VKC and corneal topography

Disease, which mainly affects children under the age of 10, is prone to complications

Priscilla Lynch

Posted: Sunday, March 1, 2020

Corneal topography should be performed in all cases of vernal keratoconjunctivitis (VKC) due to the high risk of corneal complications with this condition, the dedicated session on ocular surface diseases in paediatric patients during the 10th EuCornea Congress in Paris, France, was told.
VKC, a severe form of ocular allergy that causes itching, photophobia, burning and tearing, mainly occurs in children, particularly under the age of 10 years, explained Sihem Lazreg MD, Algeria. It is an IgE- and T-cell mediated disease in which eosinophil, lymphocyte and structural cell activation are involved. The incidence of VKC is higher in males by a ratio of three to one.
VKC usually appears from early spring until autumn, but is more prevalent and perennial in countries with warmer climates, she noted.
There are three forms – tarsal VKC, limbal and mixed forms. Tarsal forms are the most common, with a giant papillae in the tarsal side of the conjunctiva. Most cases present with an irregular astigmatism, and some with keratoconus, probably due to eye rubbing, Dr Lazreg told the meeting.
Corneal involvement in VKC is very frequent and can be very severe, compromising visual function, hence the need for corneal topography, she stressed.
Dr Lazreg presented the findings of a large retrospective study from her own clinic, involving 867 cases of VKC over an 11-year period (2008-2019). Nearly two-thirds (62%) of the cohort had an allergic history (rhinitis 51%, asthma 21%, etc) with corneal involvement in 57% of cases, ie, vernal plaques, punctate keratitis, stem cell deficiency, corneal opacities and keratoconus.
Steroids are very effective for VKC, Dr Lazreg noted, adding that as ciclosporin is not available in Algeria she uses triamcinolone (supratarsal injection), while tacrolimus ointment is also effective in non-responders. Following treatment, 73% of her cases had significantly improved signs and symptoms, while 21% had satisfactory results but frequent relapses, 5% had dependence on corticosteroids, while 1% had non-responding severe forms.
Dr Lazreg also drew attention to the severe iatrogenic complications that can occur when patients self-medicate with steroids for VKC, highlighting a number of cases of steroid-related glaucoma, some very severe with loss of vision, and cataracts, which occurred in Algeria. Concluding, Dr Lazreg stressed that the psychological impact of VKC must also be addressed as well as allergen avoidance for the best outcomes in these young patients.

Sihem Lazreg:

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