Systematic review and meta-analysis of randomised clinical trials on topical treatments for vernal keratoconjunctivitis

Abstract

Aims: The aim of this study was to assess the efficacy of currently available topical drugs for vernal keratoconjunctivitis (VKC) through a meta-analysis of randomised clinical trials (RCTs). Methods: Twenty-seven RCTs (n = 2184 eyes) that had evaluated the efficacy of topical drugs for the treatment of VKC were selected according to the set criteria; 10 of these trials were suitable for statistical analysis and were enrolled in the meta-analysis. Articles published up to December 2005 were identified from the following data sources: Medline, Embase, Lilacs, the Cochrane Controlled Trials Register, and references from relevant articles. Articles in any language published with an English abstract, were screened, and those selected for inclusion were written in English, French, German, Italian, Portuguese or Spanish. The quality of the trials was assessed by the Delphi list. Statistical analysis was performed using STATAH software. Results: A significant improvement in all signs and symptoms, except photophobia, was observed after topical treatment for active VKC, independent of the type of treatment. Comparison of the efficacy of different drugs was not possible due to a lack of standardised criteria among studies. Conclusion:The currently available topical drugs are effective in treating acute phases of VKC. However, there is a lack of evidence to support the recommendation of one specific type of medication for treating this disorder. There is a need for standard criteria to assess diagnosis and therapy based on severity. There is also a need for RCTs assessing long-term effects of single drugs to control the disease and to prevent complications. V ernal keratoconjunctivitis (VKC) is a recurrent bilateral chronic allergic inflammatory disease of the ocular surface affecting mainly young males in the first decade of life. Diagnosis is based on signs and symptoms including itching, photophobia, sticky mucous discharge, giant papillae on the upper tarsal conjunctiva or at the limbus, superficial keratopathy and corneal shield ulcer. An immunopathogenic mechanism has been proposed for this disease on the basis of personal or familial history of atopy, increased serum levels of total and specific IgE, the response to antiallergic therapy and the presence of several immune cells and mediators in the conjunctiva. [1][2][3] At present, the exact pathogenic mechanism has not been completely identified. In spite of its generally benign and selflimited presentation, therapeutic measures are required to control signs and symptoms of the disease and to avoid the longstanding permanent inflammatory sequelae that may lead to fibrovascular reaction, new collagen deposition, tissue remodelling and permanent visual damage. 1-3Several reports indicate that topical anti-inflammatory and antiallergic eye-drops are the mainstay of treatment for VKC, but a gold-standard treatment has not yet been established for this disease. In the present report, we systematically reviewed RCTs and conducted a meta-analysis of the combined results ...

Topical Cyclosporine A 0.05% Eyedrops in the Treatment of Vernal Keratoconjunctivitis – Randomized Placebo-Controlled Trial

“…VKC mainly affects boys in their first decade of life and the sequelae of the disease may be responsible for permanent visual impairment. Diagnosis is based on symptoms and signs including itching, photophobia, sticky mucous discharge, giant papillae on the upper tarsal conjunctiva or at the limbus, Trantas' dots, superficial keratopathy, and corneal shield ulcer [1][2][3]. Recent studies have documented various alterations of cornea, conjunctiva and tear film in VKC patients [4][5][6].…”

A Clinical Study of Vernal Keratoconjunctivitis

“…Diagnosis is based on signs and symptoms including itching, photophobia, sticky mucous discharge, and giant papillae on the upper tarsal conjunctiva or at the limbus, superficial keratopathy and corneal shield ulcer. 1 The distribution of vernal conjunctivitis is worldwide accounting from 0.1% to 0.5% of patients with ocular problems. 2 The disease is usually seasonal, lasting from the beginning of spring until autumn.…”

Ocular allergy latin american consensus

“…Advances in the understanding of ocular allergic disorders mechanisms have provided foundation for more rational guidelines of treatment of these diseases. The goals of therapy should include not only the control of signs and symptoms, but also improvement of ocular health of patients with ocular allergies (2,4,6,19) . Panelists suggested measures including environmental control and avoidance of allergens, which might be achieved by removing allergens source or changing occupational venue, as first line treatment.…”