the four-month therapy with cyclosporine 1% eyedrops. Moreover, children who had more than a cycle of treatment with cyclosporine eyedrops showed a faster and long-lasting clinical improvement. Eosinophils were detectable by scrapings test in the conjunctival epithelium of all enrolled patients during the acute phase of the ocular disease, and they normalized by the end of the therapy (Tesse, et al., 2010). The group of children who entered the study and received topical cyclosporine at the time of the first symptoms and signs of VKC, showed faster and more significant improvement of their ocular condition, than those who already experienced for months clinical symptoms of the disease before starting therapy (Tesse, et al.
, 2010). The study confirms that in their population study cyclosporine 1% might represent a valid alternative to the use of steroids for treatment of severe VKC cases.Strengths and Limitations Strengths of this study were that they were that it was well designed and the population that they studied was very specific to minimize outliers. Limitations of this study are the possible long-term side-effects of cyclosporine use, parents or children may not have followed all the rules to the study. Tesse, et al., (2010) suggested that a longer follow-up study is required to assess if long-term local therapy with cyclosporine may improve the prognosis of the disease or whether it would cause visual acuity damages. Recall bias may have occurred when the parents filled out the questionnaires. Bias in the population that was studied was also possible as the researches only choose to study Caucasians.
Epidemic Kerato-Conjunctivitis The objective of the study was to compare the efficacy and safety of topical immune-modulatory drug cyclosporine 0.05% versus topical corticosteroids (flouromethalone) eye drops in the management of epidemic keratoconjunctivitis (Wali, Jadoon, Khan, 2016). The purpose of this study was to determine the efficacy and safety of topical cyclosporine (0.05%) eye drops in comparison with topical steroids in the management of EKC (Wali, Jadoon, Khan, 2016).
Study Design A randomized prospective clinical trial was conducted in the ophthalmology department of the Government Naseerullah Babar Memorial Hospital, Peshawar, Pakistan from July 2015 till September 2015 (Wali, Jadoon, Khan, 2016). The target population was 100 patients (42% male and 58% female) with ages ranging from 4 to 40 years old who presented with severe epidemic keratoconjunctivitis. They were divided equally into two groups. In group “A” the patients were treated with fluorometholone eye drops, artificial tears, and hot compresses. In group “B” patients were treated with topical cyclosporine 0.05% eye drops, artificial tears, and warm compresses.
According to Wali, Jadoon, Khan, (2016), all patients were advised to wash their hands frequently especially after touching the eyes. They were informed about the contagious nature of the disease and told to use separate towels, tissues, and other communal objects. They were advised to discontinue wearing of contact lenses if using. Improvement in symptoms and signs was recorded after one week and three weeks post-treatment. Clinical signs and symptoms were recorded at the beginning of the treatment and at follow up visits at one week and three weeks after treatment. The data was entered and analyzed in SPSS version 16.
A Chi-square Test was used to generate the p-value and a p-value of < 0.05 was considered highly significant (Wali, Jadoon, Khan, 2016). Group “A’s” p-value was 0.027 and group “B’s” p-value was highly significant. Therefore, they can accept the null hypothesis.
Results and Conclusion The duration of therapy was three weeks. There was marked subjective as well as objective improvement in all cases. However, patients on topical cyclosporine were comparatively, (Group B) more comfortable and showed a more rapid visual recovery as compared to patients on topical steroid therapy (Group A). No toxic effects of cyclosporine (0.05%) eye drops were observed. Follow up was conducted for longer in patients with residual sub-epithelial infiltrates (SEI) not resolved at three weeks and they were advised to continue the medication in tapering doses. The use of topical cyclosporine (0.
05%) eye drops in patients with moderate to severe EKC is recommended as an effective and safe alternative to topical steroids (Wali, Jadoon, Khan, 2016).Strengths and Limitations Strengths of the study are how they split the sample population into two even groups and were successfully able to determine which medication had the greater effect. Limitations of the study are that the sample population was very diverse which could have skewed the results (age ranged from four to forty years old). The patients were advised to always wash their hands and not to touch their eyes, but that would be very difficult for children to do. The children could have been spreading the virus back in forth between the eyes or prolonging the healing. I did not notice any forms of bias in this study.
Discussion Both studies were slightly different but resulted in the same conclusion that cyclosporin for the treatment of conjunctivitis is effective. The conclusion of the first study was not generalizable to the overall population of Italy. The study focused on Caucasian children and therefore the results would not fit into the rest of the Italian population. The second study was generalizable to the overall population in Pakistan because the study looked at both genders and a large age range.
I believe the second study is the most superior methodology because of the diversity of the patients that were sampled. The study also specifically measured the difference in treatment effectiveness between two different medications through clinical trials. Being able to compare two medications and show a significant difference in recovery of a patient would make me to believe that study more than a study that looks at one medication over a long period of time. If I were tasked to design an ideal study to examine this hypothesis I would perform a randomized controlled study. The population would be both genders aged eighteen years old and up. I would have two groups, a treatment group, and a control group. The treatment group would receive the cyclosporin and the control group would receive artificial tears.
According to Wali, Jadoon, Khan, (2016), epidemic keratoconjunctivitis is a self-limiting disease with a natural course thus treatment is mostly supportive and for symptomatic relief. I would like to see in my study whether the cyclosporin would speed up the recovery of EKC or if it would take the same amount of time without medication.