Vascular Endothelial Growth Factor (VEGF) Serological and Lacrimal Signaling in Patients Affected by Vernal Keratoconjunctivitis (VKC)

Abstract

Background Vernal keratoconjunctivitis (VKC) is a rare inflammatory disease involving the ocular surface, with seasonally exacerbated symptoms. Both type-1 and type-4 hypersensitivity reactions play a role in the development of VKC. Purpose The aim of the present study was to assess the presence and evaluate the concentration of the vascular endothelial growth factor (VEGF) in tear and blood samples from patients with VKC, during the acute phase, based on the histopathological vasculostromal structure of the tarsal papillae. Methods Two groups of children aged between 6 and 16 years of life were enrolled: 21 patients (16 males, 76%) affected by VKC, tarsal or mixed form, and 13 healthy children (5 males, 38%) used as controls. Blood and tear samples were obtained from all patients, in order to specifically assess the presence of VEGF. Statistical analyses were performed with one-way ANOVA, followed by post hoc comparisons with the Bonferroni tests. Pearson's correlation was chosen as statistical analysis to assess the relationship between the expression levels of VEGF in tears and blood and the clinical parameters measured. Results Comparing the 2 groups for VEGF concentration, a statistically significant difference was found in tear samples: the mean value was 12.13 pg/mL (±5.54 SD) in the patient group and 7 pg/ml (±4.76 SD) in controls (p < 0.05). However, no statistically significant difference was found when comparing VEGF concentration in blood samples (p > 0.05), with a mean value of 45.17 pg/mL (±18.67 SD) in VKC patients and 38.08 pg/mL (±19.43 SD) in controls. Conclusions This pilot study highlights the importance of lacrimal and vascular inflammatory biomarkers that can be detected in VKC patients during the acute phase, but not in healthy children. The small group of patients warrants additional studies on a larger sample, not only to further investigate the role of VEGF but also to evaluate the angiogenic biomarkers before and after topical treatment.

Role of Immune Cell Diversity and Heterogeneity in Corneal Graft Survival: A Systematic Review and Meta-Analysis

“…Corneal neovascularization is mediated by VEGF [115,116]; VEGF-A combined with VEGF receptor 1 and VEGFR-2 can initiate neovascularization. Furthermore, VEGF plays an important pathogenic role in ocular surface disorders [116][117][118]. In corneal transplantation, neovascularization is the major cause of graft failure, especially in high-risk corneal grafts [73,[119][120][121].…”

When to start tacrolimus ointment for vernal keratoconjunctivitis? A proposed treatment protocol

“…[1] The typical clinical course is characterized by seasonal exacerbations, but up to 23% can entail perennial symptoms that can recur throughout the year. [2][3][4] The diagnosis of VKC is based on the patient's clinical history and symptoms. There is no consensual grading system, and several scales have been developed with emphasis on severity of symptoms from no in ammatory changes to severe changes.…”

“…[6] Depending on the conjunctival site involved, 3 forms of VKC can be characterized: tarsal (palpebral), limbal (bulbar), and mixed. [3] The palpebral form is characterized by large tarsal papillae, ranging from 1 to 7-8 mm, which are known as cobblestone papillae. The limbal form includes conjunctival hyperemia, which are limbal nodules that appear as gray, jelly-like, elevated lumps with vascular cores.…”

When To Start Tacrolimus Ointment For Vernal Keratoconjunctivitis? A Proposed Treatment Protocol

“…[1] The typical clinical course is characterized by seasonal exacerbations, but up to 23% can entail perennial symptoms that can recur throughout the year. [2][3][4] The diagnosis of VKC is based on the patient's clinical history and symptoms. There is no consensual grading system, and several scales have been developed with emphasis on severity of symptoms from no in ammatory changes to severe changes.…”