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Rodríguez-Ausín, D. Antolín-Garcia, M. Ruano del Salado, C. Hita-Antón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Rodríguez-Ausín" "email" => array:1 [ 0 => "pazrausin@telefonica.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "Antolín-Garcia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Ruano del Salado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Hita-Antón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tacrolimus tópico al 0,03% en el tratamiento de la psoriasis ocular" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 758 "Ancho" => 900 "Tamanyo" => 79073 ] ] "descripcion" => array:1 [ "en" => "Chronic corneal involvement with a nasal pseudo-pterygium over stromal thinning and leukomae." ] ] ] "textoCompleto" => "IntroductionPsoriasis is a relatively frequent inflammatory skin disease, affecting up to 2% of the population and diminishing quality of life in 80% de patients.<a class="elsevierStyleCrossRef" href="#bib0035">1</a> Ocular psoriasis rates are not precisely determined but range between 10 and 67% according to different authors.<a class="elsevierStyleCrossRef" href="#bib0040">2</a> A series of 4 patients with ocular psoriasis is presented, who experienced quality of life improvement after beginning treatment with 0.03% topical tacrolimus.Clinic case reportsPatientsFour patients, 2 males and 2 females, with a mean age of 72±2.82 years, with psoriasis since youth and experiencing pruritus and chronic ocular discomfort. All four exhibited mixed blepharitis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and inferior keratitis punctata, while 3 had circumferential pseudopterygium (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and corneal opacities. In one of the patients (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), the right eye (RE) exhibited severe thinning and topographic signs of secondary ectasia. Palpebral hygiene measures for blepharitis and oral doxycycline were insufficient, with a patient experiencing relapse after suspending said treatment. Topical 0.5% cyclosporine in oily carrier (middle chain triglycerids) was applied although intolerance arose in all cases. After obtaining the authorization of the pharmacy committee of the hospital and requesting the patient to sign an informed consent, off label utilization of 0.03% topical tacrolimus was prescribed in a preparation with vaseline, supplied by the hospital pharmacy. The prescription established 2 daily applications for the first 15 days, followed by an indefinite single nocturnal maintenance application. Subjective improvement appeared in 2 weeks, and after one month pruritus and keratitis diminished, while lacrimal film stabilized. In one case, keratitis disappeared at month 3. Gradual reduction of applications up to one weekly application at 6 months follow-up was considered. Follow-up ranged between 3 months and 3 years, without adverse effects. All patients referred substantial changes in their quality of life and none required systemic treatment for psoriasis.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionPsoriasis is a chronic disease, the elementary lesion of which is a scale-covered erithematous papula with highly variable clinic and evolution. Ocular symptoms as frequently underestimated in psoriasis patients, with doctors or patients failing to appreciate the possible connection with the base disease. Extracutaneous expressions are infrequent although, due to the epithelial nature of psoriasis, ocular involvement must be considered in addition to the possible existence of psoriasis plaque on the skin of the eyelids.<a class="elsevierStyleCrossRef" href="#bib0035">1</a>In a review on ocular psoriasis, Rehal et al.<a class="elsevierStyleCrossRef" href="#bib0040">2</a> described mixed blepharitis as the most prevalent ocular finding, with burning and itching as the most frequent symptoms. Psoriasis tends to respect the face and therefore the appearance of facial lesions is considered a severity marker. Psoriasis plaque rarely appears on the eyelids and is treated on the basis of corticoids and equivalent medications such as tacrolimus. Nonspecific chronic conjunctivitis and/or yellow-reddish plaque can appear on the palpebral conjunctiva and in addition 18% of patients suffer dry eye due to lacrimal gland involvement as in other selfimmune systemic diseases.<a class="elsevierStyleCrossRef" href="#bib0040">2</a> Corneal disease is very rare, normally secondary to dry eye and trichiasis. The most common finding is keratitis punctata, although the clinic range comprises opacities, sterile infiltrates, neovascularization, cicatrization and severe peripheral ulcerative keratitis.<a class="elsevierStyleCrossRef" href="#bib0045">3</a>Additional ocular involvement of psoriasis includes anterior uveitis and Birdshot chorioretinopathy. The side effects of psoriasis treatments cannot be dismissed, such as isotretinoin and methotrexate, with possible involvement of the ocular posterior pole by the former (neuropathy, maculopathy) and keratitis and dry eye by the latter. Doxycycline should not be utilized simultaneously with isotretinoin as it increases its neurological toxicity.The 4 patients of the series have chronic blepharitis, 3 with a significant corneal involvement that indicates chronicity such as circumferential pseudopterygium. The main symptom is ocular and palpebral pruritus, which improves slightly with palpebral hygiene, heat and massage and more with oral doxycycline and corticoids. Relapse upon suspension of this treatment indicates an efficient anti-inflammatory therapy with less side effects than corticoids.Tacrolimus, Protopic® (Astellas Pharma, Pozuelo de Alarcón, Madrid, Spain), is a calcineurin inhibitor generally used at 0.03% for atopic dermatitis. The presence of excipients (propylene carbonate) in the skin cream gives rise to doubts about ocular surface toxicity although literature references report goods tolerance in anterior segment diseases refractory to corticoid treatment.<a class="elsevierStyleCrossRefs" href="#bib0050">4–6</a> To date, local or systemic side effects attributable to the use of tacrolimus on the ocular surface have not published. By way of conclusion, 0.03% topical tacrolimus could be an efficient and well tolerated therapeutic option for ocular psoriasis when it has a negative repercussion on the quality of life of patients.Conflict of interestsNo conflict of interests was declared by the authors." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres733573" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective/methods" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Results/conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec737397" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres733572" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Objetivo/método" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Resultados/conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec737398" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Clinic case reports" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-07" "fechaAceptado" => "2016-03-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec737397" "palabras" => array:5 [ 0 => "Tacrolimus" 1 => "Ocular psoriasis" 2 => "Psoriasis" 3 => "Blepharitis" 4 => "Pseudopterygium" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec737398" "palabras" => array:5 [ 0 => "Tacrolimus" 1 => "Psoriasis ocular" 2 => "Psoriasis" 3 => "Blefaritis" 4 => "Seudopterigión" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Objective/methodsCases are presented of 4 patients suffering from severe symptoms due to ocular psoriasis and who were treated with off-label 0.03% tacrolimus once a day. Results/conclusionsAll four patients had a mixed blepharitis and keratitis. Pseudopterygium and corneal opacities were present in three of them. All of them experienced an improvement of their itching and ocular surface. They all referred to a marked improvement of their quality of life in a follow-up period ranging from six months to two years. Therefore, topical tacrolimus could be considered an option in the treatment of ocular psoriasis." "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective/methods" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Results/conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Objetivo/métodoPresentamos una serie de 4 pacientes afectos de psoriasis ocular con sintomatología severa, a los que se indicó tratamiento off label con tacrolimus tópico al 0,03% una vez al día. Resultados/conclusiónLa blefaritis mixta y queratitis es común a los 4, y en 3 casos hay seudopterigión y opacidades corneales. Se apreció mejoría subjetiva del prurito en 2 semanas, y al mes mejoría de la superficie. Todos manifiestan mejoría significativa de su calidad de vida tras un rango de seguimiento de 6 meses a 2 años. El tacrolimus tópico puede ser considerado una opción en el tratamiento de la psoriasis ocular." "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Objetivo/método" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Resultados/conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Rodríguez-Ausín P, Antolín-Garcia D, Ruano del Salado M, Hita-Antón C. Tacrolimus tópico al 0,03% en el tratamiento de la psoriasis ocular. Arch Soc Esp Oftalmol. 2016;91:505–507." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 672 "Ancho" => 900 "Tamanyo" => 83967 ] ] "descripcion" => array:1 [ "en" => "Mixed blepharitis, the most frequent finding in psoriasis." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 716 "Ancho" => 851 "Tamanyo" => 59905 ] ] "descripcion" => array:1 [ "en" => "Circumferential pseudo-pterygium with small vessels and whitish line parallel to the limbus." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 758 "Ancho" => 900 "Tamanyo" => 79073 ] ] "descripcion" => array:1 [ "en" => "Chronic corneal involvement with a nasal pseudo-pterygium over stromal thinning and leukomae." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.B. 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ISSN: 2173-5794
e-ISSN: 1989-7286

Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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