Atopic keratoconjunctivitis: long-term results of medical treatment and penetrating keratoplasty

Abstract

Purpose: To evaluate the long-term outcomes of medically or surgically treated patients with atopic keratoconjunctivitis (AKC). Methods: Charts of 16 patients with AKC (32 eyes) observed between 1996 and 2013 were reviewed retrospectively. Outcome measures included demographic features, follow-up duration, and biomicroscopic findings at the first and most recent visits. The corrected distance visual acuity (CDVA; in decimal units) was evaluated at the initial visit and the 1-, 6-, and 12-month follow-up visits. Results: In the medically treated group (25 eyes of 15 patients), the median follow-up duration was 3 (range, 1-9) years, and the median CDVA values were 0.01 (0.001-1.0) at the first visit and 0.01 (0.001-0.8) at the most recent visit (p=0.916). In the penetrating keratoplasty (PK) group (7 eyes of 6 patients), the median follow-up duration was 7 years (range, 1-11), and the median CDVA increased from 0.01 (0.001-0.01) to 0.2 (0.001-0.7) postoperatively (p=0.043). Conclusion: Whereas most AKC patients maintained a useful CDVA with medical treatment, PK may be required in some cases. Despite the frequent occurrence of complications, PK can significantly improve the CDVA. (variação, 1-9) e a CDVA média foi de 0,01 (0,001-1,0) na visita inicial e 0,01 (0,001-0,8) na visita mais recente (p=0,916) Keywords

Early Postoperative Therapeutic Scleral Lens Intervention for Penetrating Keratoplasty Complications in Atopic Keratoconjunctivitis

“…3 Ocular comorbidities of AKC, including corneal neovascularization, conjunctival scarring, and LSCD, elevate the risk of PK complications, with AKC patients having a reported 25% incidence of a PED post-PK. 3 Undergoing PK is a risk factor for the recurrence of herpes keratitis (HK). 8 Although the patient had no known history of HK, his lack of symptoms postoperatively suggested preexisting neurotrophic keratopathy (NTK).…”

“…3 Ocular comorbidities of AKC, including corneal neovascularization, conjunctival scarring, and LSCD, elevate the risk of PK complications, with AKC patients having a reported 25% incidence of a PED post-PK. 3…”

“…Immunopathogenic mechanism of AKC is complex and involves activation of T cells, chronic immunoglobulin (Ig) E–mediated mast cell degranulation, and other inflammatory cells. 3,4 High serum IgE levels and eosinophils are present in the conjunctiva and tears of AKC patients, which potentiate corneal damage with tissue remodeling, subepithelial fibrosis, and elevated risk for corneal graft failure. 4–6 Severe AKC can manifest as chronic conjunctivitis, conjunctival scarring, limbal stem cell deficiency (LSCD), and persistent epithelial defect (PED) and is associated with keratoconus (KCN).…”

“…7 Patients with AKC may have limited therapeutic options in the management of acute postoperative complications. 3 In this case, we report the early therapeutic use of a customized scleral lens in managing acute post-PK complications in a patient with AKC. The patient was fit and treated with Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE, BostonSight, Needham, MA), which uses a customized scleral lens for patients with irregular corneal shape and/or ocular surface disorders.…”

Successful Subcutaneous Allergen-Specific Immunotherapy in Refractory Atopic Keratoconjunctivitis: A Case Report

“…Atopic keratoconjunctivitis (AKC) is one of the most severe forms of chronic ocular allergy. Moreover, in the worst case, it leads to corneal blindness requiring corneal transplantation [ 1 , 2 ]. This particular type of ocular allergy is characterized by chronic allergic conjunctivitis resulting in conjunctival scarring, fornix shortening, symblepharon, corneal ulceration, and corneal neovascularization [ 3 ].…”