Combined medical and surgical treatment of severe vernal keratoconjunctivitis.
OBJECTIVE
We report the efficacy of an alternative method of treatment for vernal keratoconjunctivitis (VKC) that consists of excision of the palpebral conjunctiva followed by supratarsal injection of corticosteroid and five times daily topical application of 0.05% cyclosporine A (CsA) and cromolyn sodium.


METHODS
We evaluated 10 patients with severe treat-resistant VKC with corneal complications. The patients were evaluated for symptoms and for signs, including conjunctival changes, corneal limbal infiltrates, vascularization, reduction of epitheliopathy, meibomitis, visual acuity, intraocular pressure, and pathologic evaluation, before and after treatment.


RESULTS
All patients showed marked improvement after 2 weeks of treatment. The symptoms (P <.01), signs (P <.02), and the visual acuity of all patients (P <.01) had significantly improved following treatment. Histological examination showed significant inflammatory cell decreases 4 weeks after surgery (P <. 05).


CONCLUSIONS
Surgery plus topical drug therapy may be useful in treating patients with very severe VKC.
Fujishima
H
H
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
Fukagawa
K
K
Satake
Y
Y
Saito
I
I
Shimazaki
J
J
Takano
Y
Y
Tsubota
K
K
D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000473:pathology / Q000601:surgery; D003233:Conjunctivitis, Allergic / Q000473:pathology / Q000628:therapy*; D003315:Cornea / Q000473:pathology / Q000601:surgery; D004205:Cromolyn Sodium / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005143:Eyelids / Q000473:pathology / Q000601:surgery; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007429:Intraocular Pressure; D008297:Male; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014792:Visual Acuity
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D004205:Cromolyn Sodium