Vernal Keratoconjunctivitis Patients Research Articles

To study efficacy of tacrolimus (0.03%) Eye ointment, cyclosporine (0.1%) eye drops and fluorometholone (0.1%) eye drops in vernal keratoconjunctivitis

VKC (Vernal keratoconjunctivitis) is a chronic, bilateral ocular inflammatory disorder that primarily impacts young patients. Management of VKC is challenging due to its complex immunological etiology and chronic inflammatory components. This prospective, single-center, randomized study was executed at the Outpatient Department of Ophthalmology, SGT Medical College, Hospital and Research Institute (FMHS), Budhera, Gurugram, for a duration of 18 months. A total of 102 clinically diagnosed VKC patients, aged above 5 years, have been then randomly divided into 3 groups (34 each). Group A received fluorometholone (0.1%) eye drops, Group B received cyclosporine (0.1%) eye drops, and Group C received tacrolimus (0.03%) eye ointment. Patients were evaluated at days 0, 7, 14, 28, 35, and two weeks post-medication using the Clinical Scoring System by Bleik and Tabbara to assess TSSS (Total Subjective Symptom Score) and TOSS (Total Objective Ocular Sign Score). Most patients were between 6-10 years old, with over 78% being males. Group A showed significant symptom reduction from the first week (mean TSSS reduction from 2.29±0.46 to 0.21±0.41, p<0.0001), while Groups B and C showed significant improvements from the second week (Group B: mean TSSS reduction from 2.5±0.51 to 0.12±0.33, p<0.0001; Group C: mean TSSS reduction from 2.29±0.46 to 1.00±0.00, p<0.0001). Conjunctival hyperemia and tarsal papillae improvements were more pronounced in Group B as compared to Groups A & C. No ocular complications were found, except for dose-dependent irritation in Group C. While fluorometholone (0.1percent) eye drops provided early symptom relief, its effects were not sustained. Cyclosporine (0.1percent) eye drops and tacrolimus (0.03percent) eye ointment showed delayed but sustained efficacy, making them suitable for long-term treatment of moderate to severe VKC. Fluorometholone may be used initially alongside immunomodulators for rapid symptom relief, followed by tapering as immunomodulators take effect.

Evaluation of Meibomian Gland Structure and Function in Patients with Vernal Keratoconjunctivitis Using Non Contact Meibography and Lipid Layer Interferometry

ABSTRACT Purpose This study evaluated the structural and functional impact of vernal keratoconjunctivitis (VKC) on meibomian glands (MGs) using a combination of noncontact meibography and lipid layer interferometry. Methods In this observational study 50 patients with moderate persistent or severe VKC and 50 age-matched controls underwent MG imaging and lipid layer thickness (LLT) measurements with Lipiview II. Image J software was used to assess MG loss (meibograde) in both lids. All patients underwent dry eye evaluation comprising tear break-up time (TBUT), ocular surface staining (OSS), Schirmer I scoring, and meiboscoring (expressibility and quality of meibum secreted). Results Meibograde, OSS score, and meiboscore was higher in cases (2.68 ± 0.96, 0.580 ± 1.07, and 0.56 ± 0.95 respectively) than controls (1.80 ± 0.67, 0.00 ± 0.00, 0.22 ± 0.47 respectively) (p < 0.001, 0.001, 0.025 respectively). LLT and TBUT was lower in cases (54.58 ± 9.43 nm and 4.92 ± 3.09 sec respectively) than controls (70.14 ± 22.50 nm and 12.02 ± 2.73 sec respectively) (both p’s = 0.001). Both groups had comparable Schirmer I scores. Conclusion Children with VKC have significant MG dropouts, deterioration in meibum quality and a thinner and less stable tear film. VKC patients are thus prone to a vicious cycle of inflammation attributable both to the allergic component and to deterioration in MG structure and function. Co-management of MG dysfunction warrants as much attention as the allergic component itself.

Endoplasmic Reticulum Stress and Unfolded Protein Response in Vernal Keratoconjunctivitis.

Vernal keratoconjunctivitis (VKC) is an ocular allergic disease characterized by a type 2 inflammation, tissue remodeling, and low quality of life for the affected patients. We investigated the involvement of endoplasmic reticulum (ER) stress and unfolded protein response in VKC. Conjunctival imprints from VKC patients and normal subjects (CTs) were collected, and RNA was isolated, reverse transcribed, and analyzed with the Affymetrix microarray. Differentially expressed genes between VKC patients and CTs were evaluated. Genes related to ER stress, apoptosis, and autophagy were further considered. VKC and CT conjunctival biopsies were analyzed by immunohistochemistry (IHC) with specific antibodies against unfolded protein response (UPR), apoptosis, and inflammation. Conjunctival fibroblast and epithelial cell cultures were exposed to the conditioned medium of activated U937 monocytes and analyzed by quantitative PCR for the expression of UPR, apoptosis, autophagy, and inflammatory markers. ER chaperones HSPA5 (GRP78/BiP) and HYOU1 (GRP170) were upregulated in VKC patients compared to CTs. Genes encoding for ER transmembrane proteins, PKR-like ER kinase (PERK), activating transcription factor 6 (ATF6), ER-associated degradation (ERAD), and autophagy were upregulated, but not those related to apoptosis. Increased positive reactivity of BiP and ATF6 and unchanged expression of apoptosis markers were confirmed by IHC. Cell cultures in stress conditions showed an overexpression of UPR, proinflammatory, apoptosis, and autophagy markers. A significant overexpression of genes encoding for ER stress, UPR, and pro-inflammatory pathway components was reported for VKC. Even though these pathways may lead to ER homeostasis, apoptosis, or inflammation, ER stress in VKC may predominantly contribute to promote inflammation.

Reserve drug as first-line management: Topical interferon α-2b for vernal keratoconjunctivitis.

To elucidate the efficacy and safety profile of interferon α-2b in vernal keratoconjunctivitis (VKC). In this prospective interventional study, VKC patients fulfilling the inclusion and exclusion criteria were included and their signs and symptoms were scored based on the Clinical Scoring System. Patients were treated with topical interferon α-2b eye drop (1 MIU/ml) QID dosing for 6 weeks. Changes in symptoms and signs were evaluated at 2, 4, 8 weeks and 6 months after initiating treatment. A higher score meant severe disease, and a decline in score meant improvement in clinical signs and symptoms. Categorical variables were presented in number and percentage (%) and continuous variables as mean ± standard deviation (SD). Post-medication total subjective symptom score (TSSS) and total objective sign score (TOSS) were compared with baseline, and a P- value of <0.05 was considered significant. Possible ocular and systemic complications were evaluated. The study included 40 patients (32 male and eight female) with a mean age of 8.05 ± 2.33 years. Mean baseline TSSS and TOSS were 6.71 ± 0.564 and 6.59 ± 0.262, respectively, which reduced to 2.71 ± 0.011 ( P = 0.040) and 2.96 ± 0.210 ( P = 0.032), respectively, at 4 weeks and further reduced to 0.42 ± 0.552 and 0.47 ± 0.434, respectively, at 8 weeks. After 6 months of stopping the drug, mean TSSS and TOSS did increase to 2.80 ± 0.820 ( P = 0.044) and 2.50 ± 0.520 ( P = 0.030), respectively, but was still statistically significant improvement compared to the baseline. Also, no ocular or systemic side effects were observed anytime during the study period. Eye drop interferon α-2b (1 million IU/ml) is a safe and effective option as first-line monotherapy for VKC. No side effects and recurrence were observed for 6 months.

Ocular Complication in Vernal Keratoconjunctivitis Patients

Background: Vernal keratoconjunctivitis (VKC) is a chronic ocular allergic condition predominantly affecting the pediatric population. It is characterized by severe inflammation of the conjunctiva and cornea, leading to a spectrum of complications if not adequately treated. The prevalence and impact of VKC vary geographically and demographically, necessitating region-specific investigations to understand its epidemiology, clinical manifestations, and outcomes. Objective: The study aimed to investigate the distribution of VKC types among affected individuals in a specific region, identify the prevalence of associated ocular complications, and evaluate the demographic characteristics of the patient population. Methods: This descriptive study was conducted over an 8-month period, assessing 200 patients diagnosed with VKC at the outpatient department of ophthalmology in HMC Peshawar. Patients were included based on recurrent signs and symptoms of VKC, excluding those with other ocular conditions. A comprehensive ophthalmic examination was performed, encompassing uncorrected and corrected visual acuity tests, anterior slit lamp examination, fundus examination with a 78D lens, intraocular pressure measurement using a Goldman applanation tonometer, and keratometry. Corneal topography was conducted for suspected cases. Data were analyzed using SPSS version 25.0, focusing on the distribution of VKC types, gender prevalence, and complication rates. Results: The study revealed a significant male predominance (73%) among VKC patients, with the limbal type being the most common form of the condition (45%). Complications were observed in 21% of the patients, with irregular astigmatism (35.7%) and keratoconus (26.2%) being the most prevalent. The gender distribution and types of VKC highlighted the need for targeted clinical attention, especially considering the potential for serious complications such as corneal scarring, cataract, and glaucoma. Conclusion: VKC remains a significant pediatric ocular health concern, with a marked male predominance and a high incidence of complications that can impact the quality of life. Early diagnosis, effective management, and regular follow-up are crucial to mitigate the risk of long-term visual impairment. The findings underscore the importance of awareness and education among healthcare providers and caregivers regarding the potential severity of VKC and the necessity for timely intervention.

Burden of Vernal Keratoconjunctivitis in the United States: A Retrospective Claims Database Analysis

In this claims analysis, vernal keratoconjunctivitis (VKC) patients (≤18 years) treated with immunomodulators or corticosteroids had more corneal complications and higher ophthalmic care costs versus matched non-VKC controls, indicating a need for more effective treatments.

Long-Term Observation of Prognostic Factors and Clinical Outcome of Vernal Keratoconjunctivitis in Childhood.

Vernal keratoconjunctivitis (VKC) is a refractory ocular allergic disorder that mainly affects boys. Long-term follow-up has been rarely reported for VKC. We investigated the long-term clinical outcome of VKC to identify relevant clinical features of prognostic value based on follow-up for a median of 70 months. In total, 45 consecutive patients clinically diagnosed with VKC aged 4 to 12 years at onset at the Department of Ophthalmology of Fukuoka University Hospital were included. Patients were treated with immunosuppressive eye drops without simultaneous corticosteroid eye drops, except for the occurrence of exacerbations. Collated variables were gender, age at onset, clinical score of ocular lesions (conjunctival giant papillae, limbal edema and corneal epithelial lesions) at the first visit, and clinical score of atopic dermatitis (AD) at baseline. Cumulative cure rate was estimated using Kaplan-Meier method. A binomial logistic predictive model was used to determine the most reliable clinical predictors of VKC outcome. The observation period ranged from 24 to 188 months, with median of 70 months. Among the 45 cases enrolled, all non-cured cases (14 cases) observed clinically were complicated by AD. Cumulative cure rate was 74.5% and 84.9% at eight- and ten-year follow-up, respectively. Ten-year cumulative cure rates of cases with and without AD were 50.5% and 100%, respectively, and a significant difference was found between these cumulative cure curves. Binomial regression analysis revealed that AD and gender were significantly related to worse outcome, and this binomial regression model had high sensitivity and specificity. This study demonstrated that th eclinical outcomeof VKC might be predicted by several factors that can beobtained in the early clinical phase. Information on the long-term prognosis of VKC patients might play an important role for precision medicine for VKC in childhood.

Long-Term Clinical Outcome of Tacrolimus Skin Ointment (0.03%) for the Treatment of Vernal Keratoconjunctivitis: A Quasi-Experimental Study.

Background Vernal keratoconjunctivitis (VKC) is an allergic conjunctival inflammation with severe ocular complications if left untreated. The current management regimen is plagued with adverse effects, long-term problems, and clinical relapses. Tacrolimus offers an alternative treatment option, and long-term studies are needed to determine its efficacy. Methods A two-year follow-up based study was conducted on moderate to severe VKC patients, who were prescribed tacrolimus skin ointment. The 5-5-5 exacerbation scale was used for the monitoring and grading severity of the disease. Analysis of variance (ANOVA) and intergroup comparisons were conducted on exacerbation scale scores among follow-ups. Results A significant reduction was observed in the total score of severity from baseline (203.17±102.05) to three months' follow-up (69.94±70.54), and it kept reducing for 18 months post therapy. Similar results with statistically significant reduction were observed for all grades of the scale. The relapse rate was 5.71% within a month after therapy cessation, and none of the other patients showed relapse afterward. No significant ocular and systemic complications were observed during the study. Conclusion Tacrolimus is effective in the long-term management of VKC without the complications of conventional steroid-based therapy.

Classification of Subtypes of Vernal Keratoconjunctivitis by Cluster Analysis Based on Clinical Features.

Vernal keratoconjunctivitis (VKC) is a refractory ocular allergic disorder that mainly affects boys. A few studies have attempted to develop a classification of subtypes of VKC. In this study, we investigated a computational approach called cluster analysis to separate VKC cases into groups based on clinically relevant characteristics. In total, 41 consecutive patients clinically diagnosed with VKC at the Department of Ophthalmology of Fukuoka University Hospital were included. Patients were treated with immunosuppressive eye drops without simultaneous corticosteroid eye drops, except for the occurrence of exacerbations. Collated variables were age at onset, clinical score of ocular lesions at baseline, clinical score of ocular lesions at final visit, clinical score of atopic dermatitis (AD) at baseline, frequency of exacerbations of VKC, serum total IgE level and peripheral blood eosinophil count. VKC patients were grouped into three clusters by cluster analysis, and cluster 1, 2, and 3 comprised 25, 9 and 7 cases, respectively. There were differences in the incidence of complications of AD and age at onset among the clusters; therefore, we named the three clusters for better understanding as traditional VKC (cluster 1), early-onset atopic keratoconjunctivitis (AKC)/VKC (cluster 2) and puberty-onset AKC (cluster 3). We found in this study that VKC in childhood has three phenotypes which were previously unknown. Our findings may help to establish precision medicine by focusing on the phenotype of each case to develop individualized medicine to prevent exacerbations.

Clinical Profile of Vernal Keratoconjunctivitis (VKC) Patients: A Retrospective Study at a Peripheral Combined Military Hospital in Bangladesh

Background: Vernal keratoconjunctivitis (VKC) is an allergic eye disease that especially affects young boys. The most common symptoms are itching, photophobia, burning, and redness. This study was conducted to assess the clinical profile of vernal keratoconjunctivitis (VKC) among the local population reported at a peripheral combined military hospital over 1 year. This study aimed to analyze the cases of vernal keratoconjunctivitis at a peripheral combined military hospital. Material &amp; Methods: This is a retrospective study carried out in the Department of Ophthalmology at Combined Military Hospital, Saidpur. A total number of 110 patients with VKC were diagnosed based on their history, clinical features, and characteristic symptoms and sign over a period of 1 year from Jan 2021 to Dec 2021. Best-corrected visual acuity (VCVA) was assessed and each patient was thoroughly examined with a Slit Lamp Bi microscope, Fluorescein staining, and Tear film break-up time. Follow-up was done every 4 weeks, 3 months, and 6 months for 01 year. A purposive sampling technique was used in this study. Data was collected by a pre-designed questionnaire. All data were analyzed using SPSS version 20 (IBM Corp, Armonk, NY, USA) results were compiled in the frequency distribution table. Informed written consent was taken from all participants. Ethical clearance was obtained by the ethical committee of CMH. Results: Out of 110 patients, 80 (72.72%) were male and 30 (27.27%) were female. The highest incidence of VKC occurred in the age group of 11–15 years. In maximum cases 70 (63.63%) had palpebral form followed by mixed form 25 (22.72%) and then bulbar form 15 (13.63%). Corneal complications occurred in 27 (24.54%) patients; Out of 27, 25 patients had minor complications and 2 had major complications. The minor complications were usually superficial punctate keratopathy (SPK) or other epithelial disturbance. Major complications were superior pannus and pseudogerontoxon. Although patients with VKC often give a history of allergies or atopic diseases such as allergic rhinitis, asthma, or hay fever, in the present study, coexisting allergic conditions could be detected only 40 (36.36%) patients. Conclusion: VKC is a common form of allergic conjunctivitis among the age group of 11–15 years of male patients. The most common is the palpebral form followed by mixed and then bulbar forms. Some cases showed a history of atopy and other allergic conditions.

A survey‐based study on diagnosis and management of vernal keratoconjunctivitis

A survey‐based study on diagnosis and management of vernal keratoconjunctivitis

Evaluation of dry eyes in children with vernal kerato-conjunctivitis using clinical tests and ocular surface analysis.

To evaluate dry eyes in children with vernal kerato-conjunctivitis (VKC) and correlate it with symptoms, clinical findings, and ocular surface analysis (OSA) parameters. Children with clinically diagnosed VKC underwent complete ophthalmological examination, Schirmer's testing, modified ocular surface disease index (OSDI) scoring, Bonini grading, fluorescein tear-film break-up time (TBUT), VKC - Collaborative Longitudinal Evaluation of Keratoconus (CLEK) scoring, and OSA. Children with a TBUT of < 10 s were defined to have dry eyes. The above-mentioned parameters were compared between dry eye and non-dry eye VKC children. The mean age of the 87 children included in the study was 9.1 ± 2.9 years. Dry eyes were seen in 60.9% [95% confidence interval (CI); 51% to 71%]. The mean TBUT was 13.4 ± 3.8 and 5.9 ± 1.9 s in non-dry and dry eye groups, respectively (P < 0.001). The mean value of Schirmer's test was 25.9 ± 9.8 and 20.8 ± 8.6 mm in the non-dry and dry eye groups, respectively (P = 0.01). The two groups did not differ in their OSDI scores, Bonini grading, and CLEK scores. The OSA parameter of non-invasive break-up time (NIBUT) was 8.3 ± 3.2 s in non-dry eye group and 6.4 ± 2.9 s in dry eye group, P = 0.008. The lower lid Meibomian gland (MG) loss was 7.4% in non-dry eye group and 12.2% in dry eye group, P = 0.028. Other OSA parameters did not differ significantly among the two groups. Dry eyes are seen in two-thirds of pediatric VKC. Evaluation of dry eyes should be incorporated in their clinical evaluation. Among OSA parameters, NIBUT and lower lid MG loss are associated with dry eyes in pediatric VKC patients.

Prevalence of dry eye disease in the patients of allergic conjunctivitis: Hospital-based cross-sectional study.

Allergic conjunctivitis (AC) is commonly associated with dry eye. This study was conducted to assess the prevalence of dry eye in different subsets of AC patients. This observational, cross-sectional study, conducted in the Department of Ophthalmology of a tertiary center in north India, included 132 patients of AC. The diagnosis of dry eye disease (DED) was made on the basis of Ocular Surface Disease Index (OSDI), Schirmer's test, and tear film break-up time (TFBUT). The prevalence of dry eye in AC patients was found to range between 31% and 36%. On OSDI scoring, 20.45% of patients had mild, 18.18% moderate, and 31.81% had a severe grade of DED, respectively. The mean OSDI score was noted to be significantly higher in patients with perennial allergic conjunctivitis (PAC) (29.82 ± 12.41), followed by seasonal allergic conjunctivitis (SAC) (25.35 ± 12.88), and least in the patients of vernal keratoconjunctivitis (VKC) (13.60 ± 8.63) (p < 0.0001), respectively. The TFBUT was found to be less than 10 s in 45.45% of PAC, 30.43% of SAC, and 20% of VKC patients, respectively. The difference between the mean TFBUT among the three groups was statistically insignificant (p = 0.683). Schirmer's test value of <10 mm was observed in 45.45% of PAC, 43.47% of SAC, and 10% of VKC patients, respectively. This study revealed a high prevalence of DED in patients with AC. Among the different types of AC patients, PAC had the highest percentage of DED followed by SAC and least in VKC, respectively.

Clinical Study on Corneal Topographical Changes in Vernal Keratoconjunctivitis by Using OCULUS Pentacam®.

To evaluate the corneal topographical changes in vernal keratoconjunctivitis (VKC) subjects using OCULUS Pentacam. This was a cross-sectional study. VKC patients and normal subjects who fulfilled the inclusion and exclusion criteria were recruited by convenience sampling into the study. Subjects underwent a best-corrected visual acuity measurement with a Snellen chart, retinoscopy, and corneal topography (OCULUS Pentacam®), followed by anterior segment and fundus examination and intraocular pressure measurement. Data were collected and analyzed using SPSS version 26.0 for Windows (SPSS Inc. Chicago, IL, USA). A p-value <0.05 was considered statistically significant. A total of 78 eyes of 43 VKC patients and 84 eyes of normal subjects were included in the study. Most of the VKC subjects were Malay males aged 10 years or less. A majority (71.8%) had palpebral VKC of five years duration or less (57.7%) and presented between the ages of six and 10 years (44.9%). Central corneal curvature and astigmatism were significantly higher in VKC subjects compared to the normal population (p < 0.05). The minimal pachymetry was significantly lower with a longer duration of VKC (p < 0.05). Older age of presentation of VKC was associated with higher central corneal curvatures and thinner minimal pachymetry (p < 0.05). There was no association between the type of VKC and corneal topography changes. The prevalence of keratoconus and subclinical keratoconus among VKC subjects was 10.3% and 11.5%, respectively. Longer duration and older age of presentation of VKC are associated with significant corneal topographical changes, thus exposing them to a higher risk of the future development of keratoconus.

Comparision of efficacy and safety of 0.03% and 0.1% tacrolimus ointment in children with vernal keratoconjunctivitis.

Topical immunosuppressants such as tacrolimus in different concentrations are a breakthrough in the management of recalcitrant vernal keratoconjunctivitis (VKC); however, there is a lacks of comparative studies to guide their use in VKC management. To compare the efficacy and safety of tacrolimus 0.03% and 0.1% eye ointment in the treatment of recalcitrant VKC. A retrospective comparative single-centre observational study. We reviewed records of a total of 48 recalcitrant VKC patients treated with two different strengths of tacrolimus ointment between April 2016 and March 2017. Of these, 39 fulfilled the inclusion criteria and were categorized into two groups, A and B, depending on the use of strength of tacrolimus (0.03% and 0.1%) used, respectively. Group A had 18 patients, while group B had 21 patients. Thirty-six patients, 18 from each group, were finally analysed and compared. Records of patients were explored for the subjective symptoms and objective sign score of the patient at baseline and at each time point. The main outcome measures were composite scoring and comparison of total subjective symptom scores (TSSSs) and total objective sign scores (TOSSs) within and between the groups at each follow-up. Percentage of patient with significant reduction in symptom and sign scores as compared with baseline was considered success of treatment. Chi-square and t-tests were used for comparison of outcomes between both groups. Mixed variety was most commonly encountered type of VKC. The signs and symptoms were significantly reduced in patients with treatment in both groups (p = 0.001) in all types of VKC. However, in group B, there was significant improvement in the size of papillae (p = 0.04) as compared baseline in contrast to group A. Side effects like burning and stinging in group B were significantly higher as compared with group A. Both strengths of tacrolimus (0.03% and 0.1%) are effective in all forms of recalcitrant VKC. Papillary component of VKC responds better with higher strength (0.1%) but is associated with more significant side effects. Different strengths of tacrolimus can be used strategically depending upon the severity and clinical type of VKC to intensify outcome and minimize side effects.

The effects of topical 0.1% cyclosporin treatment on the corneal topography, pachymetry, and densitometry values in severe pediatric vernal keratoconjunctivitis patients

The effects of topical 0.1% cyclosporin treatment on the corneal topography, pachymetry, and densitometry values in severe pediatric vernal keratoconjunctivitis patients

Corneal biomechanical properties in vernal keratoconjunctivitis and its subtypes: a preliminary study.

To explore the corneal biomechanical properties (CBPs) of patients with vernal keratoconjunctivitis (VKC) and the discrepancies among three subtypes of VKC including palpebral, limbal, and mixed forms. Forty eyes of 20 VKC patients and twenty eyes of ten non-VKC patients were included in this case-control study. Patients with VKC were further divided into three subtypes (six patients in Palpebral form, five patients in limbal form, and nine patients in mixed form). The CBPs of all patients were obtained from the Corneal Visualization Scheimpflug Technology (Corvis ST). First applanation (A1) length, Ambrosio relational thickness in horizontal (ARTh), and stiffness parameter at first applanation (SP-A1) were significantly lower in the VKC group while A1 velocity was significantly higher in the VKC group (p < 0.05), compared to the non-VKC group. Furthermore, A1 velocity presented a positive correlation with disease course (p < 0.05). In addition, VKC patients of limbal form had lower central corneal thickness (CCT), SP-A1, and higher deformation amplitude ratio (DA ratio), compared to the other two subtypes (p < 0.05). Besides, patients in limbal form had higher A1 velocity, integrated radius, and corneal biomechanical index (CBI) compared with mixed form, and lower A1 length than palpebral form (p < 0.05). The corneas of VKC patients were softer and more protruded compared with the control group, and the property of steepness was closely related to disease course. VKC patients in limbal form were more inclined to be keratoconus than the other two subtypes due to their CBPs` discrepancies.

Prevalence of steroid-induced glaucoma among patients suffering from vernal kerato-conjunctivitis in central India

The present study is aimed to assess the prevalence of steroid-induced glaucoma in vernal kerato-conjunctivitis patients treated with topical steroids and to determine the association between different types of topical steroids and the presence of steroid-induced glaucoma. This study was conducted as a hospital-based cross-sectional study on patients belonging to the age range of 8 years to18 years who were already diagnosed with vernal kerato-conjunctivitis and were using topical steroids as treatment. Detailed clinical history and ophthalmologic examination were done. Depending upon the potency of steroids and their intra-ocular pressure raising potential, patients were categorized into one of the 4 groups (A, B, C, D). Intra-ocular pressure levels were raised in 32.9% of the patients managed with topical corticosteroids. Steroid-induced glaucoma was observed in 15 (6.1%) of the patients with vernal kerato-conjunctivitis. Steroid-induced glaucoma was significantly associated with prolonged duration of corticosteroids and high potency corticosteroid use (p&amp;#60;0.05). Steroid-induced glaucoma is one of the common complications of injudicious and long-term use of topical corticosteroids particularly high potency steroids. Approximately one-third of the patients on treatment for vernal kerato-conjunctivitis are corticosteroid responders. High potency steroids and prolonged use of steroids are factors associated with steroid-induced glaucoma.

Ocular surface characteristics in pediatric vernal keratoconjunctivitis: a clinico-cytological study

To compare the ocular surface parameters of children with vernal keratoconjunctivitis (VKC) with those of healthy controls and to correlate cytological characteristics with clinical findings and disease severity. Newly diagnosed cases of VKC, not currently being treated, were recruited, along with age-matched controls with no ocular comorbidities. The Ocular Surface Disease Index questionnaire (OSDI) was administered to all children. Slit lamp biomicroscopy for meibomian gland dysfunction and ocular surface analysis was performed, including tear meniscus height, noninvasive tear film break-up time, lipid layer thickness, meibomian gland morphology, and meibomian gland duct distortion on meibography imaging. Conjunctival impression cytology was also performed. A total of 68 VKC patients and 33 controls were included. Statistically significant difference was seen in the mean OSDI score (30 ± 13.7 vs 16.1 ± 3 [P ≤ 0.01]), lipid layer thickness (24.2 ± 7.9 nm vs 69.9 ± 15.1 nm [P <0.001]), and noninvasive tear film break-up time (6.8 ± 1.7 vs 12.5 ± 1.8 sec [P < 0.01]) between groups. Mean tear meniscus height was 0.22 ± 0.06 mm in the VKC and 0.24 ± 0.04 mm in the control group (P = 0.096). Significant association was seen between grade of squamous metaplasia and severity of VKC (P<0.01). Severity of VKC was found to be positively correlated with OSDI score (r=0.767), grade of squamous metaplasia (r = 0.64) and negatively correlated with noninvasive tear film break-up time (r = -0.468), and lipid layer thickness (r = -0.253). This study highlights the poor ocular surface health of children with VKC, with severe disease being associated with worse forms of dry eye disease.

Using Survey Scale to Assess the Reduction in Intensity of Vernal Keratoconjunctivitis Symptoms after Administration of Drugs in Tertiary Care Hospital

Purpose:To establish the practicality of the survey scale in estimating baseline severity at the time of diagnosis and resolution of the vernal keratoconjunctivitis (VKC) symptoms after topical medication Study Design:Longitudinal survey design Place and Duration of Study: Ophthalmology department of Nishtar Medical Hospital, Multan.from June 2021 to November 2021 Methods: A total of 267 VKC (vernal keratoconjunctivitis) patients' data was filled in on preformed Google forms. Improvement in symptoms after follow-ups was recorded on it. Chi-squared test an Kruskal-Wallis test were employed to determine the statistical significance of the variables. Results:There were 52.4% females and mean age of the patients was 29.52+18.39 years. There was preponderance of patients falling under 20 years of age. At baseline, 63.3% patients were on topical steroids, while 5.6% of patients were using steroids at the second follow-up visit. The mean interval between patients’ visits to the hospital was 7.64 ± 2.086 weeks. Nonparametric Kruskal-Wallis test was used to calculate the difference in means of radial point scale scores at the baseline examination (4.47 ± 2.321) and second follow-up (1.31 ± 1.615) visits. Z-score value was 15.266 with a significance of 0.001. For patient satisfaction and resolution of symptoms at the second follow-up visit, Chi-square values were 164.75 and 119.55, respectively, with a significance of 0.001 in each case. Conclusion: The survey scale aided in quantifying disease symptoms, which can be useful in prescribing and adjusting the medications’ dosage easier.