Effectiveness of steroids versus immunomodulators intreatment of vernal kerato-conjunctivitis. a study at armed forces institute of ophthalmology

Objective: To evaluate whether steroids or immunomodulator is a better mode of treatment in long term management of vernal keratoconjunctivitis.Study Design: A quasi experimental study. Place and Duration of Study: Armed Forces institute of Ophthalmology, Rawalpindi, from Feb 2019 to Oct 2019. Methodology: Ninety-two patients in between ages of 5-20 years were divided into two equal groups of 46 patients each. After instillation of 0.1% Fluoromethalone (steroid) into both eyes of patients of vernal keratoconjunctivitis, in group A and outcomes were compared with those of 0.05% Cyclosporine (immunomodulator) administered in the same manner in group B. All the patients were followed up regularly after 1, 3, and 6 weeks, 3 months, and 6 months and data recorded for inference. Results: Both the drugs were found to effectively reduce the foreign body sensation but had no or minimal effect on visual acuity and intraocular pressure (p-vale<0.001). Few patients in steroid group showed noticeable rise of intraocular pressure. (p=0.02). Cyclosporine was found to markedly reduce the mucoid discharge and photophobia without any adverse side effects (p-value=0.02). Conclusion: Cyclosporine appears to be more effective in control of mucous discharge and inflammation than steroids in vernal keratoconjunctivitis with minimal or no side effects and hence was found to be a safe alternative to steroid usage in long-term treatment groups.