Clinical Outcome of Vernal Keratoconjunctivitis in Childhood: Long-Term Observation
Vernal keratoconjunctivitis (VKC) is an ocular disorder characterized by severe inflammation affecting both the cornea and conjunctiva that mainly affects boys in the first decade of life. Although the symptoms of VKC usually persist despite treatment, with seasonal deterioration, the condition generally resolves spontaneously with the onset of puberty. Some cases of VKC result in refractory atopic keratoconjunctivitis (AKC) in adulthood. Those cases complicated by atopic dermatitis (AD) may require therapeutic measures beyond this age into adulthood to control the disease, and permanent changes to the ocular surface and visual impairment may occur. Long-term follow-up has been rarely reported for VKC because of the need for long-term clinical evaluation. Authors investigated the long-term clinical outcome of VKC treated and controlled in their hospital, which might reflect the recent changes in clinical features of VKC especially derived by the introduction of immunosuppressive eye drops. The most relevant clinical features that emerged from this evaluation were analyzed for their prognostic value based on longterm follow-up. The aim of the present study was also to evaluate the relationship between the cure/non-cure groups and clinical findings derived from long-term observation of VKC cases
In total, 45 consecutive patients clinically diagnosed with VKC aged 4 to 12 years at onset at the Department of Ophthalmology of Fukuoka University Hospital were included. Patients were treated with immunosuppressive eye drops without simultaneous corticosteroid eye drops, except for the occurrence of exacerbations. Collated variables were gender, age at onset, clinical score of ocular lesions (conjunctival giant papillae, limbal edema and corneal epithelial lesions) at the first visit, and clinical score of atopic dermatitis (AD) at baseline.
The observation period ranged from 24 to 188 months, with median of 70 months. Among the 45 cases enrolled, all noncured cases (14 cases) observed clinically were complicated by AD. Cumulative cure rate was 74.5% and 84.9% at eight- and ten-year follow-up, respectively. Ten-year cumulative cure rates of cases with and without AD were 50.5% and 100%, respectively, and a significant difference was found between these cumulative cure curves. Binomial regression analysis revealed that AD and gender were significantly related to worse outcome, and this binomial regression model had high sensitivity and specificity.
In conclusion, several novel findings have been gained from this observational case series. In this chronological survey, the ten-year cumulative cure rate of VKC was 84.9%, and 15.1% of cases remained uncured after 10 years of observation in the cure curve. There was a significant difference in the long-term outcome between VKC cases with and without AD. Binomial regression analysis showed that AD and male gender were significantly related to a worse outcome. The binomial regression model had high sensitivity and specificity. The clinical outcome in VKC might be predicted by several factors that can be evaluated in the early clinical phase.
Source: Shimokawa et al; Clinical Ophthalmology 2024:18 2339–2347
