Comparative efficacy of medical treatments for vernal keratoconjunctivitis in children and young adults: a systematic review with network meta‐analyses

Abstract

To systematically review the literature on the treatment of vernal keratoconjunctivitis (VKC) in children and young adults and conduct comparative efficacy analysis on clinical signs and symptoms using network meta-analyses. Methods.We systematically searched the databases PubMed/MEDLINE, EMBASE, Cochrane Central and Web of Science on 21 October 2019 for randomized controlled trials (RCT). Studies considered had patients with VKC < 20 years of age randomized into either intervention (any medical intervention) or comparator (active treatment, placebo treatment or non-treatment control), where pre-defined outcomes (data from ≥2 weeks and as close as possible to 2 months) of symptoms (itching, tearing, photophobia and foreign body sensation) and signs (hyperaemia, punctate keratitis, Horner-Trantas dots and macropapillae) were reported. Risk of bias within studies was evaluated using the Cochrane risk of bias tool. Comparisons were made using network meta-analyses. Results.We identified 39 studies with data on 2046 individuals. Twenty-three studies were eligible for quantitative analyses. None were systemic therapy. Temporal trend analysis showed that an initial focus on topical mast cell stabilizers turned to a focus on calcineurin inhibitors and a more diverse variety of pharmacological strategies. Studies varied in population, treatment duration and quality. The quantitative analysis revealed that efficacy of different therapies differed substantially across important clinical signs and symptoms, but there was a general trend of superior efficacy when using topical corticosteroids with stronger efficacy of the more potent corticosteroids. Conclusion.We provide an overview of RCTs comparing the efficacy of treatments for VKC in children and young adults, which we find differs across symptoms and signs. Overall, we saw a general trend of superior efficacy with topical corticosteroids. However, our findings highlight the need for better studies, consensus on core outcomes and potential for individualized therapy.

A Patient-Centered Approach to Vernal Keratoconjunctivitis (VKC): A Podcast

“…We see vernal keratoconjunctivitis globally, but it’s most commonly observed in the Mediterranean region, the Middle East, Africa, Central America, the Indian subcontinent, and less frequently in northern Europe, North America, and Australia. We know that vernal keratoconjunctivitis is more prevalent in patients with a family history of atopy, but an actual genetic component has not been identified [ 1 – 7 ].…”

“…Usually, they don’t attend any leisure activities. So, it has a significant limit on their daily activities, and it affects the child’s psychosocial well-being and diminishes their overall quality of life from the entire family [ 1 , 14 – 17 ].…”

Role of the ocular surface microbiome in allergic eye diseases

“…Due to their potential for vision-threatening adverse effects, including risks of steroid-induced glaucoma, infection, and cataracts, topical steroid-sparing immunomodulators are more appropriate for long-term control of severe disease [28]. Calcineurin inhibitors, most commonly cyclosporine A and tacrolimus ophthalmic formulations (drops and ointments) at varying doses, have been extensively studied in VKC/AKC patients with excellent safety and efficacy in relieving symptoms and preventing disease progression [49 ▪ ]. As the pathophysiology of severe forms of allergic eye diseases has become better understood, a stepwise approach to management has been recommended by expert consensus panels based on disease severity, progression, and response to prior treatments [50].…”

Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta‐analyses

“…Using direct and indirect comparisons, treatment efficacies of all available treatments can be ranked according to a pre‐defined group, such as non‐treatment control, if it is possible to draw a complete network between treatment modalities (Subhi et al, 2022). This method of evidence synthesis has allowed more comprehensive reviews of treatment efficacies, where multiple treatments exist for different diseases in ophthalmology (Bicket et al, 2021; Fallico et al, 2021; Ha et al, 2022; Halili et al, 2020; Li et al, 2021; Rasmussen et al, 2022). For the case of cCSC, network meta‐analyses potentially allow comparison between different treatment modalities to the natural disease course without treatment.…”