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Alqurashi KA, Bamahfouz AY, Almasoudi BM. Prevalence and causative agents of allergic conjunctivitis and its determinants in adult citizens of Western Saudi Arabia: A survey. Oman J Ophthalmol 2020; 13:29-33. [PMID: 32174737 PMCID: PMC7050458 DOI: 10.4103/ojo.ojo_31_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/22/2019] [Accepted: 11/19/2019] [Indexed: 12/03/2022] Open
Abstract
PURPOSE: To estimate the prevalence of allergic conjunctivitis (AC) and its related allergic ailments among Saudi adults in the western region. METHODS: Adult population of Taif, Makkah, and Jeddah cities was surveyed from 2017 to June 2018. Subjective questionnaire was used to collect the response. Participants were asked about symptoms (redness, itching, watering, based diagnosis and details of AC, treatment taken in the pasts, and associated conditions, such as allergic asthma and rhinitis). The age-sex-adjusted prevalence, its determinants, and associations to other ailments were assessed. RESULTS: We surveyed 2187 participants (mean age 26.0 ± 9.1 years). The age-sex-adjusted prevalence of AC was 70.5% (95% confidence interval [CI] 68.6–72.4). There could be 2.1 million AC patients among 3.1 million adult populations in Western KSA. It was significantly higher in females compared to males (odds ratio [OR] = 1.7 [95% CI 1.4–2.2]). The risk of AC did not vary by age group (χ2 = 2.5, df = 3, P = 0.1). The variation of AC in three provinces was not significant (χ2 = 0.3, df = 3, P = 0.6). Dust (42.6%) and unknown (24.8%) allergens were the main causative agents of AC. AC was significantly associated to asthma (OR = 2.8) and allergic rhinitis (OR = 2.2). CONCLUSION: AC affects seven in ten adults in Western Saudi Arabia. AC is positively associated to allergic rhinitis and bronchial asthma. Public health policies at primary eye-care level should focus on early detection and care of persons with AC.
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Affiliation(s)
- Khaled A Alqurashi
- Department of Ophthalmology, Faculty of Medicine, Taif University, Taif, Saudi Arabia
| | - Ashjan Yousef Bamahfouz
- Department of Ophthalmology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.,Department of Ophthalmology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Bayan Mutlaq Almasoudi
- Department of Ophthalmology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Bruschi G, Ghiglioni DG, Osnaghi S, Rosazza C, Pires Marafon D, Landi M, Marchisio PG. Role of ocular cytology in vernal keratoconjunctivitis. IMMUNITY INFLAMMATION AND DISEASE 2019; 8:3-7. [PMID: 31804769 PMCID: PMC7016839 DOI: 10.1002/iid3.278] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/04/2022]
Abstract
Background Children with vernal keratoconjunctivitis (VKC) present symptoms that are similar to other ocular allergies, but more pronounced, and are controlled using topical steroids. To avoid excessive and prolonged use of topical steroid eye drops, over the past 20 years galenic eye drops of cyclosporine with a concentration of 1% to 2% and tacrolimus with a concentration of 0.1% have been introduced as a treatment for the severe and unresponsive forms. The main symptoms of VKC occur most frequently during the spring and tend to get worse during the summer, meaning that affected children tend to avoid exposure to sunlight. The aim of this study was to assess the most common cell types present in the conjunctiva of children with VKC, how ocular treatment can influence them, and whether affected children express a typical conjunctival pattern, which could be useful as a pathognomonic pattern of VKC, allowing us to study this rare eye disease. Method This was a cohort study of 56 children, of whom 17 were not receiving any treatment at the time of testing, 14 were using steroid eye drops or had taken them in the previous 10 days, and 25 were treated with cyclosporine eye drops or tacrolimus eye drops 0.1%. Result Children in group 1 (no topical therapy) express more epithelial cells, neutrophils, mast cells, eosinophils, and lymphocytes than the other two groups. Conclusion Given the ease of performance, when conducting further longitudinal studies, the conjunctival cytology examination could be used, on the one hand, to diagnose VKC, especially when the clinical diagnosis is uncertain, and, on the other, to follow disease evolution and monitor the response to topical treatment.
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Affiliation(s)
- Gaia Bruschi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Daniele G Ghiglioni
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Osnaghi
- Department of Ophthalmology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Rosazza
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Denise Pires Marafon
- Paediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Landi
- Pediatric National Healthcare System, Turin - Istituto di Biomedicina e Immunologia molecolare, Italian National Research Council, Palermo, Italy
| | - Paola G Marchisio
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Safety and Efficacy of Supratarsal Triamcinolone for Treatment of Vernal Keratoconjunctivitis in Ireland. Cornea 2019; 38:955-958. [PMID: 31276459 DOI: 10.1097/ico.0000000000001963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the clinical features, risk factors, and treatment outcomes after supratarsal injection of triamcinolone for vernal keratoconjunctivitis (VKC). METHODS A retrospective review of all patients treated with supratarsal triamcinolone for VKC between February 2002 and May 2017 at the Royal Victoria Eye and Ear Hospital and Our Lady's Children Hospital Crumlin, Dublin, Ireland, was performed. RESULTS Twenty-five patients, 46 eyes, and 145 injections were included for analysis. The mean age at first injection was 9.1 ± 5.7 years. Ninety-six percent of the patients were male. A seasonal variation was noted, with 59 injections (41%) of triamcinolone administered for acute and refractive cases of VKC in the summer compared with 35 (24%), 35 (24%), and 16 (11%) in the spring, autumn, and winter months, respectively. The most common presenting complaint was red eye, which was seen in all cases. Hay fever (64%) was the most common associated systemic disease. Each eye required, on average, 3.2 injections (range 1-9 injections), and the mean duration from the onset of symptoms to final treatment was 3.03 years (range 0-7.9 years). The mean presenting and final visual acuities were 0.33 and 0.11 logarithm of the minimum angle of resolution, respectively (P < 0.0001). During our study period, no patient experienced intraocular pressure rise requiring treatment, development of lenticular opacity, or ptosis after supratarsal injection of triamcinolone. CONCLUSIONS In this case series, supratarsal triamcinolone was used in cases of VKC in which topical medications had failed to control the disease process. All patients reported improvement after treatment. There were no cases of intraocular pressure rise, lenticular opacity, or ptosis development after treatment.
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Zicari AM, Capata G, Nebbioso M, De Castro G, Midulla F, Leonardi L, Loffredo L, Spalice A, Perri L, Duse M. Vernal Keratoconjunctivitis: an update focused on clinical grading system. Ital J Pediatr 2019; 45:64. [PMID: 31113464 PMCID: PMC6528205 DOI: 10.1186/s13052-019-0656-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/05/2019] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Vernal keratoconjunctivitis (VKC) is a severe disease with a prevalence of < 1 case out of 10,000 in Europe, which occurs mainly in pediatric age and is characterized by a severe and often bilateral chronic inflammation of the ocular surface. The diagnosis is generally confirmed by the finding at the ocular examination of conjunctival hyperemia, papillary hypertrophy in the tarsal conjunctiva, giant papillae, papillae in the limbus region. OBJECTIVE Aim of this review is to provide an updated overview on the disease focused on clinical grading system, searching papers published in the last decade on VKC in scientific databases. RESULTS Currently there are no standardized criteria for diagnosis of VKC and there is no uniformity to define disease severity, which makes difficult to diagnose and treat the disease. CONCLUSIONS Given the wide overlap of the symptoms of VKC with the allergic conjunctivitis, criteria of probable, possible or improbable diagnosis are needed, providing pediatricians with parameters useful for deciding whether to drive the patient to the ophthalmologist for diagnostic confirmation.
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Affiliation(s)
- A. M. Zicari
- Department of Pediatrics, “Sapienza” University of Rome, Viale Regina Elena 324, Rome, Italy
| | - G. Capata
- Department of Pediatrics, “Sapienza” University of Rome, Viale Regina Elena 324, Rome, Italy
| | - M. Nebbioso
- Department of Sense Organs, “Sapienza” University of Rome, Rome, Italy
| | - G. De Castro
- Department of Pediatrics, “Sapienza” University of Rome, Viale Regina Elena 324, Rome, Italy
| | - F. Midulla
- Department of Pediatrics, “Sapienza” University of Rome, Viale Regina Elena 324, Rome, Italy
| | - L. Leonardi
- Department of Pediatrics, “Sapienza” University of Rome, Viale Regina Elena 324, Rome, Italy
| | - L. Loffredo
- Department of Internal Medicine and Medical Specialities, “Sapienza” University of Rome, Rome, Italy
| | - A. Spalice
- Department of Pediatrics, “Sapienza” University of Rome, Viale Regina Elena 324, Rome, Italy
| | - L. Perri
- Department of Internal Medicine and Medical Specialities, “Sapienza” University of Rome, Rome, Italy
| | - M. Duse
- Department of Pediatrics, “Sapienza” University of Rome, Viale Regina Elena 324, Rome, Italy
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Singhal D, Sahay P, Maharana PK, Raj N, Sharma N, Titiyal JS. Vernal Keratoconjunctivitis. Surv Ophthalmol 2019; 64:289-311. [DOI: 10.1016/j.survophthal.2018.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
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Leonardi A, Doan S, Amrane M, Ismail D, Montero J, Németh J, Aragona P, Bremond-Gignac D. A Randomized, Controlled Trial of Cyclosporine A Cationic Emulsion in Pediatric Vernal Keratoconjunctivitis. Ophthalmology 2019; 126:671-681. [DOI: 10.1016/j.ophtha.2018.12.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 11/24/2022] Open
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Alemayehu AM, Yibekal BT, Fekadu SA. Prevalence of vernal keratoconjunctivitis and its associated factors among children in Gambella town, southwest Ethiopia, June 2018. PLoS One 2019; 14:e0215528. [PMID: 30998721 PMCID: PMC6472775 DOI: 10.1371/journal.pone.0215528] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/03/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Vernal keratoconjunctivitis is a chronic bilateral severe form of allergic conjunctivitis which affects normal activities in school/work. It is a severe form of allergies in warm and dry tropical and sub-tropical countries. Its prevalence in Ethiopia ranges from 5.2% to7.3%. Most studies are institution based and do not address specific factors associated with vernal keratoconjunctivitis. There is no a study that shows the magnitude of vernal keratoconjunctivitis in the study area. Objective To assess the prevalence of vernal keratoconjunctivitis and its associated factors among children in Gambella town, Southwest Ethiopia, 2018. Methods and materials A community based cross-sectional study was conducted from April 25 to May 12, 2018, in Gambella town. A total of 578 study participants were selected using a systematic random sampling technique. A pre-tested semi-structured questionnaire, torch, and magnifying loop were used to collect data. The data was entered into epidemiological information 7.1 and exported to statistical package for social science for analysis. Binary logistic regression analysis model was fitted to identify factors associated with vernal keratoconjunctivitis. Odds ratio with respected 95% CI was used to identify the direction and strength of association. Results A total of 574 children participated in this study representing a response rate of 99.30%. The mean age of the participants was 9.74±4.0 years. The prevalence of vernal keratoconjunctivitis was 11.10% (95% CI: 8.70, 13.90). Male sex (adjusted odds ratio = 4.12(95% CI: 1.42, 11.91)), close animal contact (adjusted odds ratio = 3.45(95% CI: 1.14, 10.41)), dust exposure (adjusted odds ratio = 3.38(95% CI: 1.31, 10.04)), and personal systemic allergy history (adjusted odds ratio = 4.82(1.40, 16.72) were independently associated with vernal keratoconjunctivitis. Conclusion The prevalence of VKC was high among children in Gambella town. Sex being male, close animal contact, personal systemic allergy history, and dust exposure were positively associated with vernal keratoconjunctivitis independently.
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Affiliation(s)
- Abiy Maru Alemayehu
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Betelhem Temesgen Yibekal
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sofonias Addis Fekadu
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kim SE, Quartilho A, Larkin F, Hingorani M, Tuft S, Dahlmann-Noor A. Systemic interventions for severe atopic and vernal keratoconjunctivitis in children and young people up to the age of 16 years. Hippokratia 2019. [DOI: 10.1002/14651858.cd013298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Soyang Ella Kim
- Royal Free London NHS Foundation Trust; Pond Street London UK NW3 2QG
| | - Ana Quartilho
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; London UK EC1V 2PD
| | - Frank Larkin
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Melanie Hingorani
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Stephen Tuft
- Moorfields Eye Hospital NHS Foundation Trust; 162 City Road London UK EC1V 2PD
| | - Annegret Dahlmann-Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; London UK EC1V 2PD
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Abd Hamid MR, Tai ELM, Wan Hazabbah WH, Ramli N. Vernal Keratoconjunctivitis-When Medication Fails. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:1308-1309. [PMID: 30581132 DOI: 10.1016/j.jaip.2018.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/05/2018] [Accepted: 11/07/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Muhamad Ruzaini Abd Hamid
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Department of Ophthalmology, Hospital Tuanku Fauziah, Kangar, Perlis, Malaysia
| | - Evelyn Li Min Tai
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
| | - Wan Hitam Wan Hazabbah
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Noramazlan Ramli
- Department of Ophthalmology, Hospital Tuanku Fauziah, Kangar, Perlis, Malaysia
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Andrade FEC, Corrêa MP, Gimenes AD, dos Santos MS, Campos M, Chammas R, Gomes JÁP, Gil CD. Galectin-3: role in ocular allergy and potential as a predictive biomarker. Br J Ophthalmol 2018; 102:1003-1010. [DOI: 10.1136/bjophthalmol-2017-311473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/31/2018] [Accepted: 02/16/2018] [Indexed: 12/31/2022]
Abstract
AimsTo evaluate galectin-3 (Gal-3), a β-galactoside binding protein, as a possible biomarker in ocular allergy and further investigated the role of endogenous Gal-3 in a murine model of ovalbumin (OVA)-induced allergic conjunctivitis (AC).MethodsConjunctival impression cytology specimens from control and patients with severe vernal keratoconjunctivitis, treated or untreated, were used to evaluate Gal-3 expression by immunocytochemistry. To investigate the mechanism of action of Gal-3, OVA-immunised BALB/c male wild-type (WT) and Gal-3 null (Gal-3-/-) mice were challenged with eye drops containing OVA on days 14–16 with a subset of animals pretreated with 0.03% tacrolimus (TC) or dexamethasone (Dex).ResultsPatients with AC and OVA-sensitised WT mice exhibited increased levels of Gal-3 in the conjunctiva compared with control, an effect reverted by the action of Dex and TC therapy. Twenty-four hours after the final OVA challenge, total and anti-OVA IgE levels increased significantly in the blood of OVA-sensitised WT and Gal-3-/- mice compared with controls, supporting the efficacy of the AC model. The lack of endogenous Gal-3 exacerbated the local inflammatory response, increasing the influx of eosinophils and mast cell activation. Additionally, OVA-sensitised Gal-3-/- animals exhibited increased CD4+ expression in the eyes as well as eotaxin, IL-4, IL-13 and interferon-γ levels in the tear fluid compared with WT animals.ConclusionGal-3 contributes to the pathogenesis of ocular allergy and represents a relevant therapeutic target.
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Alhawari HH, Khader YS, Alhawari HH, Alomari AF, Abbasi HN, El-Faouri MS, Al Bdour MD. Autoimmune Thyroid Disease and Keratoconus: Is There an Association? Int J Endocrinol 2018; 2018:7907512. [PMID: 30154844 PMCID: PMC6091451 DOI: 10.1155/2018/7907512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/05/2018] [Accepted: 07/13/2018] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The association between autoimmune diseases and keratoconus (KC) has been proposed based on previous retrospective studies and case reports. The aim of our study is to investigate whether KC is associated with autoimmune thyroid disease. Methods. A comparative study was conducted on 131 adult subjects from September 2015 to May 2017 at Jordan University Hospital, Amman, Jordan. Subjects were classified into 2 groups: subjects with autoimmune thyroid disease, including Graves' disease and Hashimoto's thyroiditis (n = 68), and a healthy group for comparison (n = 63). Subjects with any other conditions known to be associated with KC were excluded. The diagnosis of KC was based on clinical and corneal topographic findings utilizing the Oculus-Pentacam machine. In addition, TSH and total T4 levels as well as thyroid peroxidase antibodies were measured in all study participants. Antithyroglobulin antibodies, thyroid stimulating immunoglobulin, thyroid ultrasound, and thyroid uptake and scan were also selectively performed in some participants. RESULTS This study included a total of 131 participants (101 females and 30 males), including patients and controls. In the multivariate analysis, autoimmune disease was not significantly associated with keratoconus (OR = 1.1; 95% confidence interval: 0.3, 3.8; p value = 0.353) after adjusting for age and gender. CONCLUSION This study did not show a statistically significant association between autoimmune thyroid disease and KC.
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Affiliation(s)
- Hussam H. Alhawari
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Yousef S. Khader
- Department of Community Medicine, Public Health and Family Medicine, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hussein H. Alhawari
- Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Amal F. Alomari
- Division of Ophthalmology, Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
| | - Hiba N. Abbasi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Muhannd S. El-Faouri
- Division of Ophthalmology, Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
| | - Muawyah D. Al Bdour
- Division of Ophthalmology, Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
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Poly (d, l-lactide-co-glycolide) nanoparticles for sustained release of tacrolimus in rabbit eyes. Biomed Pharmacother 2017; 94:402-411. [DOI: 10.1016/j.biopha.2017.07.110] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 11/22/2022] Open
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Palioura S, Kymionis G. Corneal neovascularization in childhood keratitis. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1379900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sotiria Palioura
- Athens Vision Eye Institute, Cornea Service, Athens, Greece
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - George Kymionis
- Jules Gonin Eye Hospital, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Ophthalmology, ‘Gennimatas Hospital’, National and Kapoditrian University of Athens, Athens, Greece
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Mastropasqua R, Agnifili L, Fasanella V, Nubile M, Gnama AA, Falconio G, Perri P, Di Staso S, Mariotti C. The Conjunctiva-Associated Lymphoid Tissue in Chronic Ocular Surface Diseases. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2017; 23:697-707. [PMID: 28480834 DOI: 10.1017/s1431927617000538] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ocular surface diseases (OSDs) represent a widely investigated field of research given their growing incidence and the negative impact on quality of life. During OSDs, cytokines generated by damaged epithelia trigger and deregulate the lymphoid cells composing the eye-associated lymphoid tissues, inducing an immune-mediated chronic inflammation that amplifies and propagates the disease during time. The conjunctiva-associated lymphoid tissue (CALT), given its particular position that permits immune cells covering the cornea, might play a crucial role in the development of OSDs. Despite the recognized inflammatory role of mucosa-associated lymphoid tissues in other stations taking contact with the external environment (gut or bronchus), CALT did not gain the deserved consideration. In the last years, the diffusion of the in vivo confocal microscopy (IVCM) stimulated the interest to CALT, especially in dry eye, ocular allergy, and glaucoma. Though the initial stimuli were different, IVCM documented similar changes, represented by increased lymphoid cells within the diffuse layer, follicles and interfollicular spaces. These findings, which need to be validated by immunohistology, support the CALT stimulation during OSDs. However, while an involvement of the CALT in OSDs is hypothesizable, the exact role of this structure in their pathogenesis remains unclear and warrants further investigations.
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Affiliation(s)
| | - Luca Agnifili
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Vincenzo Fasanella
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Mario Nubile
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Agbeanda A Gnama
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Gennaro Falconio
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Paolo Perri
- 3Department of Biomedical and Surgical Sciences,Division of Ophthalmology,University of Ferrara,Ferrara 44100,Italy
| | - Silvio Di Staso
- 4Department of Surgical Science,Ophthalmic Clinic,University of L'Aquila,L'Aquila 67100,Italy
| | - Cesare Mariotti
- 5Eye Clinic,Polytechnic University of Marche,Ancona 60020,Italy
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Zahir-Jouzdani F, Atyabi F, Mojtabavi N. Interleukin-6 participation in pathology of ocular diseases. ACTA ACUST UNITED AC 2017. [PMID: 28629694 DOI: 10.1016/j.pathophys.2017.05.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Interleukin-6 (IL-6) is a multifunctional cytokine that affects a variety of cells in the body such as osteoclasts, hepatocytes, endothelial cells, epithelial cells, white and red blood cells and etc. Elevated levels of IL-6 have been detected in many ocular diseases. Studies show that IL-6 has a major role in the pathology of glaucoma, CRVO, macular edema, ocular neovascularization, posterior capsule opacity formation, keratitis, dry eye disease, allergic eye disease, ocular autoimmune disease, corneal chemical burn, ocular inflammation and so on. IL-6 does its effects through the classic or trans-signal pathways in cells. Blocking of IL-6 signal pathways via Tocilizumab or other chemicals and therapeutics will help to overcome complications related to ocular diseases.
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Affiliation(s)
- Forouhe Zahir-Jouzdani
- Department of Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tehran University of Medical Science, Tehran, Iran; Nanotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14174, Iran
| | - Fatemeh Atyabi
- Department of Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tehran University of Medical Science, Tehran, Iran; Nanotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14174, Iran.
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Individualize treatment for vernal keratoconjunctivitis based on clinical features and personal preferences. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Neuronal Fc-epsilon receptor I contributes to antigen-evoked pruritus in a murine model of ocular allergy. Brain Behav Immun 2017; 61:165-175. [PMID: 27865948 DOI: 10.1016/j.bbi.2016.11.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/30/2016] [Accepted: 11/15/2016] [Indexed: 11/23/2022] Open
Abstract
Pruritus is the major symptom of ocular allergy but currently available treatments are often ineffective. Previous studies demonstrated that subpopulations of primary sensory neurons express Fc receptors and may contribute to antigen-specific pain. We investigated the role of neuronal Fc-epsilon Receptor I (FcεRI) in allergic ocular pruritus. Ovalbumin (OVA) was used as allergen together with alum adjuvant (OVA+alum) to produce a mouse model of ocular allergy with a significant elevation in the serum levels of both antigen-specific IgE and IgG. Mice sensitized by OVA without alum only induced elevation of serum IgG but not IgE. Scratching behavior toward the eyes with the hindlimb was used as an indicator of ocular itch. Topical OVA challenging to the eye dose-dependently induced scratching toward the eye in the OVA+alum sensitized mice, but not those sensitized by OVA only. The antigen-induced scratching was largely abolished by topical application of the blocking antibody to FcεRIα, but was only partially alleviated by pretreatment of mast cell stabilizer or histamine I receptor antagonist. The expression of FcεRI was detected in subpopulations of trigeminal ganglion (TG) neurons including those expressing pruriceptive markers and innervating the conjunctiva in the naïve mice. Moreover, FcεRI was found significantly upregulated in small-sized TG neurons in the OVA+alum sensitized mice. In acutely dissociated TG neurons, IgE-immune complex (IC), but not the antibody or antigen alone, induced intracellular calcium increase. The neuronal responses to IgE-IC could be specifically blocked by pre-application of a siRNA for FcεRIα. Our results indicate that FcεRI expressed on peripheral nociceptive neurons in the TG may be directly activated by IgE-IC and contribute to allergic ocular pruritus. This study may suggest a novel mechanism for the development of pathological itch in allergic diseases.
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Zicari AM, Cafarotti A, Occasi F, Lollobrigida V, Nebbioso M, Pecorella I, De Castro G, Spalice A, Loffredo L, Villa MP, Duse M. Vitamin D levels in children affected by vernal keratoconjunctivitis. Curr Med Res Opin 2017; 33:269-274. [PMID: 27786545 DOI: 10.1080/03007995.2016.1254602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vernal keratoconjunctivitis (VKC) is a chronic and often severe bilateral conjunctivitis. VKC etiology still remains unclear although endocrine, genetic, neurogenic and environmental factors have been implicated. Vitamin D is a fat-soluble prohormone whose main function is the regulation of calcium and phosphate metabolism. The aim of this study was to evaluate serum vitamin D in children affected by VKC compared to the healthy children and investigate the relationship between its levels and disease severity. METHODS A total of 110 children, 47 affected by VKC, aged between 5 and 12 years were enrolled at the Department of Pediatrics, Division of Allergy and Immunology, "Sapienza" University of Rome. Used as controls were 63 healthy children with negative skin prick test (SPT), without allergic, ocular and systemic disease. Serum samples were obtained in April from all the children included in the study. Vitamin D dosage was repeated in October in 20 patients after therapy and in 20 controls. A conjunctival scraping was performed in all children affected by VKC. RESULTS Children affected by VKC had lower vitamin D levels compared to healthy controls and we found an increase in vitamin D levels after therapy with cyclosporine eye drops 1% although this increase was lower than that of healthy controls. Moreover we found significant correlations between vitamin D level and the severity of the disease. CONCLUSIONS The study shows that children affected by VKC have lower vitamin D levels when compared to healthy controls and highlights a significant correlation between its levels and disease severity.
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Affiliation(s)
- Anna Maria Zicari
- a Department of Pediatrics , "Sapienza" University of Rome , Rome , Italy
| | - Arianna Cafarotti
- a Department of Pediatrics , "Sapienza" University of Rome , Rome , Italy
| | - Francesca Occasi
- a Department of Pediatrics , "Sapienza" University of Rome , Rome , Italy
| | | | - Marcella Nebbioso
- b Department of Sense Organs , "Sapienza" University of Rome , Rome , Italy
| | - Irene Pecorella
- c Department of Radiologic, Oncologic and Anatomic Pathology , "Sapienza" University of Rome , Rome , Italy
| | - Giovanna De Castro
- a Department of Pediatrics , "Sapienza" University of Rome , Rome , Italy
| | - Alberto Spalice
- a Department of Pediatrics , "Sapienza" University of Rome , Rome , Italy
| | - Lorenzo Loffredo
- d Department of Internal Medicine and Medical Specialities , "Sapienza" University of Rome , Rome , Italy
| | - Maria Pia Villa
- a Department of Pediatrics , "Sapienza" University of Rome , Rome , Italy
| | - Marzia Duse
- a Department of Pediatrics , "Sapienza" University of Rome , Rome , Italy
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Nuyen B, Weinreb RN, Robbins SL. Steroid-induced glaucoma in the pediatric population. J AAPOS 2017; 21:1-6. [PMID: 28087345 DOI: 10.1016/j.jaapos.2016.09.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 11/28/2022]
Abstract
Steroid medications may cause elevation of intraocular pressure, sometimes with permanent damage to the optic nerve. These therapies, via various routes of administration, are commonly prescribed for children, but the potential sequelae of elevated intraocular pressure and glaucomatous optic nerve damage can be even more severe and devastating in children than in adults. This review discusses the pathophysiology and potential risk factors, including the impact of intraocular pressure elevation via the different common routes of administration of steroids, clinical evaluation, and management of steroid response and steroid-induced glaucoma in children.
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Affiliation(s)
- Brenda Nuyen
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Shira L Robbins
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California San Diego, La Jolla, California.
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71
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Hopper JS, Holding E, Scurrell EJ, Featherstone H. Vernal-like conjunctivitis in a western lowland gorilla (Gorilla gorilla gorilla). Vet Ophthalmol 2017; 21:199-204. [PMID: 28058762 DOI: 10.1111/vop.12457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CASE DESCRIPTION A 17-year-old female western lowland gorilla presented with bilateral ocular discharge, conjunctivitis, and rhinitis that was investigated and treated over a 34-month period. Clinical findings, diagnostic results, treatment, and follow-up are described. CLINICAL FINDING A mild intermittent mucoid ocular discharge was initially noted. 10 months later, conjunctival hyperemia and thickening developed and progressed rapidly to a mass-like lesion covering the right eye. Hematology revealed eosinophilia. Conjunctival cytology revealed eosinophils and neutrophils, and histopathology revealed a chronic proliferative eosinophilic conjunctivitis. 21 months after, the ocular lesions were investigated the gorilla developed masses within both external nares. Histopathology of the nasal lesions revealed chronic-active eosinophilic rhinitis. TREATMENT AND OUTCOME Treatment of the gorilla was based on protocols recommended for human patients. Protocols for mild, moderate, and finally severe disease were used, involving topical and oral combinations of treatments. The gorilla eventually responded to systemic immunosuppressant therapy recommended for severe refractory disease. CLINICAL SIGNIFICANCE To the authors' knowledge, this is the first reported case of vernal-like conjunctivitis in a western lowland gorilla.
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Affiliation(s)
- Jane S Hopper
- Aspinall Foundation, Port Lympne Wild Animal Park, Aldington Road, Lympne, Kent, CT21 4PD, UK
| | - Ellen Holding
- Aspinall Foundation, Port Lympne Wild Animal Park, Aldington Road, Lympne, Kent, CT21 4PD, UK
| | - Emma J Scurrell
- Cytopath Ltd, PO Box 24, Ledbury, Hertfordshire, HR8 2YD, UK
| | - Heidi Featherstone
- Willows Veterinary Centre and Referral service, Highlands Road, Shirley, Solihull, West Midlands, B90 4NH, UK
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72
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Song HJ, Kwon JY, Han JS, Yang JH, Kwon JW. A Case of Intractable Vernal Keratoconjunctivitis Treated by Papillectomy and Amniotic Membrane Transplantation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.8.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hee Jun Song
- Department of Ophthalmology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Jin Young Kwon
- Department of Ophthalmology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Ji Sang Han
- Department of Ophthalmology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Ji Ho Yang
- Department of Ophthalmology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Ji Won Kwon
- Department of Ophthalmology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
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73
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Wei Q, Le Q, Hong J, Xiang J, Wei A, Xu J. In vivo confocal microscopy of meibomian glands and palpebral conjunctiva in vernal keratoconjunctivitis. Indian J Ophthalmol 2016; 63:327-30. [PMID: 26044472 PMCID: PMC4463557 DOI: 10.4103/0301-4738.158073] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To investigate the correlations between conjunctival inflammatory status and meibomian gland (MG) morphology in vernal keratoconjunctivitis (VKC) patients by using in vivo confocal microscopy (CM). Materials and Methods: Nineteen VKC patients (7 limbal, 7 tarsal, and 5 mixed forms) and 16 normal volunteers (controls) were enrolled. All subjects underwent CM scanning to obtain the images of upper palpebral conjunctiva and MGs. Inflammatory cell (IC) density in palpebral conjunctival epithelial and stromal layers, Langerhans cell (LC) density at lid margins and the stroma adjacent to the MG, and MG acinar unit density (MGAUD) were recorded. The longest and shortest diameters of MG acinar were measured. The Kruskal-Wallis test was used to compare the parameter differences whereas the Spearman's rank correlation analysis was applied to determine their correlations. Results: Among all groups, no significant statistical differences were found in epithelial and stromal IC densities, mean values of MG acinar unit densities, or longest and shortest diameters. Both LC parameters in the tarsal-mixed groups were significantly higher than those in the limbal and control groups. All LC densities of VKC patients showed a positive correlation with MGAUD and shortest diameter. Conclusions: In VKC patients, the conjunctival inflammatory status could be associated with the MG status. In vivo CM is a noninvasive, efficient tool in the assessment of MG status and ocular surface.
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Affiliation(s)
| | | | | | | | | | - Jianjiang Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
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Esposito S, Fior G, Mori A, Osnaghi S, Ghiglioni D. An Update on the Therapeutic Approach to Vernal Keratoconjunctivitis. Paediatr Drugs 2016; 18:347-55. [PMID: 27461427 DOI: 10.1007/s40272-016-0185-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vernal keratoconjunctivitis (VKC) is an inflammatory disease of the ocular surface. It commonly occurs in the first decade of life, has a wide geographical distribution, and usually occurs in warm, dry areas. The pathogenesis of VKC seems to have an immune, nervous, and endocrine basis. The most common eye symptoms are itching, discharge, tearing, eye irritation, redness of the eyes, and photophobia. Although VKC generally has a good prognosis, the lack of clarity regarding the origin of the disease makes treatment a challenge for pediatricians and ophthalmologists. The purpose of this review is to discuss the pathogenesis, clinical features, and diagnostic criteria in VKC, with a focus on its therapeutic management. The selection of a therapeutic scheme from the many available options is based on clinical features and the personal preferences of both physicians and patients. Due to the lack of uniform grading of disease severity, there is no worldwide consensus on first-line and second-line therapeutic approaches. The choice of treatment for long-term moderate to severe VKC includes topical cyclosporine or tacrolimus. Further data are needed to define the minimal effective concentration and the safety of these drugs in eye drops and to clarify the diagnosis of VKC in patients who require these drugs. Finally, while promising newly discovered drugs are expected to enter into clinical practice, further studies on their efficacy and safety are required.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Giulia Fior
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Alessandro Mori
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Silvia Osnaghi
- Oculistic Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Ghiglioni
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
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75
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Kumar S, Al Khars W. Vitiligo in association with vernal keratoconjunctivitis. Saudi J Ophthalmol 2016; 30:128-9. [PMID: 27330391 PMCID: PMC4908059 DOI: 10.1016/j.sjopt.2015.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 12/22/2015] [Indexed: 11/15/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic allergic inflammation of ocular surface involving the tarsal and/or bulbar conjunctiva. Signs of VKC are confined to the conjunctiva and cornea. The skin of the lid remains uninvolved. Here we report a case of 17 year-old male suffering from VKC who develops vitiligo of lid skin and lash poliosis. All ocular and systemic causes of localized skin and lash depigmentation were excluded in our patient by thorough clinical examination and investigations. During regular follow-up for two-year patient did not develop any ocular and systemic illness presenting as vitiligo and poliosis. We believe that VKC was the most possible etiology of Vitiligo of lid and lash poliosis in this patient.
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Affiliation(s)
- Sunil Kumar
- Specialist Eye Hospital, Dhahran, Al Khobar, Saudi Arabia
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Abstract
PURPOSE OF REVIEW Vernal keratoconjunctivitis (VKC) is a severe bilateral chronic allergic inflammatory disease of the ocular surface. In most of the cases, the disease is limited to the tarsal conjunctiva and to the limbus. However, in the more severe cases, the cornea may be involved, leading to potentially sight threatening complications. Prompt recognition of these complications is crucial in the management of VKC, which is one of the most severe ocular allergic diseases. RECENT FINDINGS A vicious cycle of inflammation occurs as a result of a set of reciprocal interactions between the conjunctiva and the cornea, which results in damage to the corneal epithelium and corneal stoma, and to the formation of shield ulcers and plaques, infectious keratitis, keratoconus, scarring, and limbal stem cell deficiency. These corneal complications can cause permanent decrease or loss of vision in children suffering from VKC. SUMMARY Corneal complications in VKC are the result of an on-going process of uncontrolled inflammation. Proper recognition of the corneal complications in VKC is crucial, as most of these can be managed or prevented by a combination of medical and surgical measures.
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77
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Marey HM, Mandour SS, El Morsy OA, Farahat HG, Shokry SM. Impact of Vernal Keratoconjunctivitis on School Children in Egypt. Semin Ophthalmol 2016; 32:543-549. [PMID: 27128625 DOI: 10.3109/08820538.2015.1123737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the prevalence of vernal keratoconjunctivitis (VKC) and its impact on school children in Egypt. METHODS A total of 3,706 students from six randomly selected schools of Menoufia were included where 126 had symptoms according to the VKC related symptoms questionnaire. Selected children were referred to a hospital for further assessment. RESULTS The mean age of included children was 8.79±31.87 years, with a VKC prevalence of 3.3%, and male-to-female ratio of 2.3:1. The most frequently reported symptoms were ocular itching, followed by burning sensation, tearing, red eye, discharge, and photophobia. Signs vary between mild and severe cases; however, all cases had a negative impact on school attendance and performance. CONCLUSION The prevalence of VKC differs according to the age group of included cases and the local temperature of the study area. School attendance, performance, lifestyle, and social activities were negatively affected by VKC.
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Affiliation(s)
- Hatem M Marey
- a Department of Ophthalmology , Menoufia Faculty of Medicine , Shebin El Kom , Egypt
| | - Sameh S Mandour
- a Department of Ophthalmology , Menoufia Faculty of Medicine , Shebin El Kom , Egypt
| | - Osama A El Morsy
- a Department of Ophthalmology , Menoufia Faculty of Medicine , Shebin El Kom , Egypt
| | - Hassan G Farahat
- a Department of Ophthalmology , Menoufia Faculty of Medicine , Shebin El Kom , Egypt
| | - Shaimaa M Shokry
- a Department of Ophthalmology , Menoufia Faculty of Medicine , Shebin El Kom , Egypt
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78
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Shoughy SS, Jaroudi MO, Tabbara KF. Efficacy and safety of low-dose topical tacrolimus in vernal keratoconjunctivitis. Clin Ophthalmol 2016; 10:643-7. [PMID: 27103784 PMCID: PMC4827889 DOI: 10.2147/opth.s99157] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to evaluate the efficacy and safety of topical low-dose tacrolimus (0.01%) solution in patients with vernal keratoconjunctivitis (VKC). Patients and methods A total of 62 consecutive patients with VKC refractory to conventional treatment were included retrospectively. Tacrolimus 0.01% ophthalmic solution was administered to patients twice daily after discontinuation of all previous topical medications. The duration of treatment ranged from 1 month to 29 months. The clinical symptoms of itching, redness, foreign body sensation, and discharge and the clinical signs of conjunctival hyperemia, conjunctival papillary hypertrophy, limbal infiltration, Trantas dots, and superficial punctate keratopathy were graded as 0 (normal), 1+ (mild), 2+ (moderate), or 3+ (severe). Assessment was carried out before initiation of therapy and on the last visit after treatment. Results There were 62 patients with VKC comprising 49 male and 13 female patients. The median age was 12 years (range: 5–47 years). The mean visual acuity improved from 20/30 to 20/25 following treatment. There was statistically significant improvement in symptoms of itching (P<0.001), redness (P<0.001), foreign body sensation (P<0.001), and discharge (P<0.001). Statistically significant improvement was also observed in clinical signs of conjunctival hyperemia (P<0.001), limbal infiltration (P<0.001), Trantas dots (P<0.001), superficial punctate keratopathy (P<0.001), and conjunctival papillary hypertrophy (P<0.001). The solution form of tacrolimus was well tolerated. None of the patients developed elevation of intraocular pressure, cataract, or infectious keratitis. Conclusion Low-dose topical tacrolimus 0.01% solution is effective and safe in the management of patients with refractory VKC.
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Affiliation(s)
- Samir S Shoughy
- The Eye Center and The Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud O Jaroudi
- The Eye Center and The Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia
| | - Khalid F Tabbara
- The Eye Center and The Eye Foundation for Research in Ophthalmology, King Saud University, Riyadh, Saudi Arabia; Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Wilmer Ophthalmological Institute of the Johns Hopkins University School of Medicine, Baltimore, MD, USA
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79
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Sofi RA, Mufti A. Vernal Keratoconjunctivitis in Kashmir: A temperate zone. Int Ophthalmol 2016; 36:875-879. [PMID: 26961753 DOI: 10.1007/s10792-016-0213-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/01/2016] [Indexed: 11/28/2022]
Abstract
The objective of this study was to observe the clinical features of patients with vernal keratoconjunctivitis attending the Outpatient Department of a mobile eye unit, Directorate of Health Services, Jammu and Kashmir over a period of 1 year. The greater prevalence of VKC is seen in the regions with hot, humid climate, and higher load of airborne allergens. The clinical profile of this disease seems to have geographical variation. The study was conducted in the mobile eye unit, Directorate of Health Services, Kashmir, a comparatively cooler area. All the patients with vernal keratoconjunctivitis who presented to the OPD during this period were examined. The diagnosis of vernal keratoconjunctivitis was based on typical history, clinical features, and examination. All the patients with the complaints of itching, watering, and photophobia were examined. After proper history, clinical features, and ocular examination under slit lamp, the data were recorded for patients who were diagnosed with vernal keratoconjunctivitis. Of all the patients who had allergic ocular disorders, a total of 212 patients were diagnosed as cases with vernal keratoconjunctivitis. This is a non-interventional study, and the ethical clearance was obtained from the regulatory board of the hospital. The study abides by the tenets laid down in the declaration of Helsinki. During this 1-year period, 212 vernal keratoconjunctivitis patients were examined, of whom 155 (73 %) were males and 57 (27 %) were females. As per the age group, 40 % (85) of patients were in the age group of 11-15 years. 93 % (197) of patients had bilateral disease, and 7 % (15) had unilateral. It was seen that 75 % (159) had seasonal attack. Different types of disease were observed: 77 % (163) had bulbar disease, 7 % (15) had palpebral, and 16 % (34) had mixed disease. During this period, we noticed that VKC led to complications also. It was seen that 3 % (6) of patients had steroid induced glaucoma, 5 % (11) had developed cataract, 6 % (13) of patients had keratoconus, and 6 % (13) of patients had corneal scarring. Other complications were also seen. VKC is a bilateral disease. Males are affected more than females. Ocular complications were seen in around 30 % of patients. Visual impairment ranging from severe visual impairment to blindness was observed in 2 % of patients. VKC patients should be instructed to use medication under the supervision of an ophthalmologist. There is a need to assess disease severity in order to develop standardized guidelines based on the stage of vernal keratoconjunctivitis.
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Affiliation(s)
| | - Asmat Mufti
- Mobile Surgical Unit, JK Health Services, Srinagar, India
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Kwon DH, Moon JD, Park WJ, Kang WY, Kim SH, Lim HM, Ahn JS, Chae HJ. Case series of keratitis in poultry abattoir workers induced by exposure to the ultraviolet disinfection lamp. Ann Occup Environ Med 2016; 28:3. [PMID: 26779342 PMCID: PMC4714468 DOI: 10.1186/s40557-015-0087-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background An outbreak of eye diseases occurred among workers at a poultry abattoir in South Korea from December 2012 to June 2013. An epidemiological investigation of the causative agent was conducted. The workers were given a special health examination and workplace environmental monitoring was performed. Workers with ocular symptoms subsequently underwent an ophthalmic examination. Case Presentaion From a total of 41 workers, 26 (63.4 %) were diagnosed with keratoepitheliopathy by ophthalmic examination. Environmental monitoring of the workplace revealed that the ultraviolet (UV) apron-disinfection lamp had not been turning off at the set times, and so the workers’ faces had been exposed to UV radiation. Effective radiation dose measurement showed a UV-B exposure of 7-30 μW/cm2, and a UV-C exposure of 40-200 μW/cm2; both values exceed the occupational exposure limits. The outbreak ceased after the lamp was repaired. Conclusions This case shows that inappropriate use of the UV disinfection lamp can cause mass photokeratitis. In order to prevent this, the UV disinfection lamp must be checked regularly, workers must be educated on the health effects of UV radiation, and appropriate eye protection must be worn.
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Affiliation(s)
- Do-Hyeong Kwon
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, 519-763 Hwasun, Jeollanam-do Korea
| | - Jai-Dong Moon
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, 519-763 Hwasun, Jeollanam-do Korea
| | - Won-Ju Park
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, 519-763 Hwasun, Jeollanam-do Korea
| | - Won-Yang Kang
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, 519-763 Hwasun, Jeollanam-do Korea
| | - Soo-Hyeon Kim
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, 519-763 Hwasun, Jeollanam-do Korea
| | - Hyeong-Min Lim
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, 519-763 Hwasun, Jeollanam-do Korea
| | - Ji-Sung Ahn
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, 519-763 Hwasun, Jeollanam-do Korea
| | - Hong-Jae Chae
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, 519-763 Hwasun, Jeollanam-do Korea
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81
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Yücel OE, Ulus ND. Efficacy and safety of topical cyclosporine A 0.05% in vernal keratoconjunctivitis. Singapore Med J 2015; 57:507-10. [PMID: 26768065 DOI: 10.11622/smedj.2015161] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION While corticosteroids are an effective choice of treatment for severe vernal keratoconjunctivitis (VKC), their long-term use is restricted due to side effects. This study was conducted to evaluate the efficacy and safety of topical cyclosporine A (CsA) 0.05% in the treatment of VKC. METHODS A total of 30 patients with VKC that was resistant to topical corticosteroids, antihistamines and mast cell stabilisers were treated with topical CsA 0.05%. Patients were evaluated at Weeks 4, 8 and 12 after the initiation of therapy. Symptoms and signs observed before and after treatment were recorded and scores were assigned. Scores for symptoms and signs, the need for topical corticosteroids and ocular side effects were evaluated. RESULTS At baseline, the median values of the symptom and sign scores were 10.0 (range 5.0-18.0) and 6.0 (range 2.0-13.0), respectively. At Week 4 of treatment with topical CsA 0.05%, the median values of the symptom and sign scores were 3.0 (range 0-14.0) and 3.0 (range 0-8.0), respectively. The reductions in the symptom and sign scores were statistically significant. The reduction in the need for corticosteroid was statistically significant by Week 12 of therapy. No significant side effects were reported. CONCLUSION Topical CsA 0.05%, which can help to reduce corticosteroid usage, is an effective and safe alternative for the treatment of resistant VKC. Further studies are needed to determine the optimal duration of therapy and possibility of recurrence.
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Affiliation(s)
- Ozlem Eski Yücel
- Department of Ophthalmology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Nihal Demir Ulus
- Clinics of Ophthalmology, Eskisehir State Hospital, Eskişehir, Turkey
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Andalibi S, Haidara M, Bor N, Levin M. An Update on Neonatal and Pediatric Conjunctivitis. CURRENT OPHTHALMOLOGY REPORTS 2015. [DOI: 10.1007/s40135-015-0080-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Al-Hakami AM, Al-Amri A, Abdulrahim I, Hamid ME. Is there is an association between the presence of Staphylococcus species and occurrence of vernal keratoconjunctivitis? Saudi J Ophthalmol 2015; 29:255-8. [PMID: 26586974 PMCID: PMC4625191 DOI: 10.1016/j.sjopt.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 04/17/2015] [Accepted: 05/07/2015] [Indexed: 01/08/2023] Open
Abstract
Purpose The aim of this study was to identify the association of normal bacterial flora with vernal keratoconjunctivitis (VKC) occurrence in VKC and non-VKC groups. Methods Conjunctival specimens were collected from 18 VKC patients and 22 healthy controls, cultured and identified following standard methods. The association between the presence of bacteria and occurrence of VKC was analyzed using Chi square statistic. Results Comparable bacterial growth was observed in VKC (77.8%) as well as control group (77.2%) (p = 0.970). Analysis of individual bacterial revealed that Staphylococcus aureus was detected more frequently in VKC (27.78% vs. 4.55% in control, p = 0.041) and Staphylococcus epidermidis was found much more commonly in the control eyes (45.45% in control vs. 5.56% in VKC, p = 0.005). Conclusions An aggravating role of S. aureus colonization in the occurrence of VKC, and a possible role of S. epidermidis against the occurrence of VKC were concluded.
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Affiliation(s)
- Ahmed M Al-Hakami
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Saudi Arabia
| | - Abdulrahaman Al-Amri
- Department of Surgery, College of Medicine, King Khalid University, Saudi Arabia
| | - Ihab Abdulrahim
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Saudi Arabia
| | - Mohamed E Hamid
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Saudi Arabia
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Bilkhu PS, Naroo SA, Wolffsohn JS. Treatment of ocular allergies: nonpharmacologic, pharmacologic and immunotherapy. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1036031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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85
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A comprehensive review on vernal keratoconjunctivitis with emphasis on proteomics. Life Sci 2015; 128:47-54. [DOI: 10.1016/j.lfs.2015.01.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/19/2015] [Accepted: 01/26/2015] [Indexed: 01/21/2023]
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Nishida T, Inui M, Nomizu M. Peptide therapies for ocular surface disturbances based on fibronectin-integrin interactions. Prog Retin Eye Res 2015; 47:38-63. [PMID: 25645519 DOI: 10.1016/j.preteyeres.2015.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 01/18/2015] [Accepted: 01/21/2015] [Indexed: 11/24/2022]
Abstract
The condition of the corneal epithelium is a critical determinant of corneal transparency and clear vision. The corneal epithelium serves as a barrier to protect the eye from external insults, with its smooth surface being essential for its optical properties. Disorders of the corneal epithelium include superficial punctate keratopathy, corneal erosion, and persistent epithelial defects (PEDs). The prompt resolution of these disorders is important for minimization of further damage to the cornea. Currently available treatment modalities for corneal epithelial disorders are based on protection of the ocular surface in order to allow natural healing to proceed. PEDs remain among the most difficult corneal conditions to treat, however. On the basis of characterization of the pathobiology of PEDs at the cell and molecular biological levels, we have strived to develop new modes of treatment for these defects. These treatments rely on two key concepts: provision of a substrate, such as the adhesive glycoprotein fibronectin, for the attachment and migration of corneal epithelial cells, and activation of these cells by biological agents such as the combination of substance P and insulin-like growth factor-1 (IGF-1). Central to both approaches is the role of the fibronectin-integrin system in corneal epithelial wound healing. Determination of the minimum amino acid sequences required for the promotion of corneal epithelial wound closure by fibronectin (PHSRN) and by substance P (FGLM-amide) plus IGF-1 (SSSR) has led to the development of peptide eyedrops for the treatment of PEDs that are free of adverse effects of the parent molecules.
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Affiliation(s)
- Teruo Nishida
- Ohshima Hospital of Ophthalmology, 11-8 Kamigofuku, Hakata-ku, Fukuoka 812-0036, Japan; Yamaguchi University, 1-1-1 Minami-kogushi, Ube City, Yamaguchi 755-8505, Japan.
| | - Makoto Inui
- Department of Pharmacology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube City, Yamaguchi 755-8505, Japan
| | - Motoyoshi Nomizu
- Laboratory of Clinical Biochemistry, School of Pharmacy, Tokyo University of Pharmacy and Life Science, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
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Thanathanee O, Bhoomibunchoo C, Suwan-apichon O. Treatment of asymmetrical vernal keratoconjunctivitis with supratarsal corticosteroid injection. BMJ Case Rep 2014; 2014:bcr-2014-206401. [PMID: 25410033 DOI: 10.1136/bcr-2014-206401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 6-year-old Thai girl presented with itching, redness and copious discharge in both eyes. Slit-lamp biomicroscopy of the left eye revealed cobblestone papillae with marked ptosis while in the right eye only small papillae were observed. Punctuate epithelial keratitis was noted only in the left eye. There were no associated factors for giant papillary conjunctivitis (ie, suture or contact lens). The cobblestone papillae in the left eye persisted after maximal topical and oral antiallergic medications. Two doses of supratarsal corticosteroid (20 mg of triamcinolone acetonide) injection without any topical or oral antiallergic medications were undertaken in the left eye 1 month apart. Cobblestone papillae and punctate epithelial erosion (including allergic symptoms) were completely recovered. There was no recurrence after 18 months of follow-up. This case report indicates that using supratarsal corticosteroid injection by itself in recalcitrant vernal keratoconjunctivitis provides promising results.
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Affiliation(s)
- Onsiri Thanathanee
- Department of Ophthalmology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Chavakij Bhoomibunchoo
- Department of Ophthalmology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Olan Suwan-apichon
- Department of Ophthalmology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
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Nebbioso M, Zicari AM, Celani C, Lollobrigida V, Grenga R, Duse M. Pathogenesis of Vernal Keratoconjunctivitis and Associated Factors. Semin Ophthalmol 2014; 30:340-4. [DOI: 10.3109/08820538.2013.874483] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Liu M, Gao H, Wang T, Wang S, Li S, Shi W. An essential role for dendritic cells in vernal keratoconjunctivitis: analysis by laser scanning confocal microscopy. Clin Exp Allergy 2014; 44:362-70. [PMID: 24372712 DOI: 10.1111/cea.12264] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 11/22/2013] [Accepted: 11/25/2013] [Indexed: 11/28/2022]
Affiliation(s)
- M. Liu
- Shandong Eye Hospital; Shandong Eye Institute; Shandong Academy of Medical Sciences; Qingdao China
| | - H. Gao
- Shandong Eye Hospital; Shandong Eye Institute; Shandong Academy of Medical Sciences; Qingdao China
| | - T. Wang
- Shandong Eye Hospital; Shandong Eye Institute; Shandong Academy of Medical Sciences; Qingdao China
| | - S. Wang
- Shandong Eye Hospital; Shandong Eye Institute; Shandong Academy of Medical Sciences; Qingdao China
| | - S. Li
- Shandong Eye Hospital; Shandong Eye Institute; Shandong Academy of Medical Sciences; Qingdao China
| | - W. Shi
- Shandong Eye Hospital; Shandong Eye Institute; Shandong Academy of Medical Sciences; Qingdao China
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Cingü AK, Kaya S, Çınar Y, Şahin M, Türkçü FM, Yüksel H, Murat M, Çaça İ. Effect of vernal keratoconjunctivitis on vitreous depth in patients with keratoconus. Semin Ophthalmol 2014; 30:197-201. [PMID: 24409941 DOI: 10.3109/08820538.2013.839804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this study was to comparatively evaluate the vitreous depth (VD) of keratoconic eyes in patients with or without vernal keratoconjunctivitis (VKC). MATERIAL AND METHODS Eighty eyes of 80 consecutive keratoconus (KC) patients and 40 emmetropic control subjects were enrolled. KC patients were divided into two groups according to accompanying VKC (VKC-KC group and KC group). Mean outcome measures were best-corrected visual acuity (BCVA), spherical equivalent (SE), mean keratometry (Km), intraocular pressure (IOP), and axial length (AL) and its components. The eyes with the highest Km were selected for statistical analysis for each participant. RESULTS There were 50, 30, and 40 patients in the VKC-KC group, KC group, and control group respectively. The KC group and VKC-KC group were similar in BCVA, SE, Km, CCT, ACD, LT, and IOP (p>0.05). The mean ACD was significantly lower in the control group when compared with the KC group and VKC-KC group. The mean AL and VD were significantly higher in VKC-KC group than those of KC group and the control group, whereas similar in KC and control groups (p>0.05). CONCLUSION In the current study we showed that VKC-associated KC patients have significantly longer AL and VD when compared with KC patients without VKC. Posterior segment elongation in VKC-KC group may be associated with the type IV collagen destruction due to chronic longstanding inflammation in VKC patients.
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Affiliation(s)
- Abdullah Kürşat Cingü
- Department of Ophthalmology, Dicle University Faculty of Medicine , 21280, Diyarbakir , Turkey and
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Stagi S, Pucci N, Di Grande L, de Libero C, Caputo R, Pantano S, Mattei I, Mori F, de Martino M, Novembre E. Increased incidence of thyroid dysfunction and autoimmunity in patients with vernal keratoconjunctivitis. Int J Endocrinol 2014; 2014:804870. [PMID: 25140177 PMCID: PMC4130298 DOI: 10.1155/2014/804870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/06/2014] [Indexed: 11/29/2022] Open
Abstract
Hormones may play a role in the pathophysiology of vernal keratoconjunctivitis (VKC). An increased incidence of thyroid autoantibodies was recently observed in VKC, although there were no data on thyroid function. Two hundred and eighty-eight patients (202 males, 86 females; range 5.5 to 16.9 years) with VKC were evaluated and compared with 188 normal age- and sex-matched subjects. In all subjects, serum concentrations of free T4, TSH, thyroperoxidase, thyroglobulin, and TSHr autoantibodies were evaluated. In VKC, the family history of thyroid diseases showed no significant differences compared to the controls (9.4 versus 8.6%), whereas the family history of autoimmune diseases was significantly higher (13.2% versus 6.3%; P<0.05). Subclinical hypothyroidism was diagnosed in 6.6% (versus 1.6% of the controls; P<0.05) and overt hypothyroidism in 0.7% (versus 0.0% of the controls; P = NS). Finally, 5.2% of patients were positive for thyroid autoantibodies, which were significantly higher with respect to the controls (0.5%, P<0.05). In the patients positive for thyroid autoantibodies, 80% showed a sonography pattern that suggested autoimmune thyroiditis. Thyroid function and autoimmunity abnormalities are frequently present in children with VKC. Children with VKC should be screened for thyroid function and evaluated for thyroid autoimmunity.
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Affiliation(s)
- Stefano Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Neri Pucci
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- *Neri Pucci:
| | - Laura Di Grande
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Cinzia de Libero
- Clinical Ophthalmology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Roberto Caputo
- Clinical Ophthalmology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Stefano Pantano
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Ivan Mattei
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Francesca Mori
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Elio Novembre
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
- Paediatric Allergology Unit, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
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Changes in sensory activity of ocular surface sensory nerves during allergic keratoconjunctivitis. Pain 2013; 154:2353-2362. [PMID: 23867735 DOI: 10.1016/j.pain.2013.07.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/21/2013] [Accepted: 07/10/2013] [Indexed: 11/23/2022]
Abstract
Peripheral neural mechanisms underlying the sensations of irritation, discomfort, and itch accompanying the eye allergic response have not been hitherto analyzed. We explored this question recording the changes in the electrical activity of corneoconjunctival sensory nerve fibers of the guinea pig after an ocular allergic challenge. Sensitization was produced by i.p. ovalbumin followed by repeated application in the eye of 10% ovalbumin on days 14 to 18. Blinking and tearing rate were measured. Spontaneous and stimulus-evoked (mechanical, thermal, chemical) impulse activity was recorded from mechanonociceptor, polymodal nociceptor and cold corneoscleral sensory afferent fibers. After a single (day 14) or repeated daily exposures to the allergen during the following 3 to 4days, tearing and blinking rate increased significantly. Also, sensitization was observed in mechanonociceptors (transient reduction of mechanical threshold only on day 14) and in polymodal nociceptors (sustained enhancement of the impulse response to acidic stimulation). In contrast, cold thermoreceptors showed a significant decrease in basal ongoing activity and in the response to cooling. Treatment with the TRPV1 and TRPA1 blockers capsazepine and HC-030031 reversed the augmented blinking. Only capsazepine attenuated tearing rate increase and sensitization of the polymodal nociceptors response to CO2. Capsazepine also prevented the decrease in cold thermoreceptor activity caused by the allergic challenge. We conclude that changes in nerve impulse activity accompanying the ocular allergic response, primarily mediated by activation of nociceptor's TRPV1 and to a lesser degree by activation of TRPA1 channels, explain the eye discomfort sensations accompanying allergic episodes.
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Nebbioso M, Zicari AM, Lollobrigida V, Marenco M, Duse M. Assessment of Corneal Alterations by Confocal Microscopy in Vernal Keratoconjunctivitis. Semin Ophthalmol 2013; 30:40-3. [DOI: 10.3109/08820538.2013.821508] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Namba H, Narumi M, Sugano A, Murata I, Suzuki T, Yamakawa M, Yamashita H. Pathological findings of pemphigus vulgaris showing giant cobblestone-like conjunctival papillae. Case Rep Ophthalmol 2013; 4:114-21. [PMID: 24163678 PMCID: PMC3806711 DOI: 10.1159/000355374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose To describe the pathophysiological findings of a patient with pemphigus vulgaris (PV) showing giant conjunctival papillae. Methods A 64-year-old man who had mucosal-dominant PV with giant conjunctival papillae, resembling those of vernal keratoconjunctivitis (VKC), underwent an ophthalmological workup. The clinical and pathological findings were investigated. Results Ophthalmic interventions were unable to provide the desired beneficial effects, and multiple excisions were necessary to remove the proliferative conjunctival lesions. Histopathological investigations of the excised tissues demonstrated acantholysis and a subconjunctival infiltration with numerous inflammatory cells such as lymphocytes, plasma cells, and neutrophils. However, in contrast to typical VKC, mast cells and eosinophils were rarely found in the subconjunctival tissues. Direct immunofluorescent staining showed a significant deposition of immunoglobulin G and complement component 3 in the epithelial intercellular substance, consistent with mucosal-dominant PV. Then, the patient was hospitalized because of oral erosion exacerbation and malnutrition. Because of the patient's declining general condition, we administered an increasing dose of a systemic steroid with an intravenous immunoglobulin, after which his ocular lesions and symptoms improved. Conclusions The histological conjunctival papilla findings were quite different from those of VKC papillae. If PV causes a lesion in a patient, systemic immunosuppression might be more effective than topical ophthalmic treatment because of overall immunological involvement.
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Affiliation(s)
- Hiroyuki Namba
- Department of Ophthalmology and Visual Science, Yamagata University Faculty of Medicine, Yamagata City, Japan
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Abstract
Keratoglobus is a rare noninflammatory corneal thinning disorder characterised by generalised thinning and globular protrusion of the cornea. It was first described as a separate clinical entity by Verrey in 1947. Both congenital and acquired forms have been shown to occur, and may be associated with various other ocular and systemic syndromes including the connective tissue disorders. Similarities have been found with other noninflammatory thinning disorders like keratoconus that has given rise to hypotheses about the aetiopathogenesis. However, the exact genetics and pathogenesis are still unclear. Clinical presentation is characterised by progressive diminution resulting from irregular corneal topography with increased corneal fragility due to extreme thinning. Conservative and surgical management for visual rehabilitation and improved tectonic stability have been described, but remains challenging. In the absence of a definitive standard procedure for management of this disorder, various surgical procedures have been attempted in order to overcome the difficulties. This article reviews the aetiological factors, differential diagnosis, histopathology, and management options of keratoglobus.
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Affiliation(s)
- B S Wallang
- Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, India
| | - S Das
- Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, India
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Lin HY, Yeh PT, Shiao CS, Hu FR. Surgical management and immunohistochemical study of corneal plaques in vernal keratoconjunctivitis. J Formos Med Assoc 2013; 112:569-73. [DOI: 10.1016/j.jfma.2012.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 02/11/2010] [Accepted: 04/20/2010] [Indexed: 11/17/2022] Open
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Surgical Resection and Amniotic Membrane Transplantation for Treatment of Refractory Giant Papillae in Vernal Keratoconjunctivitis. Cornea 2013; 32:816-20. [DOI: 10.1097/ico.0b013e31826a1e53] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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