Surgical Debridement Plus Topical Cyclosporine a in the Treatment and Vernal Shield Ulcers

Caputo, Roberto; Pucci, Neri; Mori, Francesca; Libero, Cinzia de; Grande, Laura Di; Bacci, Giacomo Maria

doi:10.1177/039463201202500326

Cited by 7 publications

(9 citation statements)

References 25 publications

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“…The remaining 13 records were evaluated in full-text form. Of these, 10 full-text articles were deemed eligible for our systematic review [11][12][13][14][15][16][17][18][19][20]. Figure 1…”

Section: Search Results and Study Selectionmentioning

confidence: 99%

Surgical Treatment of Corneal Shield Ulcer in Vernal Keratoconjunctivitis: A Systematic Review

Azizi

Subhi

Rasmussen

2023

JPM

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Background: Vernal keratoconjunctivitis (VKC) severely affects the quality of life of affected patients. The development of a shield ulcer is considered one of the most severe late-stage complications, which when untreated leads to irreversible vision loss. In this systematic review, we outlined the results of surgical treatments of corneal shield ulcers in VKC. Methods: We searched 12 literature databases on 3 April 2023 for studies of patients with VKC in which shield ulcers were treated by any surgical treatment. Treatment results were reviewed qualitatively. Assessments of the risk of bias of individual studies were made using the Clinical Appraisal Skills Programme. Results: Ten studies with 398 patients with VKC were eligible for the qualitative review. Two categories of surgical approaches were described: supratarsal corticosteroid injection and debridement with or without amniotic membrane transplantation. Almost all patients experienced resolution or improvement of their shield ulcers, regardless of treatment modality. Time to healing was faster with surgical debridement. A small proportion experienced recurrence and side effects. Conclusions: Surgical treatment for shield ulcers in VKC seems highly effective, but careful post-operative treatment and follow-ups are necessary due to the risk of recurrence and potential side effects.

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Section: Search Results and Study Selectionmentioning

confidence: 99%

Surgical Treatment of Corneal Shield Ulcer in Vernal Keratoconjunctivitis: A Systematic Review

Azizi

Subhi

Rasmussen

2023

JPM

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“…According to the ocular involvement, VKC is classified as tarsal VKC, characterized by giant cobblestone papillae in the upper tarsal conjunctiva, or limbal/bulbar VKC, characterized by gelatinous opacification at limbus with Horner-Trantas dots. Corneal involvement is present in most cases, ranging from mild epithelial keratopathy to plaque ulcers 3 potentially leading to permanent sequelae such as visual impairment. [4][5][6] The etiology of VKC is still unknown, but both immunoglobulin E (IgE)mediated and non-IgE-mediated mechanisms are implicated.…”

mentioning

confidence: 99%

Efficacy of a Cationic Emulsion of Cyclosporine in Moderate Vernal Keratoconjunctivitis

Caputo,

Di Grande,

de Libero

et al. 2023

Cornea

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Purpose: The aim of this study was to demonstrate the efficacy of cyclosporine A 0.1% cationic emulsion (CsA CE) eye drops 4 times a day in pediatric patients affected by a moderate form of vernal keratoconjunctivitis (VKC). Methods: This was a prospective study of pediatric patients, aged 5–16 years, with an active moderate form of VKC who were poor responders to topical antihistamines treatment and were treated 4 times a day with CsA CE. The clinical signs were graded for analysis as follows: hyperemia, tarsal papillae, and limbal papillae. Results: Twenty-eight patients (22 males and 6 females) with a minimum follow-up period of 3 months were included in the analysis. Statistical analysis excluded tarsal papillae because of the very low baseline value. The clinical score of hyperemia and limbal papillae improved from the first evaluation and was maintained over the follow-up. No side effects were noted. Conclusion: CsA CE has been proposed as a treatment for severe forms of VKC. This study has shown that administration 4 times a day is also effective in the treatment of moderate forms of VKC in children.

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“…Although we have presented only two cases, few studies to date have discussed the advantages of excision of shield ulcers to interrupt the course of the disease. A database search in PubMed, ScienceDirect, Scopus, Google Scholar, SciELO, and LILACS yielded the following articles on the subject (in chronological order): Solomon et al [12], Ozbek et al [8], Fukuda et al [13], Caputo et al [14], Reddy et al [5], Mushtaq et al [9], Cameron [15], and Das [16] ( Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…The results obtained by Ozbek et al [8], Fukuda et al [13], Mushtaq et al [9], and Das [16] were excellent. Caputo et al [14] found that, among 700 children under treatment, four developed shield ulcers, and they all experienced good disease resolution after plaque removal. Excimer laser phototherapeutic keratectomy was employed as an auxiliary treatment in three eyes with shield-shaped corneal ulcers and plaques caused by vernal keratoconjunctivitis [19].…”

Section: Discussionmentioning

confidence: 99%

Surgical debridement of corneal shield ulcers in pediatric patients: two case reports and a review of the literature

et al. 2020

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Background: Ocular allergy is a common disease, especially in the pediatric population, with unpleasant and longterm consequences, including corneal complications and decreased visual acuity. This study reports two cases of corneal shield ulcer due to vernal keratoconjunctivitis, with good results of surgical debridement performed after failure of long-term clinical treatment. Furthermore, this study highlights that this therapeutic approach, although less common, is efficient in treating refractory cases that cause suffering in pediatric patients. Case presentation: The first patient was a 7-year-old Caucasian boy with chronic ocular allergy, especially photophobia, who had been treated with eye drops, antihistamine, and corticosteroids for 60 days without success. Biomicroscopy of the right eye showed the presence of gelatinous limbus, giant papillae in the tarsal conjunctiva, and a shield ulcer measuring 6.0 mm vertically and 2.7 mm horizontally. Surgical debridement was performed, and the ulcer did not recur. The second patient was a 4-year-old Caucasian boy with chronic ocular allergy, especially itching and photophobia, who had been treated with eye drops for 1 year without success. Biomicroscopy of the left eye showed a shield ulcer, with a dense central corneal plaque, measuring 8 mm vertically and 3.5 mm horizontally. Surgical debridement of the ulcer was performed immediately because of the chronicity of the case and severity of the lesion, and the treatment was effective. Conclusions: The treatment of shield ulcers caused by vernal keratoconjunctivitis in the two reported cases was curative and definitive by surgical debridement in the 7-month follow-up period. Therefore, the early debridement of shield ulcers refractory to drug treatment can considerably reduce the time of disease evolution and the probability of ocular complications caused by clinical treatment or disease chronicity. However, this approach is rarely described in the literature and needs to be included in the ophthalmologist's therapeutic arsenal.

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Surgical Debridement Plus Topical Cyclosporine a in the Treatment and Vernal Shield Ulcers

Cited by 7 publications

References 25 publications

Surgical Treatment of Corneal Shield Ulcer in Vernal Keratoconjunctivitis: A Systematic Review

Surgical Treatment of Corneal Shield Ulcer in Vernal Keratoconjunctivitis: A Systematic Review

Efficacy of a Cationic Emulsion of Cyclosporine in Moderate Vernal Keratoconjunctivitis

Surgical debridement of corneal shield ulcers in pediatric patients: two case reports and a review of the literature

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