Management of corneal complications in vernal keratoconjunctivitis: A review

Feizi, Sepehr; Javadi, Mohammad Ali; Alemzadeh-Ansari, Mohammad-Hasan; Arabi, Amir; Shahraki, Toktam; Kheirkhah, Ahmad

doi:10.1016/j.jtos.2020.10.005

Cited by 38 publications

(63 citation statements)

References 83 publications

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“…The chronic mechanical abrasion of the corneal epithelium by giant papillae on the superior tarsal conjunctiva during blink action has been shown to activate corneal epithelial cells to overexpress pro-inflammatory mediators. In immune-mediated mechanisms of corneal shield ulcer, MMP secreted by activated epithelial cells, eosinophils, and corneal fibroblasts play a pivotal role in the pathogenesis [ 12 , 83 , 110 , 111 , 112 ]. Additionally, eosinophil-derived granules released by recruited eosinophils participate in the disruption of corneal barrier function and break down of the corneal stromal matrix [ 12 , 113 , 114 ].…”

Section: Clinicopathological Correlationsmentioning

confidence: 99%

“…In immune-mediated mechanisms of corneal shield ulcer, MMP secreted by activated epithelial cells, eosinophils, and corneal fibroblasts play a pivotal role in the pathogenesis [ 12 , 83 , 110 , 111 , 112 ]. Additionally, eosinophil-derived granules released by recruited eosinophils participate in the disruption of corneal barrier function and break down of the corneal stromal matrix [ 12 , 113 , 114 ]. The degradation of the corneal stromal matrix manifests as a vernal shield ulcer, which is more common in patients with the tarsal form of VKC.…”

Section: Clinicopathological Correlationsmentioning

confidence: 99%

“…The tarsal form of VKC is common in temperate regions and is characterized by the presence of papillary hypertrophy on the upper palpebral conjunctiva [ 10 , 11 ]. The limbal form of VKC is characterized by the presence of gelatinous limbal papillary hyperplasia and is more common in warmer climates [ 12 ]. VKC usually resolves completely within 10 years of onset, but in some individuals, it could progress to atopic keratoconjunctivitis, particularly in the late teens and early twenties [ 2 , 9 , 10 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives

Chigbu

Labib

2021

Pharmaceuticals

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Vernal keratoconjunctivitis (VKC) is a complex and chronic, multifactorial Th2 cell-mediated chronic ocular surface inflammatory condition that typically affects predominantly male children in hot or warm climates. The primary symptom is intense ocular pruritus, often significant enough to affect activities of daily living. Clinical features differ from simple forms of allergic conjunctivitis in that they are more-or-less confined to the superior tarsus and limbus. There is also a risk of corneal involvement, which leads to irreversible vision loss in approximately 6% of patients. Right now, there is no standardized treatment protocol, and many of the currently available options are not effective in severe and recurrent cases. As such, it is imperative to understand this complex allergic immune response in order to identify future therapeutic targets. This review will focus on potential drug targets in VKC, with particular emphasis on immunomodulators and immunobiologic agents.

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Section: Clinicopathological Correlationsmentioning

confidence: 99%

Section: Clinicopathological Correlationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives

Chigbu

Labib

2021

Pharmaceuticals

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“…The associated symptoms are intense itching, photophobia, and tearing. During recurrences, they show severe conjunctival hyperemia, swelling, thick mucus discharge, and corneal damage [ 2 , 16 , 17 , 18 ]. Corneal involvement in VKC is the consequence of intense ocular surface inflammation, causing the development of superficial punctuate keratopathy, which may progress to corneal epithelial defects and shield ulcers [ 14 , 17 , 19 ] ( Figure 2 ).…”

Section: Clinical Characteristics Of Vkcmentioning

confidence: 99%

“…Horner-Trantas dots surrounding the cornea represent a typical sign of active inflammation and are mostly due to eosinophil infiltration ( Figure 1 b). More severe cases, with long-standing disease, may develop corneal neovascularization and scarring, associated with permanent impairment of visual function [ 2 , 17 , 19 ].…”

Section: Clinical Characteristics Of Vkcmentioning

confidence: 99%

Understanding Vernal Keratoconjunctivitis: Beyond Allergic Mechanisms

Sacchetti

Plateroti

Giustolisi

et al. 2021

Life

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Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, inflammatory disease of the cornea and conjunctiva mostly affecting boys in prepubertal age. VKC recurrence is characterized by intense symptoms of itching, redness, and photophobia associated with corneal damage, impairment of visual function, and quality of life. The pathogenesis of VKC has not yet been completely understood, and it is still controversial. In fact, VKC is considered an ocular allergic disease due to the involvement of immunoglobulin E, eosinophils, and mast cells, and of a lymphocyte T-helper type 2 reaction. However, approximately half of VKC patients have negative allergological history and testing, suggesting that other pathogenic mechanisms participate in VKC development and severity. Specifically, evidence suggests that genetic, endocrine, neuronal factors and an imbalance of innate immunity are involved in the pathogenesis of VKC. The purpose of this review is to summarize evidence on the pathogenic role of innate immunity, neuroimmune reaction, and hormonal changes in VKC. Increasing understanding of the pathogenic mechanisms behind VKC may lead to the identification of novel biomarkers for diagnosis and/or potential therapeutic targets in order to improve the management of this challenging condition.

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Prevalence and risk factors of Vernal Keratoconjunctivitis among a Ghanaian clinical cohort: A case‐control study

Kyei,

Nkansah,

Asiedu

et al. 2024

Health Science Reports

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BackgroundVernal Keratoconjunctivitis (VKC) has been determined to be highly prevalent in countries within the tropical climate region. However, little evidence from studies conducted within this region has been put forward to support this claim.AimTo determine the prevalence and risk factors of VKC among a Ghanaian clinical cohort.MethodsA 3‐year case‐control study was conducted in a tertiary eye care institution, and medical records of patients who had been diagnosed of VKC between 2018 and 2021 were reviewed.ResultsMedical records of 3800 patients were reviewed. Some cases of VKC were identified, with a population prevalence rate of . Males comprised of the population with VKC, with a male‐to‐female ratio of . The disease was more prevalent (40.8%) in children (17 years), and the overall odds of incidence decreased by 10% for a unit increase in age. Age and sex‐adjusted models revealed significant positive associations between Keratoconus [aOR = 40.760, 95% CI –5.948 to 339.937], Rhinitis [cOR = 5.183, 95% CI –2.074 to 12.022] and VKC. However, the incidence of VKC was relatively less expressive among pterygium cases [cOR = 0.315, 95% CI –0.077 to 0.846].ConclusionVKC is highly prevalent among children and is often associated with comorbidities of atopic origin that exacerbate the impact of the disease among this vulnerable population. It is imperative that clinicians provide holistic care for children with VKC.

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Management of corneal complications in vernal keratoconjunctivitis: A review

Cited by 38 publications

References 83 publications

Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives

Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives

Understanding Vernal Keratoconjunctivitis: Beyond Allergic Mechanisms

Prevalence and risk factors of Vernal Keratoconjunctivitis among a Ghanaian clinical cohort: A case‐control study

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