Immunological characteristics of patients with vernal keratoconjunctivitis.
OBJECTIVE
Previously, we have reported that local excision and immunosuppressive treatment are useful in treating patients with very severe vernal keratoconjunctivitis (VKC).


METHODS
We measured serum levels of immunoglobulins, cytokines, and interleukin-2 receptors (IL-2R) and the concentration of IL-4 in tears of 10 patients with severe VKC, and made a comparison with data from 10 healthy controls. Brush cytology specimens were examined to determine the number of inflammatory cells and the human lymphocyte antigen (HLA)-DR expression in conjunctiva.


RESULTS
The mean serum level of total immunoglobulin (Ig)E, but not IgG, was higher in severe VKC patients compared with healthy controls. Specific IgE positivity to housedust, dust mites, and cat antigens was observed in 60-80% of patients. The level of IL-4 and IL-2R in serum and IL-4 in tears before treatment was higher in patients with VKC compared with controls. Serum levels of IL-2 and interferon-gamma did not increase. Brush cytology specimens from patients expressed HLA-DR.


CONCLUSIONS
These results suggest that VKC could be a combination of type I allergic disease and an inflammatory cell disease including activated T cells, especially Th2 cells. Therefore, the surgical removal of inflammatory cells combined with immunosuppressive therapy could be advocated as a method of treatment.
Fujishima
Hiroshi
H
Department of Ophthalmology, Tokyo Dental College, Ichikawa, Chiba, Japan.
Saito
Ichiro
I
Takeuchi
Tsutomu
T
Tsubota
Kazuo
K
D000293:Adolescent; D000328:Adult; D000917:Antibody Formation; D003233:Conjunctivitis, Allergic / Q000276:immunology*; D003584:Cytological Techniques; D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D007073:Immunoglobulin E / Q000378:metabolism*; D007074:Immunoglobulin G / Q000378:metabolism; D007166:Immunosuppressive Agents; D007371:Interferon-gamma / Q000378:metabolism; D015847:Interleukin-4 / Q000378:metabolism*; D008297:Male; D015375:Receptors, Interleukin-2 / Q000378:metabolism*; D013666:Tears / Q000276:immunology* / Q000378:metabolism; D018418:Th2 Cells / Q000276:immunology
D006684:HLA-DR Antigens; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2; D015847:Interleukin-4; D007073:Immunoglobulin E; D007371:Interferon-gamma