Management of Vernal Keratoconjunctivitis

Abstract

Vernal keratoconjunctivitis (VKC) is a relatively rare, chronic form of ocular allergy that can potentially cause severe visual complications. Affecting mainly children and young adults, it is an IgE- and T cell-mediated disease, leading to a chronic inflammation in which eosinophil, lymphocyte and structural cell activation are involved. Treatment of VKC requires a multiple approach that includes conservative measures and pharmacologic treatment. Patients and parents should be made aware of the long duration of disease, its chronic evolution and possible complications. Treatment should be based on the duration and frequency of symptoms and the severity of corneal involvement. Mast cell stabilizers and antihistamines have been proven to be effective for the treatment of mild to moderate forms of VKC. In the most severe cases, topical steroids can be used as rescue medication to reduce conjunctival and corneal inflammation. Immunomodulators that have been investigated for VKC treatment include topical ocular preparations of cyclosporine A and tacrolimus. Topical cyclosporine A has been proven to be effective in the long-term treatment of VKC, significantly improving signs and symptoms without significant side effects.

Update on the Management of High-Risk Penetrating Keratoplasty

“…In severe cases including SJS, MMP and Mooren’s ulcer, any surgical manipulation may be delayed for at least 1 year (except for emergency tectonic grafts). Patients with atopic or vernal keratoconjunctivitis may benefit from treatment with topical +/− systemic CsA or tacrolimus [26]. Pre-operative (or intraoperative) treatment of vessels with an anti-VEGF agent has also been reported, but remains under study.…”

Ocular allergy

“…These include vasoconstrictors, antihistamines, mast cell stabilisers, dual mode action drugs, corticosteroids and immunosupressives (Leonardi, 2013), each of which will be reviewed.…”

“…'Corticosteroids possess immunosuppressive and antiproliferative properties as they hinder the transcription factor that regulates the transcription of Th2-derived cytokine genes and differentiates activated T-lymphocytes into Th2-lymphocytes' (La Rosa et al, 2013). Patients receiving corticosteroids eye drops for longer durations should be closely monitored for glaucoma and cataracts (Leonardi, 2013;S anchez et al, 2011). Other adverse effects of corticosteroids include delayed wound healing and secondary infections (Leonardi, 2013;S anchez et al, 2011).…”

“…Patients receiving corticosteroids eye drops for longer durations should be closely monitored for glaucoma and cataracts (Leonardi, 2013;S anchez et al, 2011). Other adverse effects of corticosteroids include delayed wound healing and secondary infections (Leonardi, 2013;S anchez et al, 2011). Intranasal corticosteroids have been reported to be effective for treating nasal symptoms of allergic rhinitis, but their effectiveness for addressing ocular symptoms is inconsistent (S anchez et al, 2011).…”

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“…Основные направления терапии больных с весенним кератоконъюнктивитом и лекарственные вещества, нашедшие применение для их реализации (по A. Leonardi (2013) [2] с дополнениями) [36]. Причем достаточно высоким клиническим эффектом также обладают и менее концентрированные растворы циклоспорина-А.…”