Surgical management of corneal plaques in vernal keratoconjunctivitis: a clinicopathologic study.
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.
Solomon
Abraham
A
Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. avisol@md.huji.ac.il
Zamir
Ehud
E
Levartovsky
Shmuel
S
Frucht-Pery
Joseph
J
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
D001798:Blood Proteins; D011509:Proteoglycans; C074129:PRG2 protein, human; D047093:Eosinophil Major Basic Protein