Long Term Outcomes of Surgical Excision of Giant Papillae with Mitomycin C and Amniotic Membrane Transplantation in the Treatment of Refractory Palpebral Vernal Keratoconjunctivitis.

Moushmi Patil,Jodhbir S Mehta

doi:10.3390/medicina58010019

Abstract

Background and Objectives: To report the long-term outcomes of patients with refractory Vernal Keratoconjunctivitis (VKC) who underwent surgical excision of giant papillae (GP) with mitomycin C (MMC) 0.02% and amniotic membrane transplantation (AMT). Materials and Methods: This is a retrospective interventional single-center case series including five eyes of four patients who had refractory, symptomatic VKC with GP, along with corneal shield ulcers and/or punctate epithelial erosions. They underwent surgical excision of GP with MMC 0.02% alone (1 eye) or with MMC 0.02% and AMT (4 eyes). Their long-term visual and surgical outcomes were studied. Results: All subjects were male with bilateral involvement and mean age of presentation 9.8 years. The surgery was uneventful in all cases. Amongst the four eyes which underwent MMC with AMT, only one eye demonstrated papillary regrowth requiring repeat surgery. Postoperative follow-up ranged from 59 to 77 months (median 66 months). Four patients had the best corrected visual acuity (BCVA) >/= 6/9.5. One patient had BCVA 6/15 at the final follow-up due to the presence of anterior corneal stromal scar and poor ocular surface. Conclusions: Surgical excision of GP in combination with MMC and AMT, in refractory VKC, is a good treatment option with better clinical outcomes over a longer follow-up.

Highlights

Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, allergic inflammation of the ocular surface, which predominantly involves the upper tarsal and/or limbal conjunctival surface [1,2]
Shield ulcers can result in decreased visual acuity due to scarring of centrally located ulcers, delayed re-epithelization, and superimposed microbial keratitis [14,15]
Severe Vernal Keratoconjunctivitis (VKC) can lead to permanent visual loss in children [16], and it is essential to have a multidisciplinary approach closely collaborated amongst the ophthalmologist, pediatrician, and allergist [17]

Summary

Introduction

Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, allergic inflammation of the ocular surface, which predominantly involves the upper tarsal and/or limbal conjunctival surface [1,2]. To report the long-term outcomes of patients with refractory Vernal Keratoconjunctivitis (VKC) who underwent surgical excision of giant papillae (GP) with mitomycin C (MMC) 0.02% and amniotic membrane transplantation (AMT). Materials and Methods: This is a retrospective interventional single-center case series including five eyes of four patients who had refractory, symptomatic VKC with GP, along with corneal shield ulcers and/or punctate epithelial erosions. They underwent surgical excision of GP with MMC 0.02% alone (1 eye) or with MMC 0.02% and AMT (4 eyes). Conclusions: Surgical excision of GP in combination with MMC and AMT, in refractory VKC, is a good treatment option with better clinical outcomes over a longer follow-up

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Discussion

Conclusion