Functional Visual Acuity Assessment of Severe Atopic Keratoconjunctivitis

Ibrahim, Osama; Doğru, Murat; Kaido, Minako; Kojima, Takashi; Fujishima, Hiroshi; Tsubota, Kazuo

doi:10.1097/ico.0000000000000245

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…Both type 1 and type 4 hypersensitivity reactions have been confirmed as a contributing factor in the pathogenesis of AKC [5]. Conjunctival biopsy specimens reveal extensive admixture of eosinophils, mast cells, Th1 and Th2 helper cells suggestive of an abnormal response from the adaptive immune system in predisposed individuals [6].…”

Section: Introductionmentioning

confidence: 99%

Ocular Surface Squamous Neoplasia Associated with Atopic Keratoconjunctivitis

2016

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Purpose: To describe 2 cases of invasive squamous cell carcinoma that originated in the setting of severe atopic keratoconjunctivitis (AKC). Methods: Case one involved a 73-year-old male with atopic eczema and severe AKC who developed a limbal lesion suspicious for ocular surface squamous neoplasia (OSSN). Slit-lamp examination was significant for a new sessile lesion in the temporal limbal region of the left eye. The lesion was treated with excisional biopsy and cryotherapy. Topical therapy with mitomycin C, topical interferon alpha 2b, and topical 5-fluorouracil provided only partial control. Exenteration was eventually needed. Case two involved a 53-year-old male with history of severe AKC and eczema. Computed tomography imaging showed an infiltrative mass of the right orbit. Incisional biopsies confirmed conjunctival squamous cell carcinoma of both sides (invasive in the right eye, in situ in the left eye). Exenteration was needed for control of invasive carcinoma in the right eye. Results: Squamous cell carcinoma was treated without success in spite of surgical excision and aggressive treatment with multiple topical agents and multiple applications of cryotherapy. Orbital exenteration was needed in both cases. Conclusion: Chronic inflammation associated with AKC may be a risk factor for the development of bilateral, diffuse, invasive, and recurrent OSSN that may require exenteration.

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Section: Introductionmentioning

confidence: 99%

Ocular Surface Squamous Neoplasia Associated with Atopic Keratoconjunctivitis

2016

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“…It is worth noting that the clinical features in our pediatric patient with AKC were not completely in conformity with those of typical adult-onset AKC, which usually manifests as subconjunctival infiltration and cicatrization in the lower lid rather than the upper lid, 20 whereas the giant papillae were concentrated on the upper lid in our pediatric patient. We suggest that the clinical characteristics and even the pathologic process involved in childhood-onset and adult-onset AKC may be different.…”

Section: S473mentioning

confidence: 52%

Recalcitrant Atopic Keratoconjunctivitis in Children: A Case Report and Literature Review

Luo

et al. 2018

Pediatrics

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Atopic keratoconjunctivitis (AKC) is the most severe type of allergic conjunctivitis and may eventually lead to blindness. Although AKC is reported to be more prevalent in adults, we report a child with AKC whose clinical characteristics were not inconsistent with those typically seen in adult patients with AKC, and who was refractory to traditional topical anti-inflammatory and immunosuppressant therapies. An 11-year-old boy presented with a 3-month history of ocular redness and itching and decreased vision for a week in both eyes. Slit-lamp examination revealed typical signs of vernal keratoconjunctivitis, including cobblestone papillae in both upper conjunctiva, superficial punctate keratopathy on the right cornea, and a sterile shield-shaped ulcer on the left cornea. Physical examination revealed eczematous lid changes and a generalized body rash, particularly on the face, neck, and flexor surfaces of the limbs. He was diagnosed to have AKC in both eyes and atopic dermatitis. The patient did not respond well to conventional topical antihistamine, mast cell stabilizers, corticosteroids, or tacrolimus, even in combination with amniotic membrane transplant. After using systemic immunosuppressants, the symptoms were relieved; the inflammation on the skin and ocular surface subsided, the cobblestone papillae disappeared, and the corneal ulcer healed gradually within 8 weeks. This case reveals that pediatric AKC should be differentiated from vernal keratoconjunctivitis because both disorders include upper cobblestone papillae, but the former is accompanied by atopic dermatitis. Pediatric AKC requires appropriate and aggressive treatment to prevent sight-threatening corneal complications. Systemic immunosuppressant should be considered when traditional topical anti-inflammatory therapies have failed.

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“…Excluded from both groups were patients with severe atopic keratoconjunctivitis, 9 a history of ocular surgery or any eye disease, except for keratoconus in the fellow eye of patients with FFKC, or any systemic disease or syndrome.…”

Section: Methodsmentioning

confidence: 99%

Enhanced Combined Tomography and Biomechanics Data for Distinguishing Forme Fruste Keratoconus

Luz¹,

Lopes

Hallahan

et al. 2016

J Refract Surg

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PURPOSE To evaluate the performance of the Ocular Response Analyzer (ORA) (Reichert Ophthalmic Instruments, Depew, NY) variables and Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany) tomographic parameters in differentiating forme fruste keratoconus (FFKC) from normal corneas, and to assess a combined biomechanical and tomographic parameter to improve outcomes. METHODS Seventy-six eyes of 76 normal patients and 21 eyes of 21 patients with FFKC were included in the study. Fifteen variables were derived from exported ORA signals to characterize putative indicators of biomechanical behavior and 37 ORA waveform parameters were tested. Sixteen tomographic parameters from Pentacam HR were tested. Logistic regression was used to produce a combined biomechanical and tomography linear model. Differences between groups were assessed by the Mann–Whitney U test. The area under the receiver operating characteristics curve (AUROC) was used to compare diagnostic performance. RESULTS No statistically significant differences were found in age, thinnest point, central corneal thickness, and maximum keratometry between groups. Twenty-one parameters showed significant differences between the FFKC and control groups. Among the ORA waveform measurements, the best parameters were those related to the area under the first peak, p1area1 (AUROC, 0.717 ± 0.065). Among the investigator ORA variables, a measure incorporating the pressure-deformation relationship of the entire response cycle was the best predictor (hysteresis loop area, AUROC, 0.688 ± 0.068). Among tomographic parameters, Belin/Ambrósio display showed the highest predictive value (AUROC, 0.91 ± 0.057). A combination of parameters showed the best result (AUROC, 0.953 ± 0.024) outperforming individual parameters. CONCLUSIONS Tomographic and biomechanical parameters demonstrated the ability to differentiate FFKC from normal eyes. A combination of both types of information further improved predictive value.

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Functional Visual Acuity Assessment of Severe Atopic Keratoconjunctivitis

Abstract: FVA and VMR are promising parameters in the assessment of dynamic visual acuity changes in AKC-affected patients and evaluation of treatment outcome.

Cited by 10 publications

References 24 publications

Ocular Surface Squamous Neoplasia Associated with Atopic Keratoconjunctivitis

Ocular Surface Squamous Neoplasia Associated with Atopic Keratoconjunctivitis

Recalcitrant Atopic Keratoconjunctivitis in Children: A Case Report and Literature Review

Enhanced Combined Tomography and Biomechanics Data for Distinguishing Forme Fruste Keratoconus

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