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Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease
Immunosuppression in aqueous-deficient dry eye disease (ADDE) is required not only to improve the symptoms and signs but also to prevent further progression of the disease and its sight-threatening sequelae. This immunomodulation can be achieved through topical and/or systemic medications, and the c...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10276741/ https://www.ncbi.nlm.nih.gov/pubmed/37026249 http://dx.doi.org/10.4103/IJO.IJO_2818_22 |
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author | Kate, Anahita Shanbhag, Swapna S Donthineni, Pragnya R Amescua, Guillermo Quinones, Victor L Perez Basu, Sayan |
author_facet | Kate, Anahita Shanbhag, Swapna S Donthineni, Pragnya R Amescua, Guillermo Quinones, Victor L Perez Basu, Sayan |
author_sort | Kate, Anahita |
collection | PubMed |
description | Immunosuppression in aqueous-deficient dry eye disease (ADDE) is required not only to improve the symptoms and signs but also to prevent further progression of the disease and its sight-threatening sequelae. This immunomodulation can be achieved through topical and/or systemic medications, and the choice of one drug over the other is determined by the underlying systemic disease. These immunosuppressive agents require a minimum of 6–8 weeks to achieve their beneficial effect, and during this time, the patient is usually placed on topical corticosteroids. Antimetabolites such as methotrexate, azathioprine, and mycophenolate mofetil, along with calcineurin inhibitors, are commonly used as first-line medications. The latter have a pivotal role in immunomodulation since T cells contribute significantly to the pathogenesis of ocular surface inflammation in dry eye disease. Alkylating agents are largely limited to controlling acute exacerbations with pulse doses of cyclophosphamide. Biologic agents, such as rituximab, are particularly useful in patients with refractory disease. Each group of drugs has its own side-effect profiles and requires a stringent monitoring schedule that must be followed to prevent systemic morbidity. A customized combination of topical and systemic medications is usually required to achieve adequate control, and this review aims to help the clinician choose the most appropriate modality and monitoring regimen for a given case of ADDE. |
format | Online Article Text |
id | pubmed-10276741 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-102767412023-06-18 Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease Kate, Anahita Shanbhag, Swapna S Donthineni, Pragnya R Amescua, Guillermo Quinones, Victor L Perez Basu, Sayan Indian J Ophthalmol Review Article - Clinical Immunosuppression in aqueous-deficient dry eye disease (ADDE) is required not only to improve the symptoms and signs but also to prevent further progression of the disease and its sight-threatening sequelae. This immunomodulation can be achieved through topical and/or systemic medications, and the choice of one drug over the other is determined by the underlying systemic disease. These immunosuppressive agents require a minimum of 6–8 weeks to achieve their beneficial effect, and during this time, the patient is usually placed on topical corticosteroids. Antimetabolites such as methotrexate, azathioprine, and mycophenolate mofetil, along with calcineurin inhibitors, are commonly used as first-line medications. The latter have a pivotal role in immunomodulation since T cells contribute significantly to the pathogenesis of ocular surface inflammation in dry eye disease. Alkylating agents are largely limited to controlling acute exacerbations with pulse doses of cyclophosphamide. Biologic agents, such as rituximab, are particularly useful in patients with refractory disease. Each group of drugs has its own side-effect profiles and requires a stringent monitoring schedule that must be followed to prevent systemic morbidity. A customized combination of topical and systemic medications is usually required to achieve adequate control, and this review aims to help the clinician choose the most appropriate modality and monitoring regimen for a given case of ADDE. Wolters Kluwer - Medknow 2023-04 2023-04-05 /pmc/articles/PMC10276741/ /pubmed/37026249 http://dx.doi.org/10.4103/IJO.IJO_2818_22 Text en Copyright: © 2023 Indian Journal of Ophthalmology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Review Article - Clinical Kate, Anahita Shanbhag, Swapna S Donthineni, Pragnya R Amescua, Guillermo Quinones, Victor L Perez Basu, Sayan Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
title | Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
title_full | Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
title_fullStr | Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
title_full_unstemmed | Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
title_short | Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
title_sort | role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
topic | Review Article - Clinical |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10276741/ https://www.ncbi.nlm.nih.gov/pubmed/37026249 http://dx.doi.org/10.4103/IJO.IJO_2818_22 |
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