LASIK flap interface deposition in limbal vernal keratoconjunctivitis

Limbal vernal keratoconjunctivitis (VKC) is an uncommon chronic allergic eye disease. It is generally seen in young males and is characterised by limbal papillae and superficial keratitis. While the condition usually resolves with age, treatment is necessary to alleviate symptoms and reduce the risk of permanent corneal damage. A 25‐year‐old male presents with recurrent red, itchy eyes. He had undergone an uncomplicated bilateral LASIK procedure five years previously. Slitlamp examination shows limbal chemosis, superficial keratitis and an unusual yellow‐white deposition that tracks along the superior LASIK flap interface. A diagnosis is made of limbal VKC with an altered corneal response associated with previous LASIK. Treatment with intensive topical steroids led to resolution of his limbal and corneal inflammation, leaving the deposition unchanged.     

对春季卡他性角结膜炎联合用药的治疗观察

目的：探讨组胺H1受体拮抗剂联合治疗春季卡他性角结膜炎的疗效.方法：口服仙特敏片,外滴10g/L苯海拉明眼液治疗患者30例,其中睑结膜型16例,混合型7例,角膜缘型6例,角膜溃疡1例.结果：2个疗程痊愈者18例,占60%,3～4个疗程者6例,占20%,4个疗程以上者4例,占13%.总治愈率93%.结论：联合用药治疗春季卡他性角结膜炎疗效较好,作用迅速,易接受.     

儿童春季卡他性角结膜炎与干眼症相关性分析

目的:探讨春季卡他性角结膜炎患儿的泪膜功能,并分析其与儿童干眼症发生的相关性。方法:取临床诊断为春季卡他性角结膜炎的86例患儿作为观察组,取年龄与之匹配的正常儿童86例作为对照组,分别做基础泪液分泌试验(schirmer Itest)、泪膜破裂时间(BUT)、角膜荧光素(FL)染色检查。结果:儿童春季卡他性角结膜炎常合并干眼症的相关症状:瞬目次数增加(33%),干涩感(14%),烧灼感(10%)。观察组泪膜功能相关检查:双眼泪液分泌试验均低于对照组(P=0.01),双眼泪膜破裂时间短于对照组(P<0.01),双眼角膜荧光素染色评分高于对照组(P<0.01)。泪膜功能改变与疾病严重程度有关,与病程、亚型分类无关。结论:春季卡他性角结膜炎患儿泪膜功能发生改变,是干眼症的易患人群。     

他克莫司治疗春季卡他性角结膜炎的疗效分析

目的：评价免疫抑制剂——他克莫司滴眼液治疗春季卡他性角结膜炎(vernal keratoconjunctivitis,VKC)的治疗效果。

方法：随机双盲试验,安慰剂对照。收集四川大学华西医院眼科16例门诊患者,将16例患者按就诊顺序随机分为治疗组与对照组。治疗组使用他克莫司滴眼液,对照组使用他克莫司滴眼液基础液,观察期为28d。对研究眼眼部体征和自觉症状分别进行单项评分,以治疗前后眼部体征总分变化量为主要疗效指标,主观症状为次要疗效指标。

结果：(1)组内比较：两组症状和体征在用药前后的差异具有统计学意义,治疗组用药后各个时期的自觉症状评分均低于用药前,且随着时间推移,症状评分逐渐降低,差异有统计学意义,对照组用药后不同时期之间的差异无统计学意义。(2)组间比较：两组患者的主观症状和体征在用药前和用药后第一次复查时差异无统计学意义,之后两次复查差异均具有统计学意义。评分变化量(用药前评分-用药后评分)在用药后第一次复查时差异无统计学意义,之后两次复查差异均具有统计学意义。

结论：他克莫司滴眼液能改善VKC患者的体征与症状,对于使用抗过敏滴眼液无明显改善的VKC,具有迅速、优良的改善效果,可应用于临床。     

Occurrence of vernal keratoconjunctivitis in children infected with human immunodeficiency virus

Purpose:To study the occurrence of vernal keratoconjunctivitis (VKC) as an ocular manifestation of human immunodeficiency virus (HIV) in pediatric patients.Methods:A retrospective study was done on the observations of cases of HIV-positive children. All seropositive patients from the Anti-Retroviral Therapy clinic were referred to the department of ophthalmology for evaluation. Retrospective correlation of CD4 count with active cases of VKC was done. All patients underwent a comprehensive ophthalmic evaluation including visual acuity, slit lamp and dilated fundus examination.Results:A total of 72 children were included, 70 males and 2 females. Of these, 63 (87.5%) had VKC, three (4.2%) had cataract, two (2.8%) had cytomegalovirus retinitis retinitis, and four (5.5%) had no ophthalmic findings.Conclusion:There is a an evident association of HIV, VKC cases, and reduced CD4 count. More research is required on this topic.     

核因子-κB在春季角结膜炎的表达

目的 研究核转录因子(nuclear factor kappa B,NF-κB)在春季角结膜炎(vernal keratoconjunctivitis,VKC)中的表达,探讨VKC的发病机制.方法 设实验组和对照组实验组为VKC结膜组,共6例,对照组为正常结膜组,共4例.取VKC眼术中切下增生的结膜组织及角巩膜缘处病变的球结膜组织,和角膜移植术中健康供体眼近角巩膜缘处的正常球结膜组织,运用免疫组织化学及免疫印迹法分别检测VKC患者病变结膜组织和正常结膜组织中NF-κB的表达情况.结果 在正常结膜组织中仅少量NF-κB表达,而VKC病变结膜组织中NF-κB的表达明显增高,后者的表达量约为前者的1.5倍,差异具有统计学意义(P＜0.05).结论 NF-κB可能参与VKC的发病机制.     

Topical 2% cyclosporine A in preservative-free artificial tears for the treatment of vernal keratoconjunctivitis

BACKGROUND: A double-masked, placebo-controlled trial to evaluate the short-term efficacy and safety of topical 2% cyclosporine A in preservative-free artificial tears for patients with vernal keratoconjunctivitis. METHODS: Twenty patients with severe vernal keratoconjunctivitis were included in the study. All were treated with topical 2% cyclosporine A eye drops. One eye of each patient was administered 2% cyclosporine A in preservative-free artificial tears; the fellow eye received the placebo (vehicle) for the first 2 weeks, in a double-masked, placebo-controlled trial. Thereafter, the placebo eye received cyclosporine A (open trial). Symptoms and signs were scored on the day of enrollment and at the end of week 2, 4, and 14. RESULTS: At the end of week 2, no statistically significant decrease was noted from baseline in mean scores of either signs (p = 0.18) or symptoms (p = 0.50) in the eyes that received placebo. On the other hand, a statistically significant decrease was observed in both sign and symptom scores (p < 0.001, for both) of eyes that received cyclosporine A. Significant differences were also noted at 2 weeks in mean scores of both signs and symptoms (p < 0.001, for both) between the eyes that received cyclosporine A and those that received placebo. At week 4 and 14, statistically significant decreases in both sign scores and symptom scores were noted compared with baseline in the eyes that received cyclosporine A and in the eyes that had initially received placebo (p < 0.001, for all). INTERPRETATION: Topical 2% cyclosporine A in preservative-free artificial tears is effective in alleviating signs and symptoms of patients with severe vernal keratoconjunctivitis and had no observed side effects over the course of the study.     

春季角结膜炎发生圆锥角膜的机制研究进展

春季角结膜炎是一种好发于儿童及青少年,以反复发作的慢性炎症为主要表现的过敏性眼表疾病,容易出现角膜并发症如圆锥角膜。圆锥角膜是一种以角膜局部圆锥样突起为主要特征的角膜病变。既往研究分别提出了春季角结膜炎及圆锥角膜的发病机制及前者进展为后者的危险因素,但具体机制尚不明确。回顾文献发现二者有共同的发生机制及类似的细胞因子表达,包括Ⅰ型及Ⅳ型超敏反应、炎症反应、酶学变化、氧化应激、机械性损伤等方面。文章旨在概述春季角结膜炎发生圆锥角膜的机制及可能涉及的细胞因子,以期为春季角结膜炎发生圆锥角膜的预防和临床诊疗策略提供参考。     

Efficacy of topical cyclosporin A 0.05% in conjunctival impression cytology specimens and clinical findings of severe vernal keratoconjunctivitis in children

Purpose  To evaluate the efficacy of topical cyclosporin A 0.05% in managing the symptoms of severe vernal keratoconjunctivitis (VKC). Methods  Fifty-four children with severe VKC were included in this study. All 54 patients were treated with topical cyclosporin A (CsA) 0.05% for 3 months. Ocular signs and symptoms were scored in all patients at entry and after 3 months. Conjunctival impression cytology specimens were examined on the day of enrollment and at the end of the treatment period. Results  The mean scores for severity of signs and symptoms significantly decreased after 3 months compared with those at entry (P < 0.001). The density of inflammatory cells in the conjunctival impression cytology specimens decreased significantly. No side effects of the treatment with CsA 0.05% eyedrops were observed. Conclusions  Topical CsA 0.05% eyedrops were found to be safe and effective in the treatment of patients with VKC. Consistent with these results, topical CsA may efficiently reduce conjunctival inflammation in severe VKC.     

睑板下注射曲安奈德改善活动期春季角结膜炎患者眼表症状的临床研究

目的 对比观察春季角结膜炎活动期患者睑板下注射曲安奈德后的眼表症状、泪膜及泪液蛋白的特点.方法 收集2010年8月至2014年6月眼科门诊确诊为春季角结膜炎活动期患者20例(24眼),随机分为A、B两组(各12眼),A组行睑板下注射曲安奈德(每次20 mg,共注射1次),B组行妥布霉素地塞米松眼液滴眼,每天3次,连续1个月.分别对两组患者治疗前与治疗后2周、1个月眼表症状评分、泪膜四项检查及泪液各蛋白测定结果并进行对比.结果 两组患者治疗前眼表症状评分、泪膜四项(泪膜破裂时间、基础泪液分泌试验、泪河高度降低及角膜荧光素染色)、泪液蛋白、乳铁蛋白、溶菌酶比较,差异均无统计学意义(均为P＞0.05);治疗14 d后,A组患者干眼症状眼数增多,眼表指数增高、泪膜破裂时间减短、基础泪液分泌试验增高、泪河高度降低、角膜荧光素染色增强,总蛋白、乳铁蛋白、溶菌酶较B组均明显降低,且差异均有统计学意义(均为P＜0.05).治疗1个月后,A组患者眼表指数、泪膜破裂时间、基础泪液分泌、泪河高度均减少,角膜荧光素染色增强,而B组患者眼表指数、泪膜破裂时间、基础泪液分泌、泪河高度及角膜荧光素染色均降低,差异均有统计学意义(均为P ＜0.05),并且A组较B组眼表指数减少,泪膜破裂时间、基础泪液分泌、泪河高度、角膜荧光素染色均明显增加(P＜0.05).结论 曲安奈德睑板下注射治疗能提高春季角结膜炎活动期患者泪膜稳定性,升高泪液蛋白含量.     

盐酸西替利嗪联合普拉洛芬治疗儿童春季角结膜炎的疗效及依从性

目的：观察盐酸西替利嗪滴剂联合普拉洛芬滴眼液治疗儿童春季角结膜炎的疗效及依从性。
　　方法：收集2014-01/2015-12到我院眼科门诊就诊,诊断为双眼春季角结膜炎的63例儿童患者,按照随机数字表法将患儿分为试验组和对照组,试验组给予盐酸西替利嗪滴剂联合1g/L普拉洛芬滴眼液进行治疗,盐酸西替利嗪滴剂2次/d,每次5滴(0.25mL,2.5mg,≤6岁)或每次10滴(0.5mL,5mg,>6岁),直接口服或加入饮料食物中服用;1 g/L普拉洛芬滴眼液4次/d ,1滴/次,点眼;对照组仅给予盐酸西替利嗪滴剂进行治疗,2次/d,每次5滴(0.25mL,2.5mg,≤6岁)或每次10滴(0.5mL,5mg,>6岁),直接口服或加入饮料食物中服用。疗程共14 d。记录患儿用药前后的症状和体征、用药依从性和药物不良反应情况,并对用药前后的症状及体征进行评分并比较。
　　结果：两组患儿治疗后的症状、体征及总体评分均有明显改善,差异有统计学意义( t试验组症状=10.41, P<0.05;t试验组体征=10.05,P<0.05;t试验组总体=10.75,P<0.05;t对照组症状=8.11,P<0.05;t对照组体征=8.89,P<0.05;t对照组总体=8.41,P<0.05);试验组治疗后症状、体征和总体评分低于对照组,差异有统计学意义(t症状=5.27,P<0.05;t体征=3.97,P<0.05;t总体=4.32,P<0.05);试验组有效率(85%)显著高于对照组有效率(60%),差异有统计学意义(χ2=4.92,P<0.05);94%的患儿依从性良好;未见患儿出现困倦及口干等不良反应。
　　结论：盐酸西替利嗪滴剂联合普拉洛芬滴眼液对于治疗儿童春季角结膜炎具有显著疗效及良好的依从性,明显提高治疗的有效率,且无明显不良反应,安全性高。     

Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India

Purpose:

To study the demographic and clinical profile of patients with vernal keratoconjunctivitis (VKC) at a tertiary eye care center in India.

Materials and Methods:

Retrospective chart analysis of 468 patients of VKC seen from January 2006 to December 2006.

Results:

Mean age at presentation was 12 years. Majority of the patients had mixed pattern disease (72%). Chronic perennial disease was seen in 36% patients. Personal or family history of allergies was noted in 5% patients. Severe disease based on clinical grading was present in 37% patients. Moderate to severe vision loss was seen in 12% of total population. Persistent disease beyond 20 years of age was found in 12% patients. VKC-related complications such as corneal scarring (11%), shield ulcer (3%), keratoconus (6%), and limbal stem cell deficiency (1.2%) were seen. Treatment-related complications like corticosteroid-induced cataract and glaucoma were seen in 6% and 4% of patients, respectively.

Conclusion:

Clinical pattern of VKC seen in the tropical climate of India is essentially similar to that seen in other tropical countries. Few distinct features that we noted represent chronic perennial disease, low association with atopy, and higher propensity for disease and treatment-related complications.     

结膜乳头磨削术治疗重度春季角结膜炎的临床研究

目的:观察并评估结膜乳头磨削术治疗重度春季角结膜炎巨大结膜乳头的安全性和有效性。方法:前瞻性、对照性临床病例研究。比较结膜乳头磨削术(8例12眼)与结膜乳头切除术(9例12眼)两种方法治疗巨大结膜乳头,手术前后的眼痒、流泪、畏光、异物感等症状和结膜乳头、角膜上皮等体征的变化情况。结果:两组病例术后1,2,4wk不适症状、体征明显改善,与术前相比统计学差异有显著性意义(P<0.01)。但术后1,2,4wk巨大结膜乳头体征、术后2wk角膜损伤修复情况等评分,磨削治疗组治疗效果优于手术切除组(P<0.05)。结论:结膜乳头磨削术能使粗糙的结膜创面快速变平,减轻不适症状,促进角结膜上皮修复,是治疗重度春季角结膜炎巨大结膜乳头的简单、安全、有效的治疗方式。     

Efficacy of nedocromil 2% versus fluorometholone 0.1%: a randomised, double masked trial comparing the effects on severe vernal keratoconjunctivitis

AIMS: To compare the efficacy of topical nedocromil 2% with fluorometholone 0.1% in vernal keratoconjunctivitis (VKC). METHODS: In a double masked random design, 24 patients with severe vernal keratoconjunctivitis were placed at random on nedocromil 2% eye drops in one eye and fluorometholone 0.1% in the fellow eye. At the end of the 2 week treatment period, the patient crossed over the eye drops (if asymptomatic in one eye), or continued with nedocromil sodium in both eyes (if asymptomatic in both eyes). All patients were examined weekly and ocular surface temperature recorded for a period of 6 weeks. RESULTS: Improvement in the watering, discharge, conjunctival hyperaemia, papillary hypertrophy, and Trantas' dots was noted in both groups, but overall fluorometholone was significantly more effective than nedocromil. Eyes treated with fluorometholone showed a significant decrease in ocular surface temperature compared with nedocromil treated eyes (p = 0.03). CONCLUSIONS: Both nedocromil and fluorometholone were effective in ameliorating the signs and symptoms of vernal keratoconjunctivitis. No adverse effects were noted in the nedocromil group.     

A contribution to the immunopathology of vernal keratoconjunctivitis

The tear fluid contains proteins which are synthesized locally in the conjunctiva and lacrimal glands, and others, which reach the tear fluid from the blood circulation. It is generally accepted that serum albumin (HSA) belongs to the latter group of tear proteins. Consequently, the ratio between the levels of HSA in the tear fluid and in the blood serum can be used as a parameter for the degree of vascular leakage. All blood-borne tear proteins will show concentration ratios in tears and blood serum similar to HSA, provided that they pass through the blood-tear barrier at the same flow rate as HSA. This principle may be used to determine whether a certain tear protein is blood-borne or locally synthesized. An additional method to determine the source of tear proteins is supposed, and is based on the assumption that blood-borne proteins will occur in tears from both eyes at a concentration ratio similar to that of HSA, whereas the concentration ratios of locally synthesized proteins will not be related to the HSA-levels in the tears of the two eyes. This method is independent of the rate of diffusion through tissue barriers.In the present study these methods have given coordinating and supplementary information. The IgG and IgM contents of tears from healthy eyes and from patients with vernal keratoconjunctivitis (VC) were shown to be essentially blood-borne. In tears from VC-patients as well as from healthy controls, IgE was usually found to be a product of local synthesis. In tears from healthy eyes, IgA was almost entirely synthesized locally, but a significant part of the IgA in tears from inflamed eyes was blood-borne.The geometrical mean (GM) of blood levels of IgE for VC-patients was not increased in relation to the GM for healthy controls of the same age groups. In contrast, the GM for IgE in tears from VC-patients (27.5 I.U./ml) was higher than the GM + 2 SD for the healthy controls (4.1 I.U./ml) and also than the highest level of IgE observed in tears from healthy eyes (6.6 I.U./ml). The tear-levels of IgE for VC-patients were strikingly dynamic and in some patients a hundred-fold increase or decrease was observed in the course of a relatively short time period. In contrast, alterations of blood-levels of IgE and of tear levels of IgA were relatively moderate. These results indicate a marked association between VC and an increased IgE-content of tears derived from local immunocytes. However, in some patients apparently suffering from typical VC, normal IgE-levels were consistently found in tears from both eyes during a number of relapses or aggravations of the disease. These results may indicate that more than one etiopathogenesis may lead to the clinical condition known as VC. A hitherto unexplained feature of VC is the pronounced lacrimation. We have shown that the concentration of the essential tear-proteins is not decreased in VC. Lacrimation is therefore associated with accelerated protein synthesis of the secretory system.     

In vivo confocal microscopy of meibomian glands and palpebral conjunctiva in vernal keratoconjunctivitis

Purpose:

To investigate the correlations between conjunctival inflammatory status and meibomian gland (MG) morphology in vernal keratoconjunctivitis (VKC) patients by using in vivo confocal microscopy (CM).

Materials and Methods:

Nineteen VKC patients (7 limbal, 7 tarsal, and 5 mixed forms) and 16 normal volunteers (controls) were enrolled. All subjects underwent CM scanning to obtain the images of upper palpebral conjunctiva and MGs. Inflammatory cell (IC) density in palpebral conjunctival epithelial and stromal layers, Langerhans cell (LC) density at lid margins and the stroma adjacent to the MG, and MG acinar unit density (MGAUD) were recorded. The longest and shortest diameters of MG acinar were measured. The Kruskal-Wallis test was used to compare the parameter differences whereas the Spearman''s rank correlation analysis was applied to determine their correlations.

Results:

Among all groups, no significant statistical differences were found in epithelial and stromal IC densities, mean values of MG acinar unit densities, or longest and shortest diameters. Both LC parameters in the tarsal-mixed groups were significantly higher than those in the limbal and control groups. All LC densities of VKC patients showed a positive correlation with MGAUD and shortest diameter.

Conclusions:

In VKC patients, the conjunctival inflammatory status could be associated with the MG status. In vivo CM is a noninvasive, efficient tool in the assessment of MG status and ocular surface.     

亚洲春季角结膜炎的诊疗规范：2022年亚洲专家共识解读

春季角结膜炎(VKC)是一种反复发作的眼部过敏性疾病,其特征表现为双侧眼表慢性炎症,若不及时干预,可导致眼表不可逆性损伤甚至失明。《亚洲春季角结膜炎的诊断、管理和治疗：亚洲春季角结膜炎管理专家工作组的建议》详细介绍了VKC的最新管理方法。本文就该共识进行全面解读,旨在进一步提高广大医务工作者诊断和治疗VKC的水平,以便更好地服务于广大眼病患者。     

Effectiveness of a modified therapeutic protocol for the management of vernal keratoconjunctivitis based on Bonini’s graded clinical severity

Purpose:To evaluate the effectiveness of a modified therapeutic protocol used for vernal keratoconjunctivitis (VKC) based on severity as per Bonini grading system.Methods: This was a prospective observational clinical study conducted with 123 eyes of 63 patients. A meticulous clinical examination was performed, and data was documented in all the cases. Patients on known systemic atopy and antiallergic therapy were excluded from the study. Eyes with a clinical diagnosis of VKC were segregated based on Bonnini’s grading system. A treatment protocol was created depending on the grade of VKC. Therapeutic responses were documented at 3 weeks, 3 months, 6 months, 12 months, and 24 months. Grading of the eyes was performed in each visit.Results: The mean age of the patients was 8.85 years with a standard deviation of 4.48 years. Males were predominant, and 95.24% had bilateral manifestation. The palpebral component was the most common form of manifestation. Itching was the most common manifestation, followed by congestion, discharge, and papillae in a decreasing order. Also, 68% of patients were in grade 2, 14% in grade 3, 12% in grade 1, and the rest were in grade 4. Following the treatment protocol, 70% showed signs of significant improvement in grade by the end of 6 weeks, reaching 90% at the end of 6 months (P = 0.074) and 92% at the end of 12 months (P = 0.002). Also, 52.4% versus 77.8% of patients had no recurrence in the pre- versus posttreatment protocol and it was statistically significant (P = 0.001).Conclusion: Grading of VKC gives a clear evaluation of the severity and progression of the condition. Besides, significant improvement in the grades was observed with fewer incidences of recurrences following execution of the therapeutic protocol. Hence, it is essential to maintain a treatment protocol in our clinical practice to provide grade-based therapy and monitor accurate changes in the clinical condition.