Understanding Vernal Keratoconjunctivitis: Beyond Allergic Mechanisms

Sacchetti, Marta; Plateroti, Rocco; Giustolisi, Rosalia; Marenco, Marco

doi:10.3390/life11101012

Cited by 13 publications

(39 citation statements)

References 90 publications

(173 reference statements)

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“…The palpebral variant is the most common type of manifestation. [ 22 ] Papillae in the palpebral conjunctiva help in grading the VKC. [ 23 ] The density of papillae is directly proportional to the manifestation of symptoms.…”

Section: Discussionmentioning

confidence: 99%

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

Pradhan

Pattanayak

Dora

et al. 2022

Indian Journal of Ophthalmology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Pradhan

Pattanayak

Dora

et al. 2022

Indian Journal of Ophthalmology

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“…This can be explained by the major role of inflammation that contributes to the symptoms of VKC, affecting their severity and persistence. However, it is to be mentioned that other factors may also play a role in VKC pathogenesis and other ophthalmic disorders as well such as neuronal factors, endocrine factors, and the involvement of specific immune cells (Sacchetti et al, 2021). Tacrolimus is one of the potent immunosuppressant drugs recently tested as therapeutic agents in several clinical conditions and showed promising, positive therapeutic outcomes.…”

Section: Discussionmentioning

confidence: 99%

Incremental Concentrations of Tacrolimus Eye Drops as a Strategy for the Management of Severe Vernal Keratoconjunctivitis

et al. 2022

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Purpose: To assess the effect of different concentrations of tacrolimus eye suspension on the epithelium and stromal keratocytes of human corneas and investigate whether it can be safely used for severe cases of vernal keratoconjunctivitis (VKC).Methods: Tacrolimus eye suspension was prepared in a range of concentrations of 0.005%, 0.01%, 0.05%, 0.1%, and 0.2%. Molecular analysis was performed ex vivo on human corneas (n = 18), obtained from the eye bank. Transparency and thickness of each cornea were measured while live/dead staining was performed using a triple labeling assay. An incremental concentration approach was then tested on three severe cases of VKC.Results: All tested tacrolimus concentrations showed no significant changes in corneal thickness or transparency. In corneas treated with 0.1%, rare scattered dead cells were observed, while the folds of corneal surfaces were mostly viable, unlike concentrations higher than 0.1% and lower than 0.05%. Stromal cell densities were highest in the 0.1% tacrolimus treatment condition. Incremental concentrations of tacrolimus suspension were shown to significantly improve VKC cases, where the concentration used for each case depended on the severity of the case.Conclusions: Topical administration of tacrolimus was not toxic to human corneal cells at all tested concentrations, and the 0.1% concentration has shown the best viability of the corneal tissue. Tacrolimus eye suspension was shown to be safe and effective for use in severe VKC and is proposed as a topical ocular immunosuppressant drug enabling clinicians to incrementally increase the drug concentration according to the clinical severity of the disease to achieve the optimal therapeutic response.

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“…VKC is traditionally considered to be a form of allergic conjunctivitis in which IgE-mediated hypersensitivity reactions play a major role in the pathogenesis of VKC, and the pathogenic role of IgE-mediated allergic reactions to environmental factors in VKC is supported in the study by Sacchetti Marta et al [6]. Bonini S. et al [7].…”

Section: Etiology and Pathogenesismentioning

confidence: 99%

Research progress in Chinese and Western medicine for the treatment of Vernal keratoconjunctivitis

Guo¹,

Ren²,

Guo³

2022

HSET

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Vernal keratoconjunctivitis (VKC) is a form of allergic conjunctivitis, also known as spring ophthalmia because of its recurrent and cyclical nature, which occurs in spring and summer. The main symptoms are ocular itching, photophobia and tearing, discharge, and foreign body sensation, and physical signs include flattened and thickened lid conjunctiva with pavement-like papillae, and gum-like thickening of the corneal rim of the upper lid (Horner-Trantas nodule). The pathogenesis of VKC is not yet fully understood and remains controversial. There are currently many treatment options for VKC, with the mainstream treatments being Western medicine and Chinese medicine, but with varying efficacy and individual differences. The author reviews the progress of research in the treatment of VKC with Chinese and Western medicine.

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Understanding Vernal Keratoconjunctivitis: Beyond Allergic Mechanisms

Cited by 13 publications

References 90 publications

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

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

Incremental Concentrations of Tacrolimus Eye Drops as a Strategy for the Management of Severe Vernal Keratoconjunctivitis

Research progress in Chinese and Western medicine for the treatment of Vernal keratoconjunctivitis

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