Quantitative evaluation of the early changes in ocular surface inflammation following MMC-aided papillary resection in severe allergic patients with corneal complications.
BACKGROUND
Atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) are chronic inflammatory allergic diseases that are associated with some common conjunctival and corneal complications.1 The clinical corneal manifestations of both entities may include superficial punctate keratitis, macroerosions, corneal ulceration, plaque formation, corneal neovascularization, and lipid infiltration.


OBJECTIVE
To quantitatively evaluate the early ocular surface inflammation before and after mitomycin C (MMC)-aided papillary resection in severe allergy patients with corneal complications.


METHODS
Three eyes with VKC and 5 eyes with AKC were included in this study. All eyes had cobblestone-like papillae on the upper tarsal conjunctiva and corneal complications such as corneal ulcers, defect, or erosions that were refractory to conventional treatment of more than 2 weeks. Papillary resection with intraoperative 0.05% MMC application for 5 minutes on the palpebral conjunctiva was carried out in all eyes. Corneal and conjunctival findings were evaluated before and 1 week and 2 weeks after surgery. Brush cytology (BC) and evaluation of tear eosinophilic cationic protein (ECP) levels by radioimmunoassay techniques were performed as well pre- and postoperatively.


RESULTS
Corneal and conjunctival complications resolved in all patients within 7 days after resection. Postoperative tear ECP levels decreased significantly with papillary resection (P< 0.05). Concomitant brush cytology showed a significant decrease in the number of eosinophils and neutrophils following papillary resection (P < 0.05).


CONCLUSIONS
MMC-aided papillary resection provided a dramatic decrease in ocular surface inflammation as evidenced by decrease in the number of inflammatory cells as well as tear ECP levels with a rapid improvement of clinical corneal and conjunctival findings.
Tanaka
Mari
M
Department of Ophthalmology, Keio University, Shinjuku-ku, Tokyo, Japan.
Dogru
Murat
M
Takano
Yoji
Y
Miyake-Kashima
Minori
M
Asano-Kato
Naoko
N
Fukagawa
Kazumi
K
Tsubota
Kazuo
K
Fujishima
Hiroshi
H
D000293:Adolescent; D000328:Adult; D000477:Alkylating Agents / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D003233:Conjunctivitis, Allergic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D003316:Corneal Diseases / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D047150:Eosinophil Cationic Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D016685:Mitomycin / Q000627:therapeutic use*; D013508:Ophthalmologic Surgical Procedures; D011863:Radioimmunoassay; D013666:Tears / Q000378:metabolism
D000477:Alkylating Agents; D016685:Mitomycin; D047150:Eosinophil Cationic Protein