title: Combined medical and surgical treatment of severe vernal keratoconjunctivitis.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Fujishima
authors.forename: K
authors.initials: K
authors.lastname: Fukagawa
authors.forename: Y
authors.initials: Y
authors.lastname: Satake
authors.forename: I
authors.initials: I
authors.lastname: Saito
authors.forename: J
authors.initials: J
authors.lastname: Shimazaki
authors.forename: Y
authors.initials: Y
authors.lastname: Takano
authors.forename: K
authors.initials: K
authors.lastname: Tsubota
mesh_terms: 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
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D004205:Cromolyn Sodium