|Year : 1980 | Volume
| Issue : 4 | Page : 179-181
Disodium cromoglycate in vernal catarrh
SL Bansal, SP Dhir, IS Jain
Department of Ophthalmology, Postgraduate Institute of Medical, Education & Research, Chandigarh, India
S L Bansal
Deptt. of Ophthalmology, Postgraduate Institute of Medical, Education & Research, Chandigarh
|How to cite this article:|
Bansal S L, Dhir S P, Jain I S. Disodium cromoglycate in vernal catarrh. Indian J Ophthalmol 1980;28:179-81
Vernal catarrh is an allergic disorder affecting conjunctiva and cornea. The therapy of this disease has been a perplexing problem. To date, only topical corticosteroids have been effective for the palliative treatment but the inherent dangers of prolonged treatment with steroids are widely known Other measures employed in the past do not bring about a significant improvement. In such a situation, search for an alternative drug becomes imperative.
Disodium cromoglycate (DSCG) is a relatively new drug in the management of allergic diseases due to exogenous allergens. In the literature, there have been reports both for and against this therapy in vernal keratoconjunctivitis We are discussing the results of a double blind trial of DSCG ointment in vernal catarrh.
| Materials and methods|| |
Identical coded tubes containing placebo ointment and ointment with 4% DSCG were used. Patients of vernal catarrh attending the Ophthalmic Outpatient Department of the Institute were selected for the study. Initial diagnosis was agreed upon by two ophthalmologists independently. If the patients were already on topical steroid therapy, it was stopped. All patients were given coded ointment for use three times a day for one week and were examined. Thereafter subjective and objective improvement was recorded as found. The criteria for subjective improvement were reduction in itching, photophobia and watering. The objective improvement was gauged by reduction of congestion and size of papillae. The results at the end of the study were divided into three groups : group I with improvement, group 11 with no change and group III with worsening. The code was opened and results analysed. The composition of the ointment was as under:
DSCG : 4.0%
Liquid paraffin . 9.6%
Yellow soft paraffin : 86.4%
Yellow soft paraffin : 72%
Liquid paraffin . 9%
Wool fat : 10%
| Observations|| |
The results were available for 145 patients. The age of patients ranged from 3-35 years. No consideration was given to the patients' sex. The site of involvement was Limbal - 27 cases (18.6%), Palpebral - 42 cases (28.9%) and Combined - 76 cases (52.5%).
The corneal involvement was seen in six instances. Three cases had immune rings, two bad Tranta's spots and one had keratoconus. Fifty six patients were already on steroid therapy - out of these two had steroid-induced glaucoma and one was with associated cataract.
Systemic involvement in the form of bronchial asthma was found in three cases.
On opening the code, it was found that seventy six patients had received treatment with active tubes and sixty nine with placebo tubes.
In the active group, 49 patients (64.5%) were found to have subjective and objective improvement whereas in the placebo group 43 patients (62.3%) were benefitted. There was almost same frequency of ineffectiveness and worsening in active as well as placebo groups.
| Discussion|| |
Disodium cromoglycate is a compound derived from Khellin the active principle of a plant found in the middle east. It has been found to be effective in preventing attacks of bronchial asthma and in certain cases of chronic proctitis. It is supposed to interfere with calcium transport across the mast cells which therefore cannot rupture. The drug has a low order of toxicity.
There have been only a few investigations on the utility of this drug in vernal keratoconjunctivitis. Good results have been reported by Easty et a1 and Tabbara and Arafat. Another study by Hyams et a1 found no significant beneficial effect of the drug on vernal catarrh in Israel. It was proposed by the latter group of workers that DSCG is probably useful only in the limbal form of the disease especially when it was associated with some systemic allergic disorder.
In our previous communication, we had found the drug as having a limited role in the management of vernal catarrh. But on completion of the study it was found that there is practically no difference in the groups treated with active and placebo tubes. It is relevant to mention here that we had two patients who had moderate to marked improvement with tubes numbered 10 & 23. The code showed that both these were placebo tubes.
Whereas all previous trials have been done with 2% DSCG drops, we undertook a study with 4% DSCG ointment and still did not get good results. Therefore, we conclude that DSCG has a doubtful role in the treatment of vernal catarrh.
| Acknowledgement|| |
We are thankful to M/s Fisons Ltd., Pharmaceutical Division, Loughborough, England for supplying the coded tubes of active and placebo ointment.
| Summary|| |
A double blind trial was undertaken with 4% disodium cromoglycate ointment on weekly follow up basis for the treatment of vernal catarrh. Almost same number of patients (64.5%) benefitted with DSCG treatment as with placebo (62.3%). It is concluded that the drug has doubtful role in vernal catarrh.
| References|| |
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|2.||Duke Elder, 1965, System of Ophthalmology Vol. VIII Part I P. 475. Henry Kimpton, London. |
|3.||Williams, M.H. and Kane, C., 1969, JAMA, 209: 1881. |
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