Topical Rebamipide Treatment for Superior Limbic Keratoconjunctivitis in Patients with Thyroid Eye Disease – Accepted Manuscript

Abstract: Purpose: To evaluate efficacy of topical rebamipide for superior limbic keratoconjunctivitis (SLK) in patients with thyroid eye disease (TED).Design: A retrospective, observational case series.Methods: Thirty-three eyes from 20 TED patients with SLK who received topical rebamipide [Mucosta® ophthalmic suspension unit dose 2%; chemical name, (2RS)-2-(4-chlorobenzoylamino)-3-(2-oxo-1, 2-dihydroquinolin-4-yl) propanoic acid] were included. The following items were evaluated before and 4 weeks after the start of treatments: presence or absence of SLK, rose bengal staining score, AD classification (A, area; D, density) of fluorescein staining, Schirmer’s test I (without topical anesthesia), tear break-up time (TBUT), Hertel exophthalmometry values, and margin reflex distances-1 and -2.Results: Twenty-eight eyes showed complete disappearance of SLK after treatment (84.8%; P < 0.001). The other 5 eyes (15.2%) demonstrated significant improvement but had residual punctate rose bengal staining and fluorescein staining, near the superior corneal limbus. All 5 eyes exhibited at least one of the following findings: proptosis > 17.7 mm and upper and/or lower eyelid retractions. Incidence of upper eyelid retraction was significantly higher in eyes with SLK than in those without SLK at the 4 week follow-up (P = 0.021). The severity of rose bengal staining, and fluorescein staining improved significantly after treatment (P < 0.001). Although the Schirmer’s test results remained constant before and after the treatment (P = 0.212), TBUT increased significantly in the post-therapeutic state (P = 0.009). No serious adverse events were reported.Conclusions: Topical rebamipide improved SLK in patients with TED, suggesting a first-line treatment in such patients.