismail D, et al. Topical ocular 0.1% cyclosporine a cationic emulsion in dry eye disease patients with severe keratitis: experience through the French early-access program. Clin Ophthalmol. 2018;12:289–99.

Download references

Acknowledgements

The work was carried out at the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Funding

This work was not supported by specific funding. A-DN is supported by the NIHR Moorfields Biomedical Research Centre.

Author information

Authors and Affiliations

  1. NIHR Moorfields Biomedical Research Centre, 162 City Road, London, EC1V 2PD, UK

    Doaa ElFadaly & Annegret Dahlmann-Noor

  2. Children’s Service, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK

    Doaa ElFadaly, Elisa Marziali & Annegret Dahlmann-Noor

  3. Department of Ophthalmology, Faculty of Medicine, Minia University, Minia, Egypt

    Doaa ElFadaly

  4. University of Cambridge, Cambridge, CB2 1TN, UK

    Pasan Fernando & Marta Chlubek

  5. Pediatric Ophthalmology Unit, A. Meyer Children’s Hospital, Florence, Italy

    Elisa Marziali

Authors
  1. Doaa ElFadaly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pasan Fernando
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marta Chlubek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisa Marziali
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Annegret Dahlmann-Noor
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A-DN designed the service evaluation and carried out the search of electronic patient records. EM, PF, MC and DEF reviewed the records and extracted data. A-DN and DEF analysed all data and drafted the manuscript, which was reviewed and discussed by all authors.

Corresponding author

Correspondence to Annegret Dahlmann-Noor.

Ethics declarations

Competing interests

AD-N has received payment from Santen, Thea, Novartis, SightGlassVision for contribution to educational activities and advisory boards.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

ElFadaly, D., Fernando, P., Chlubek, M. et al. Topical ciclosporin A for severe ocular surface inflammation: a real-world series of 1221 cases. Eye 38, 625–627 (2024). https://doi.org/10.1038/s41433-023-02714-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-023-02714-6

Search

Advanced search

Quick links