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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...

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Autores principales: Kate, Anahita, Shanbhag, Swapna S, Donthineni, Pragnya R, Amescua, Guillermo, Quinones, Victor L Perez, Basu, Sayan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2023
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.
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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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