On the prevalence of vernal keratoconjunctivitis and current possibilities of treatment
https://doi.org/10.21516/2072-0076-2017-10-4-74-81
Abstract
The importance of vernal keratoconjunctivitis (vernal conjunctivitis, or vernal catarrh) is not so much due to its level of prevalence (today its occurrence amounts to 1.25-11.29 per 10 000 population of European countries), but rather to the severity of its clinical course. Especially significant is its tarsal form, which is complicated in 3-11 % of vernal keratoconjunctivitis patients by the development of corneal ulcers. Such patients are normally treated by antiallergic agents, which offer both antihistamine and mast cell-stabilizing action. Primarily, the medicines used are 0.1 % olopatadine and 0.025 % ketotifen, which can also reduce the activation of eosinophils and the production of pro-inflammatory cytokines. The therapy of resistant forms of the disease is successfully supplemented with instillations and / or ointment forms of glucocorticoids, cyclosporine-A, tacrolimus and mitomycin-C. Giant papillae that cause gravitational ptosis or are combined with the torpid current of the disease require surgical treatment. They are excised (or cryodestructed) with intraoperative treatment of the tarsal conjunctiva with 0.02 % mitomycin-C and subsequent instillations of cyclosporine-A. There is a need to further develop and introduce into clinical practice new pathogenetically oriented medicinal preparations which provide both relief of clinical symptoms of the disease and the prevention of its relapses. For citations: Brzheskiy V.V. On the prevalence of vernal keratoconjunctivitis and current possibilities of treatment. Russian ophthalmological journal. 2017; 10 (4): 74-81. doi: 10.21516/2072-0076-2017-10-4-74-81 (in Russian).
About the Author
V. V. Brzheskiy
St. Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
References
1. Хойт К.С., Тейлор Д. Детская офтальмология: в 2 т. Пер. с англ. Сидоренко Е. И. и др. Москва: Изд-во Панфилова; 2015.
2. Leonardi A. Management of vernal keratoconjunctivitis. Ophthalmol. Ther. 2013; 2: 73-88. doi: 10.1007/s40123-013-0019-y
3. Leonardi A., Bogacka E., Fauquert J.L., et al. Ocular allergy: recognizing and diagnosing hypersensitivity disorders of the ocular surface. Allergy. 2012; 67(11): 1327-7. doi: 10.1111/all.12009.
4. Ukponmwan C.U. Vernal keratoconjunctivitis in Nigerians: 109 consecutive cases. Trop. Doct. 2003; 33(4): 242-5. doi: 10.1177/004947550303300419
5. Leonardi A., Busca F., Motterle L., et al. Case series of 406 vernal keratoconjunctivitis patients: a demographic and epidemiological study. Acta Ophthalmol. 2006; 84: 406-10.
6. Bremond-Gignac D., Donadieu J., Leonardi A., et al. Prevalence of vernal keratoconjunctivitis: a rare disease? Brit. J. Ophthalmol. 2008; 92: 1097-102. doi: 10.1136/bjo.2007.117812.
7. De Smedt St., Nkurikiye J., Fonteyne Y.,et al.Vernal keratoconjunctivitis in school children in Rwanda and its association with socio-economic status: a population-based survey. Amer. J. Trop. Med. Hyg. 2011; 85(4): 711-7. doi:10.4269/ajtmh.2011.11-0291
8. :10.4269/ajtmh.2011.11-0291Майчук Д.Ю., Лошкарева А.О., Аперьян Н.В. Особенности клинического течения и комплексной терапии весеннего катара (клинический случай). Офтальмохирургия. 2016; 4: 79-82
9. De Smedt St., Wildner G., Kestelyn P. Vernal keratoconjunctivitis: an update. Brit. J. Ophthalmol. 2013; 97 (1): 9-14. doi: 10.1136/bjophthalmol-2011-301376
10. Vichyanond P., Pacharn P., Pleyer U., Leonardi A. Vernal keratoconjunctivitis: A severe allergic eye disease with remodeling changes. Pediatric Allerg. Immunol. 2014; 25: 314-22. doi: 10.1111/pai.12197.
11. Kosrirukvongs P., Vichyanond P., Wongsawad W. Vernal keratoconjunctivitis in Thailand. Asian Pac. J. Allergy Immunol. 2003; 21: 25-30.
12. Bonini S., Lambiase A., Marchi S., et al. Vernal keratoconjunctivitis revisited: a case series of 195 patients with long-term followup. Ophthalmology. 2000; 107: 1157-63.
13. Bonini S., Lambiase A., Schiavone M., et al. Estrogen and progesterone receptors in vernal keratoconjunctivitis. Ophthalmology. 1995; 102: 1374-9.
14. Leonardi A., Sathe S., Bortolotti M., et al. Cytokines, matrix metalloproteases, angiogenic and growth factors in tears of normal subjects and vernal keratoconjunctivitis patients. Allergy. 2009; 64(5): 710-7.
15. Zicari A.M., Nebbioso M., Lollobrigida V., et al. Vernal keratoconjunctivitis: atopy and autoimmunity. Eur. Rev. Med. Pharmacol. Sci. 2013; 17(10): 1419-23. doi: 10.5021/ad.2013.25. 2.242.
16. Kumagai N., Fukuda K., Fujitsu Y., et al. Role of structural cells of the cornea and conjunctiva in the pathogenesis of vernal keratoconjunctivitis. Prog. Retin. Eye Res. 2006; 25(2): 165-87.
17. Майчук Ю.Ф. Аллергические заболевания глаз. Москва: Медицина; 1983.
18. Leonardi A., Smith L., Secchi A. Vernal keratoconjuntivitis. In: Abelson M., ed. Allergic diseases of the eye. Philadelphia: WB Saunders; 2000: 179-96.
19. Leonardi A., Lazzarini D., Bortolotti M., et al. Corneal confocal microscopy in patients with vernal keratoconjunctivitis. Ophthalmology. 2012; 119: 509-15.
20. Verin P., Allewaert R., Joyaux J.C., et al. Comparison of lodoxamide 0.1% ophthalmic solution and levocabastine 0.05% ophthalmic suspension in vernal keratoconjunctivitis. Eur. J. Ophthalmol. 2001; 11: 120-5.
21. Tabbara K.F., Arafat N.T. Cromolyn effects on vernal keratoconjunctivitis in children. Arch. Ophthalmol. 1977; 95: 2184-6.
22. Leonardi A., Borghesan F., Avarello A., et al. Effect of lodoxamide and disodium cromoglycate on tear eosinophil cationic protein in vernal keratoconjunctivitis. Brit. J. Ophthalmol. 1997; 81: 23-6.
23. Bonini S., Schiavone M., Magrini L., et al. Efficacy of lodoxamide eye drops on mast cells and eosinophils after allergen challenge in allergic conjunctivitis. Ophthalmology. 1997; 104: 849-53.
24. Leonardi A., Bremond-Gignac D., Bortolotti M., et al. Clinical and biological efficacy of preservative-free NAAGA eye-drops versus levocabastine eye-drops in vernal keratoconjunctivitis patients. Brit. J. Ophthalmol. 2007; 91(12): 1662-6.
25. Hida W.T., Nogueira D.C., Schaefer A., et al. Comparative study between 0.025% ketotifen fumarate and 0.1% olopatadine hydrochloride in the treatment of vernal keratoconjunctivitis. Arq. Bras. Oftalmol. 2006; 69(6): 851-6.
26. Gupta S., Khurana A.K., Ahluwalia B.K., Gupta N.C. Topical indomethacin for vernal keratoconjunctivitis. Acta Ophthalmol. 1991; 69(1): 95-8.
27. Sharma A., Gupta R., Ram J., Gupta A. Topical ketorolac 0.5% solution for the treatment of vernal keratoconjunctivitis. Indian J. Ophthalmol. 1997; 45(3): 177-80.
28. D’Angelo G., Lambiase A., Cortes M.,et al. Preservative-free diclofenac sodium 0.1% for vernal keratoconjunctivitis. Graefes Arch. Clin. Exp. Ophthalmol. 2003; 241(3): 192-5.
29. Vichyanond P., Tantimongkolsuk C., Dumrongkigchaiporn P., et al. Vernal keratoconjunctivitis: result of a novel therapy with 0.1% topical ophthalmic FK- 506 ointment. J. Allergy Clin. Immunol. 2004; 113: 355-8.
30. Oner V., Turkcu F.M., Tas M., et al. Topical loteprednoletabonate 0.5% for treatment of vernal keratoconjunctivitis: efficacy and safety. Jpn. J. Ophthalmol. 2012; 56: 312-8. doi: 10.1007/s10384-012-0152-5.
31. Бржеский В.В., Садовникова Н.Н., Прозорная Л.П., Попов В.Ю. Препарат для лечения синдрома «сухого глаза». Патент РФ № 2559580; 2015.
32. Holsclaw D.S., Whitcher J.P., Wong I.G., Margolis T.P. Supratarsal injection of corticosteroid in the treatment of refractory vernal keratoconjunctivitis. Amer. J. Ophthalmol. 1996; 121(3): 243-9.
33. Utine C.A., Stern M., Akpek E.K. Clinical review: topical ophthalmic use of cyclosporin A. Ocul. Immunol. Inflam. 2010; 18(5): 352-61. doi: 10.3109/09273948.2010.498657
34. Vichyanond P., Kosrirukvongs P. Use of cyclosporine A and tacrolimus in treatment of vernal keratoconjunctivitis. Curr. Allergy Asthma Rep. 2013; 13: 308-14. doi: 10.1007/s11882-013-0345-0
35. Бржеский В.В., Майчук Д.Ю. Новые возможности иммуносупрессивной терапии у больных с синдромом «сухого глаза». Офтальмологические ведомости. 2012; 5(1): 69-74. doi: 10.1097/icl.0000000000000055
36. Cetinkaya A., Akova Y.A., Dursun D., Pelit A. Topical cyclosporine in the management of shield ulcers. Cornea. 2004; 23(2): 194-200.
37. Ebihara N., Ohashi Y., Uchio E., et al. A large prospective observational study of novel cyclosporine 0.1% aqueous ophthalmic solution in the treatment of severe allergic conjunctivitis. J. Ocul. Pharmacol. Ther. 2009; 25(4): 365-72.
38. Wan K.H., Chen L.J., Rong S.S., et al. Topical cyclosporine in the treatment of allergic conjunctivitis: A meta-analysis. Ophthalmology. 2013; 120(11): 2197-203. doi: 10.1016/j.ophtha.2013.03.044
39. Lambiase A., Leonardi A., Sacchetti M.,et al. Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double-masked, controlled 2-year study. J. Allergy Clin. Immunol. 2011; 128(4): 896-7.
40. Labcharoenwongs P., Jirapongsananuruk O., Visitsunthorn N., et al. A double-masked comparison of 0.1% tacrolimus ointment and 2% cyclosporine eye drops in the treatment of vernal keratoconjunctivitis in children. Asian Pac. J. Allergy Immunol. 2012; 30; 177-84.
41. Tam P.M., Young A.L., Cheng L.L., Lam P.T. Topical tacrolimus 0.03% monotherapy for vernal keratoconjunctivitis - case series. Brit. J. Ophthalmol. 2010; 94: 1405-6. doi: 10.1136/bjo.2009.172387
42. Akpek E.K., Hasiripi H., Christen W.G., Kalayci D. A randomized trial of low-dose, topical mitomycin-C in the treatment of severe vernal keratoconjunctivitis. Ophthalmology. 2000; 107(2): 263-9.
43. Baroody F.M., Shenaq D., DeTineo M., et al. Fluticasone furoate nasal spray reduces the nasal-ocular reflex: a mechanism for the efficacy of topical steroids in controlling allergic eye symptoms. J. Allergy Clin. Immunol. 2009; 123(6): 1342-8. doi: 10.1016/j.jaci.2009.03.015
44. Bielory L., Lien K.W., Bigelsen S. Efficacy and tolerability of newer antihistamines in the treatment of allergic conjunctivitis. Drugs. 2005; 65(2): 215-28.
45. Abelson M.B., Butrus S.I., Weston J.H. Aspirin therapy in vernal conjunctivitis. Amer. J. Ophthalmol. 1983; 95(4): 502-5.
46. Anzaar F., Gallagher M.J., Bhat P. et al. Use of systemic T-lymphocyte signal transduction inhibitors in the treatment of atopic keratoconjunctivitis. Cornea. 2008; 27 (8): 884-8.
47. Lupez-Piedrahita E., Sanchez-Caraballo J.M., Ramirez-Girado R.H., Cardona-Villa R. Effectiveness of allergen immunotherapy in patients with vernal keratoconjunctivitis. Rev. Alerg. Mex. 2013; 60: 11-6.
48. Tanaka M., Dogru M., Takano Y., et al. Quantitative evaluation of the early changes in ocular surface inflammation following MMC-aided papillary resection in severe allergic patients with corneal complications. Cornea. 2006; 25(3): 281-5.
49. Sacchetti M., Lambiase A., Mantelli F., et al. Tailored approach to the treatment of vernal keratoconjunctivitis. Ophthalmology. 2010; 117(7): 1294-9.
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For citations:
Brzheskiy V.V. On the prevalence of vernal keratoconjunctivitis and current possibilities of treatment. Russian Ophthalmological Journal. 2017;10(4):74-81. (In Russ.) https://doi.org/10.21516/2072-0076-2017-10-4-74-81
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