Verkazia will offer treatment option for vernal keratoconjunctivitis
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In June 2021, Verkazia was approved for the treatment of vernal keratoconjunctivitis in children and adults.
OSN Pediatrics/Strabismus Board Members discussed the potential of Verkazia (cyclosporine ophthalmic emulsion 0.1%, Santen) and other treatments for vernal keratoconjunctivitis.
Robert S. Gold, MD: How common is vernal keratoconjunctivitis (VKC)? What are your thoughts on Verkazia as a treatment and other alternative treatments?
Erin D. Stahl, MD: I think Verkazia is great. It is an increased dose of cyclosporine over something like Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan). It has an anti-inflammatory effect and is steroid sparing. For our pediatric patients, especially those who need chronic steroids for VKC and the ones who have a steroid-induced pressure response, I think this is a great alternative.
This is useful especially for children who require higher doses of steroid who are at risk of developing cataracts over time and for children who are on and off steroids and develop corneal scarring that can be vision threatening. It is worth the treatment. I think that VKC is a significant quality of life-impacting disease. I often treat to symptoms, so even though the eye looks terrible, in our region, we typically have limbal VKC, so it is not necessarily a vision-threatening form of the condition. But patients can be uncomfortable.
With our traditional treatments, I am treating to, “Can you manage? Are you doing OK?” They can still look pretty bad, and I would love these children not to have the chronic flares and symptoms throughout the year that we tolerate now because we do not have good enough medications.
Gold: The other thing that we always have to talk about is cost.
Stahl: We do not know the cost because it is not yet commercially available.
Gold: As an alternative, what are you using? Have you been using steroids?
Stahl: Yes, and then I go off label in compounded medicine. I use Protopic ointment (tacrolimus, Astellas) for the dermatologic preparation and have patients put it in the cul-de-sac of their eyes. We can compound both tacrolimus and cyclosporine.
Gold: Do you use Restasis?
Stahl: Not usually. I do not think it is enough to compound to a higher strength. I have never done supratarsal injections. The type of VKC that we see in our area tends to be more limbal based, and usually I am looking for a steroid-sparing agent when I am at that point. I am looking forward to having something else in the toolbox, and I think cost may be our limiting factor.
I am also excited to use it in all sorts of other conditions. I think it could be useful for the plethora of anterior segment inflammatory conditions. I have some patients with blepharokeratoconjunctivitis who do not respond to anything else, and that is certainly going to be on my list of things that I would like to try. We often have these children on long-term oral antibiotics, which sometimes works and sometimes does not. I would love a topical alternative to that.
I am curious about a lot of other conditions, and I am hoping next year we can talk about where it works and where it does not.
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