Rapid Healing of Vernal Shield Ulcer After Surgical Debridement

Özbek, Zeynep; Burakgazi, Ahmet Z.; Rapuano, Christopher J.

doi:10.1097/01.ico.0000178725.04070.87

Cited by 20 publications

(16 citation statements)

References 8 publications

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“…Debridement of ulcer base, surgical removal of plaque or excimer laser phototherapeutic keratectomy helps in early re-epithelialization of vernal shield ulcer refractory to medical treatment. (Cameron et al 1995b;Solomon et al 2004;Ozbek et al 2006). Amniotic membrane implantation leads to complete re-epithelialization of persistent corneal epithelial defects and vernal plaques recalcitrant to conventional medical treatment (Rouher et al 2004;Pelegrin et al 2008).…”

Section: Surgical Treatmentmentioning

confidence: 99%

Vernal keratoconjunctivitis: a major review

Kumar

2009

Acta Ophthalmologica

191

216

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ABSTRACT.Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, at times asymmetrical, seasonally exacerbated, allergic inflammation of the ocular surface, involving tarsal and ⁄ or bulbar conjunctiva. Though the allergic nature of this entity has been accepted for a long time, the accumulation of a large amount of immunological data has proved that the pathogenesis of VKC is much more complex than a mere type 1 hypersensitivity reaction. In the past several years, many clinical and experimental studies about the cells and mediators involved in initiating and perpetuating the ocular allergic inflammation have shown that T helper type 2 cells and their cytokines, corneal fibroblasts and epithelium along with various growth factors play an important role in the pathogenesis of VKC. Based on this information about the pathogenesis of VKC newer, more selective drugs like anti-chemokine receptor antibodies and leukotriene receptor antagonists are under evaluation. Cyclosporine has been shown to be effective in the treatment of VKC but further randomized control trials are required to establish the minimum effective concentration.

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Section: Surgical Treatmentmentioning

confidence: 99%

Vernal keratoconjunctivitis: a major review

Kumar

2009

Acta Ophthalmologica

191

216

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“…Elevated plaques are grade 3 shield ulcers, which respond best to surgical therapy. Topical formulations of corticosteroids, antihistamines and artificial tears, surgical excision of giant papillae with 6 or without mitomycin, supratarsal steroid injection, 7 surgical debridement of ulcer base, 8 amniotic membrane transplant, 9 autologous conjunctival graft, excimer laser phototherapeutic keratectomy and CO 2 ‐assisted removal of giant papillae 10 have all been tried with varying degrees of success in the treatment of shield ulcer with or without plaque.…”

Section: Discussionmentioning

confidence: 99%

Combined therapy for vernal shield ulcer

Kumar

2008

Clinical and Experimental Optometry

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A 22‐year‐old male patient presented with complaints of pain and redness in the right eye. Slitlamp examination revealed giant papillae on both tarsal conjunctivae, bilateral punctate corneal epitheliopathy and a 2.9 × 2.9 mm epithelial defect in the right eye. The diagnosis was bilateral vernal keratoconjunctivitis with shield ulcer in the right eye. Treatment was commenced with prednisolone (1%) eye drops four times daily and sodium hyaluronate (0.1%) eye drops eight times daily. After one week, the patient had improved symptomatically but the epithelial defect remained unchanged. Topical cyclosporine (0.05%) applied eight times per day was added to the regimen of topical corticosteroid and artificial tears. Three weeks after commencing combined therapy, the shield ulcer had healed completely, leaving a corneal opacity that negatively stained with fluorescein. The patient was followed for five months and no recurrence of ulcer was noted, despite the discontinuation of topical cyclosporine and prednisolone. Simultaneous institution of topical corticosteroid, artificial tears and topical cyclosporine seems to augment the therapeutic efficacy of each other and may be a promising regime in the management of shield ulcer.

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“…29 Furthermore, the giant papillae can occasionally be surgically removed in conjunction with an autologous conjunctival graft or AMT, which can also accelerate the healing process of a shield ulcer. 30,31 Most patients with AKC respond well to the abovementioned topical therapies. In a few studies, authors have reported the use of systemic immunosuppressant therapy, including oral cyclosporine and tacrolimus, in patients with refractory AKC, and corticosteroid, methotrexate, azathioprine, and mycophenolate mofetil for patients with recalcitrant AD.…”

Section: S473mentioning

confidence: 99%

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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Rapid Healing of Vernal Shield Ulcer After Surgical Debridement

Cited by 20 publications

References 8 publications

Vernal keratoconjunctivitis: a major review

Vernal keratoconjunctivitis: a major review

Combined therapy for vernal shield ulcer

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

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