Purpose

The current paradigm for therapy of recalcitrant ocular surface diseases (OSD) consists of a sequential, step-up treatment approach. A combinatorial topical therapy (anti-inflammatory/immunosuppressive [steroid] with immunomodulatory [pooled human immune globulin] and tear substitute [serum]) that simultaneously targets several immunological pathways may be more efficacious. This report evaluates if the combinatorial therapy resulted in clinical benefit in patients with recalcitrant OSD.

Methods

We performed a retrospective case study of patients receiving topical, preservative-free, compounded formulations of steroids, pooled human immune globulin, and serum tears. Outcome measures included visual acuity, ocular surface disease index (OSDI), ocular discomfort score, subjective global assessment (SGA), corneal staining, conjunctival redness, and slit lamp photographs.

Results

Patients consisted of one male and 11 females ranging in age from 27 to 87 years old. Pathologies included ocular graft-versus-host disease (n = 4), Sjögren's syndrome (n = 3), ocular cicatricial pemphigoid (n = 1), pemphigus vulgaris (n = 1), peripheral ulcerative keratitis (n = 1), Stevens-Johnson syndrome (n = 1), and giant papillary conjunctivitis (n = 1). All patients were “improved” or “much improved” on SGA after combinatorial therapy. There was a clinically meaningful reduction in OSDI, ocular discomfort, corneal staining, and conjunctival injection. Additionally, three patients had improvement in their visual acuity (one from 20/400 to 20/20). Adverse effects included increased intraocular pressure in two patients, presumably due to topical steroid use.

Conclusions

Combinatorial therapy provides clinical benefit by reducing the symptoms and signs in recalcitrant OSD. Our study provides the rationale for performing prospective clinical trials to evaluate the efficacy of combinatorial therapy for treating recalcitrant OSD.

中文翻译：

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在顽固性免疫性眼表疾病中使用免疫抑制、免疫调节和泪液替代滴眼液（“三重奏”）的组合疗法

目的

目前治疗顽固性眼表疾病 (OSD) 的范例包括顺序的、逐步的治疗方法。同时靶向几种免疫途径的组合局部治疗（抗炎/免疫抑制[类固醇]与免疫调节[汇集的人免疫球蛋白]和泪液替代物[血清]）可能更有效。本报告评估了联合治疗是否对顽固性 OSD 患者产生了临床益处。

方法

我们对接受外用、无防腐剂、类固醇、混合人类免疫球蛋白和血清泪液的复合制剂的患者进行了一项回顾性案例研究。结果测量包括视力、眼表疾病指数 (OSDI)、眼部不适评分、主观整体评估 (SGA)、角膜染色、结膜发红和裂隙灯照片。

结果

患者包括一名男性和 11 名女性，年龄从 27 岁到 87 岁不等。病理学包括眼移植物抗宿主病 (n = 4)、干燥综合征 (n = 3)、眼瘢痕性类天疱疮 (n = 1)、寻常型天疱疮 (n = 1)、外周溃疡性角膜炎 (n = 1)、Stevens -约翰逊综合征（n = 1）和巨大乳头状结膜炎（n = 1）。联合治疗后，所有患者的 SGA 均“改善”或“显着改善”。OSDI、眼部不适、角膜染色和结膜注射均有临床意义的减少。此外，三名患者的视力有所改善（一名从 20/400 提高到 20/20）。不良反应包括两名患者的眼压升高，可能是由于使用了局部类固醇。

结论

组合疗法通过减少顽固性 OSD 的症状和体征来提供临床益处。我们的研究为进行前瞻性临床试验以评估联合疗法治疗顽固性 OSD 的疗效提供了依据。