title: Management, clinical outcomes, and complications of shield ulcers in vernal keratoconjunctivitis.
abstract: OBJECTIVE
  To assess the clinical outcomes and complications of shield ulcers by various treatment methods.
  
  
  METHODS
  Retrospective, interventional case series.
  
  
  METHODS
  setting: Cornea and anterior segment service of L.V. Prasad Eye Institute, India. study population: One hundred ninety-three eyes of 163 patients clinically diagnosed with vernal keratoconjunctivitis and shield ulcers. intervention: The treatment algorithm was based on the Cameron clinical grading of shield ulcers. Grade 1 ulcers received medical therapy alone. Grade 2 and grade 3 ulcers received either medical therapy alone or medical therapy combined with debridement, amniotic membrane transplantation (AMT), or both. main outcome measures: Re-epithelialization time and best-corrected visual acuity.
  
  
  RESULTS
  Grade 1 ulcers were seen in 71 (37%) eyes, grade 2 ulcers were seen in 79 (41%) eyes, and grade 3 ulcers were seen in 43 (22%) eyes. In the grade 1 group, re-epithelialization was seen in 67 (94%) eyes. In the grade 2 group, re-epithelialization was seen in 36 (88%) eyes that received medical treatment, in 20 (95%) eyes that underwent debridement, and in 17 (100%) eyes that underwent AMT. In the grade 3 group, re-epithelialization was seen in only 1 (1.7%) eye that received medical treatment, whereas it was seen in all eyes that underwent debridement and AMT. The mean best-corrected visual acuity after re-epithelialization of the shield ulcer was 20/30, 20/30, and 20/40 in the grade 1, grade 2, and grade 3 groups, respectively. Recurrence and secondary bacterial keratitis were seen in 28 (14.5%) and 20 (10%) eyes, respectively.
  
  
  CONCLUSIONS
  Grade 1 shield ulcers respond well to medical therapy alone, whereas grade 2 ulcers occasionally may require additional debridement or AMT. Grade 3 ulcers, however, largely are refractory to medical therapy and require debridement and AMT for rapid re-epithelialization.
authors.affiliation: Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Jagadesh C
authors.initials: JC
authors.lastname: Reddy
authors.forename: Sayan
authors.initials: S
authors.lastname: Basu
authors.forename: Ujwala S
authors.initials: US
authors.lastname: Saboo
authors.forename: Somasheila I
authors.initials: SI
authors.lastname: Murthy
authors.forename: Pravin K
authors.initials: PK
authors.lastname: Vaddavalli
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000637:transplantation; D002648:Child; D002675:Child, Preschool; D003233:Conjunctivitis, Allergic / Q000150:complications*; D003320:Corneal Ulcer / Q000145:classification / Q000209:etiology* / Q000628:therapy*; D003646:Debridement; D019573:Epithelium, Corneal / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult