Vitamin D levels in children affected by vernal keratoconjunctivitis

Vitamin D and tear fluid cytokines in predicting outcomes in viral conjunctivitis - A new outlook

PURPOSE

To determine the association between systemic vitamin D (VD) and immunoglobulin E (IgE) levels with severity and ocular surface inflammatory profile in patients with epidemic keratoconjunctivitis (EKC).

METHODS

210 eyes of 105 patients who were clinically diagnosed with EKC were included in the study. The levels of serum VD and serum IgE were measured. Schirmer's strip-based tear fluid (TF) was used to determine levels of IL-1β, IL-6, IL-10, IL-17A, TNFα, MMP9, sICAM1, and VEGF-A in a subset of patients.

RESULTS

Levels of VD were significantly ( P < 0.05) lower and levels of IgE were significantly higher in patients with severe forms of conjunctivitis compared to those with nonsevere forms. Majority of the patients with severe forms of the disease exhibited VD deficiency and/or abnormally high IgE. A negative correlation (r = -0.682; P < 0.0001) was observed between VD and IgE levels. TF levels of IL-1β, IL-6, TNFα, and sICAM1 were significantly higher in eyes with severe forms of conjunctivitis compared to those with nonsevere forms and controls. These factors showed a positive correlation ( P < 0.05) with IgE levels and a negative correlation ( P < 0.05) with VD levels.

CONCLUSION

Patients with severe forms of EKC exhibited VD deficiency and higher levels of IgE. Increased TF inflammatory factors demonstrated a disease causal relationship with VD and IgE. Hence, restoring the altered levels of VD and IgE to normal range would be pivotal in the prevention and management of severe conjunctivitis.

Serum vitamin D levels in children with vernal keratoconjunctivitis - A study from a tertiary care pediatric hospital of North India

BACKGROUND

To study the levels of vitamin D serum levels in children with vernal keratoconjuctivits (VKC) and comparing vitamin D levels in after giving vitamin D supplements between intervention and control group.

METHODS

The study was conducted in population between 1 to 12 years in tertiary care hospital in North India. Amongst children with VKC, full ocular examination along with Boninis clinical grading of VKC and serum vitamin D levels were assessed. Whole study group was randomly divided into two groups. Intervention group had received vitamin D powder while control group kept under observation.

RESULTS

A total of 88 children received vitamin D supplementation and 39 kept in control group.

CONCLUSION

Our study suggests that children in intervention group showed improvement in serum vitamin D levels with the clinical improvement in VKC grading too.

Management of Vernal Keratoconjunctivitis in Children in the United Kingdom: A Review of the Literature and Current Best Practice Across Six Large United Kingdom Centers

Vernal keratoconjunctivitis (VKC) is a form of ocular allergy primarily affecting children. Considered a rare disease in Europe, its prevalence varies by geographic region and is poorly studied in the United Kingdom. There is considerable national variation in the management of VKC within the United Kingdom, risking misdiagnosis and delays to treatment for some children. This can significantly impact their quality of life, with the potential for lasting negative consequences. Based on discussions between experienced clinicians from six large centers across the United Kingdom, this article describes best practice recommendations for United Kingdom settings, including principles for diagnosis, referral, initial and long-term management, and supportive care. Recommendations include guidance on referral timing, which should depend on VKC severity, and a stepwise approach to treatment. Joint management by primary care and secondary care is recommended and the importance of supportive care, including emotional support and outreach to schools, is highlighted. Because frequent flareups are common in VKC, it is essential that families have access to the information they need to manage the disease and routes to access rapid care if needed. A thorough understanding of the nature of VKC, its triggers, and how best to manage it, by both patients and their families, is critical to ensuring appropriate management and to improving patient outcomes. [J Pediatr Ophthalmol Strabismus. 2023;60(1):6-17.].

Association of serum 25-hydroxyvitamin D concentrations with Schirmer tear test 1 and tear film breakup time in dogs

BACKGROUND

The association between vitamin D and canine keratoconjunctivitis sicca (KCS) has not been investigated in dogs.

OBJECTIVES

To investigate the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with Schirmer tear test 1 (STT-1) and tear film breakup time (TFBUT) in dogs.

METHODS

Sixty-one clinically healthy, client-owned dogs were enrolled. STT-1 and TFBUT were measured in 122 (61dogs) and 82 (41 dogs out of total 61 dogs) eyes, respectively. Serum 25(OH)D concentrations were evaluated by quantitative chemiluminescent immunoassay. The dogs were classified into 6 groups according to the evaluations (STT-1: group 1, normal [≥ 15 mm/min] in both eyes; group 2, normal in one eye and abnormal [< 15 mm/min] in the fellow eye; group 3, abnormal in both eyes; TFBUT: group 4, normal [≥ 20 sec] in both eyes; group 5, normal in one eye and abnormal [< 20 sec] in the fellow eye; group 6, abnormal in both eyes).

RESULTS

STT-1 was positively correlated with TFBUT (p < 0.001). Among the STT-1 groups, the mean serum 25(OH)D concentration in group 1 was significantly higher than in groups 2 and 3 with positive correlation (p < 0.001). However, there were no significant differences among the TFBUT groups 4, 5, and 6.

CONCLUSIONS

In dogs, it was found that serum 25(OH)D concentrations had a greater effect on quantitative KCS than qualitative KCS. Therefore, it is considered that measurement of serum 25(OH)D concentration could be included in the diagnostic tests in canine quantitative KCS patients.

Vitamin D, the Vitamin D Receptor, Calcitriol Analogues and Their Link with Ocular Diseases

The global prevalence of eye diseases continues to grow, bringing with it a reduction in the activity levels and quality of life of patients, and partial or complete blindness if left untreated. As such, there is considerable interest in identifying more effective therapeutic options and preventive agents. One such agent is vitamin D, known to have a range of anti-cancer, anti-angiogenic, anti-inflammatory and anti-oxidative properties, and whose deficiency is linked to the pathogenesis of a range of cardiovascular, cancer, and inflammatory diseases. This review presents the current stage of knowledge concerning the link between vitamin D and its receptor and the occurrence of eye disease, as well as the influence of analogues of calcitriol, an active metabolite of vitamin D. Generally, patients affected by various ocular disorders have vitamin D deficiency. In addition, previous findings suggest that vitamin D modulates the course of eye diseases and may serve as a marker, and that its supplementation could mitigate some disorders. However, as these studies have some limitations, we recommend further randomized trials to clarify the link between vitamin D and its activity with eye disease.

Vitamin D and Ocular Diseases: A Systematic Review

The contributory roles of vitamin D in ocular and visual health have long been discussed, with numerous studies pointing to the adverse effects of vitamin D deficiency. In this paper, we provide a systematic review of recent findings on the association between vitamin D and different ocular diseases, including myopia, age-related macular degeneration (AMD), glaucoma, diabetic retinopathy (DR), dry eye syndrome (DES), thyroid eye disease (TED), uveitis, retinoblastoma (RB), cataract, and others, from epidemiological, clinical and basic studies, and briefly discuss vitamin D metabolism in the eye. We searched two research databases for articles examining the association between vitamin D deficiency and different ocular diseases. One hundred and sixty-two studies were found. There is evidence on the association between vitamin D and myopia, AMD, DR, and DES. Overall, 17 out of 27 studies reported an association between vitamin D and AMD, while 48 out of 54 studies reported that vitamin D was associated with DR, and 25 out of 27 studies reported an association between vitamin D and DES. However, the available evidence for the association with other ocular diseases, such as glaucoma, TED, and RB, remains limited.

Serum vitamin D levels in patients with vernal keratoconjunctivitis and its relationship with disease severity

Purpose

To evaluate the serum vitamin D levels of patients with vernal keratoconjunctivitis (VKC)

Method

A total of 39 VKC patients (21 males and 18 females) and 32 healthy individuals (19 males and 13 females) were enrolled in this study with the mean age of 18.38 ± 8.83 and 21.6 ± 9.43, respectively. The type and the grade of VKC were identified for each patient and serum 25-hydroxyvitamin D (25(OH)D) levels of all subjects were evaluated.

Results

The patients affected by VKC had statistically significant lower 25(OH)D levels (27.64 ± 8.50 ng/mL) than healthy subjects group (35.96 ± 11.34 ng/mL) ( p = 0.001). A reverse correlation was found between the serum vitamin D levels and the severity of the VKC but it was not statistically significant ( r = −0.159, p = 0.33). Besides, there were a few cases with severe and very severe VKC (2 in grade 3 and 4 in grade 4). Patients with the mixed type of the disease had lower serum vitamin D levels in comparison to tarsal and limbal forms but the difference was not statistically significant ( p = 0.38).

Conclusion

This study shows that the patients affected by VKC have lower vitamin D levels in comparison to healthy subjects and the screening of all patients with VKC for vitamin D levels seems rational.

Serum Vitamin D Level and Body Mass Index in Children with Vernal Keratoconjunctivitis

OBJECTIVES

The purpose of this study was to evaluate the body mass index (BMI) value and serum 25-hydroxyvitamin D [25(OH)D3] level in children with vernal keratoconjunctivitis (VKC).

METHODS

A total of 40 healthy, non-atopic children (control group) and 46 children with VKC (study group) were included in the study. The serum vitamin D [25(OH)D3] levels and BMI values were measured and compared between the 2 groups.

RESULTS

The mean vitamin D level measured in the healthy children (mean: 19.01±5.66 ng/mL, range: 9-33.09 ng/mL) was significantly different from the mean vitamin D level in the VKC-affected children (mean: 14.06±5.02 ng/mL, range 4.37-31 ng/mL) (p<0.001). The mean BMI in the VKC group (17.1±2.5 kg/m²) was significantly higher than the mean BMI of the healthy children (mean: 16.5±2.3 kg/m²; p=0.046). A negative correlation (Spearman's rho=-0.275; p=0.01) was observed between the vitamin D level and the BMI value.

CONCLUSION

The results indicated that children with VKC had a lower serum vitamin D level and a higher BMI value compared with healthy, age- and sex-matched children.

Eye drop emulsion containing 0.1% cyclosporin (1 mg/mL) for the treatment of severe vernal keratoconjunctivitis: an evidence-based review and place in therapy

Vernal keratoconjunctivitis (VKC) is a rare, recurrent and multifactorial ocular disease, which typically flares up during spring and affects especially male children and adolescents. This condition does not usually respond to common treatments with antihistamines or mast cells stabilizers, whereas corticosteroids have effective results. Corticosteroids need to be carefully administered, to avoid adverse effects, mainly the secondary development of glaucoma, cataracts, or infections. Immunosuppressive agents, such as cyclosporin (CyA) or tacrolimus are, therefore, frequently employed in VKC patients. Only the 0.1% CyA (1 mg/mL) concentration has an approved and specific clinical indication for the treatment of VKC and this drug was given the denomination of orphan drug by the European Commission (EU/3/06/360) in 2006. So far, few studies have been conducted to evaluate the efficacy and the side effects of topical 0.1% CyA. Different topical CyA concentrations, ranging from 0.05% to 2%, and various types of formulation are available at the moment. In the future, 0.1% CyA will presumably take an important part in the management of VKC. The present review focuses on eye drops containing 0.1% CyA; however, more studies will be needed to define its long-term efficacy in the natural course of this severe ocular disease.

Vitamin D serum levels in children with vernal keratoconjunctivitis and disease control

The aim of this study was to evaluate whether the control of ocular symptoms with cyclosporine or with tacrolimus in eye drops allows to improve sun exposure and therefore serum level of vitamin D (VD; 25OHD), in the more severe forms of vernal keratoconjunctivitis (VKC). Out of 242 children followed for active VKC, 94 were treated with 1% cyclosporine or 0.1% tacrolimus eye drops, while the other 148 with mild VKC did not need to be treated with immunomodulators. VD serum levels were measured in spring and autumn in 71 children. In total, 60 of them were treated with cyclosporine eye drops (first group) and 11 (not responding to cyclosporine therapy previously) with 0.1% tacrolimus eye drops (second group) between March and November 2016. Pre-treatment median values of VD were 23.7 ng/mL in the first group and 23.8 in the second group, and post-treatment values increased up to 32.8 and 32.9 ng/mL, respectively. Before treatment, 33% presented a deficiency (25OHD < 20 ng/mL), and at the end of summer, only 4% were deficient. The overweight children had lower improvement in VD serum levels than children with a body mass index (BMI) lower than 85th percentile. Children in therapy with cyclosporine, but requiring the administration of local steroid therapy during the summer for control of the symptoms, showed a greater improvement in 25OHD serum levels in ng/mL (23-37 ng/mL) than children who did not require steroid therapy (24-35 ng/mL). Furthermore, there was a significant difference in change of 25OHD in children presenting limbal VKC (21-41 ng/mL) versus tarsal VKC (24-35 ng/mL) ( P = 0.04). Our study suggests that ocular treatment carried out with immunomodulator eye drops could allow for an improvement in 25OHD serum levels. In children with active VKC and at risk of 25OHD deficiency, likely due to avoidance of sun exposure, the role of other risk factors (BMI, phototype and treatment) on 25OHD serum levels should be considered.