title: Surgical management of corneal plaques in vernal keratoconjunctivitis: a clinicopathologic study.
abstract: OBJECTIVE
  To describe the surgical management and histopathologic and immunohistochemical findings in corneal plaques of shield ulcers in vernal keratoconjunctivitis.
  
  
  METHODS
  Three children (ages 4, 7.5, and 9) presented with corneal plaques unresponsive to conservative systemic and topical medical treatment. Plaques were scraped under general anesthesia, and soft bandage contact lenses were placed. The excised tissue was evaluated by histopathology and immunohistochemistry.
  
  
  RESULTS
  During surgery, plaques were found to extend beyond the ulcer margins. Histopathology revealed granular, deeply-eosinophilic, laminar material, firmly attached to the Bowman layer in all cases. Immunohistochemistry confirmed this to be eosinophil-derived major basic protein (MBP). After surgical removal, complete epithelization was evident within 1-4 weeks in all cases.
  
  
  CONCLUSIONS
  Corneal plaque is a rare complication of vernal keratoconjunctivitis. These plaques usually do not resolve with standard conservative measures. Failure to epithelialize may be a result of the plaque material extending below the edges of adjacent epithelium. We suggest that MBP plaques precipitate on the denuded stromal bed, thereby playing a pathogenic role in nonhealing shield ulcers.
authors.affiliation: Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. avisol@md.huji.ac.il
authors.forename: Abraham
authors.initials: A
authors.lastname: Solomon
authors.forename: Ehud
authors.initials: E
authors.lastname: Zamir
authors.forename: Shmuel
authors.initials: S
authors.lastname: Levartovsky
authors.forename: Joseph
authors.initials: J
authors.lastname: Frucht-Pery
mesh_terms: D001798:Blood Proteins / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003233:Conjunctivitis, Allergic / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D003320:Corneal Ulcer / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D003646:Debridement; D047093:Eosinophil Major Basic Protein; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D011509:Proteoglycans / Q000378:metabolism
chemical_list: D001798:Blood Proteins; D011509:Proteoglycans; C074129:PRG2 protein, human; D047093:Eosinophil Major Basic Protein