Vernal keratoconjunctivitis revisited: A case series of 195 patients with long-term followup

• Published in: Ophthalmology (Rochester, Minn.) Vol. 107; no. 6; pp. 1157 - 1163
• Main Authors: Bonini, Stefano, Bonini, Sergio, Lambiase, Alessandro, Marchi, Stefano, Pasqualetti, Patrizio, Zuccaro, Ornella, Rama, Paolo, Magrini, Laura, Juhas, Tomas, Bucci, Massimo G.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2000; Elsevier
• Subjects: Adolescent; Adult; Biological and medical sciences; Child; Child, Preschool; Conjunctiva - immunology; Conjunctiva - pathology; Conjunctivitis, Allergic - complications; Conjunctivitis, Allergic - diagnosis; Conjunctivitis, Allergic - epidemiology; Conjunctivitis, Allergic - immunology; Cornea - immunology; Cornea - pathology; Diseases of eyelid, conjunctiva and lacrimal tracts; Female; Follow-Up Studies; Humans; Incidence; Italy - epidemiology; Male; Medical sciences; Ophthalmology; Retrospective Studies; Italy; Human; Immunopathology; Cornea; Prognosis; IgE; Vernal conjunctivitis; Keratopathy; Conjunctiva disease; Eye; Pathology; Eye disease; Histopathology; Follow up study
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/S0161-6420(00)00092-0

Objective: This study aimed at revisiting vernal keratoconjunctivitis (VKC) on the basis of anamnestic, clinical, immunologic, histopathologic, and followup data of 195 patients. Retrospective noncomparative case series. Participants: One hundred and ninety-five patients with VKC. Clinical evaluation and outcome in 151 of 195 patients with a median followup of 47 months. Evaluation was by telephone survey in 69 patients. (1) Demographic, clinical, and immunologic features of VKC and their influence on the course of the disease; (2) conjunctival and corneal complications and efficacy of treatment observed during the followup period. VKC is a chronic disease. More than 60% of patients had repeated recurrences all year round. Males had an earlier presentation of symptoms than females and the male/female ratio decreased with age. Major (greater than 80%) and minor (up to 80%) diagnostic criteria were defined for clinical signs and symptoms of the disease. Negative skin test or radioallergosorbent test was present in approximately 50% of patients, whereas eosinophil infiltration was a constant histopathologic finding. A marked conjunctival sensitivity to nonspecific stimuli was noted in more than one third of patients. In 6% of cases, a reduction of visual acuity resulted from corneal scarring, and in 2% of patients, steroid-induced glaucoma was observed. The large size of giant papillae indicates poor prognosis for the persistence of the disease and its evolution into a chronic, perennial condition. Conclusions: VKC is a chronic eosinophilic disease of the ocular surface involving IgE, non IgE-mediated mechanisms, and age-sex–related influences. Although the disease has a good prognosis, severe visual impairments may result from long-standing inflammation.