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Purpose: This study evaluated the structural and functional impact of vernal keratoconjunctivitis (VKC) on meibomian glands (MGs) using a combination of noncontact meibography and lipid layer interferometry. Methods: In this observational study 50 patients with moderate persistent or severe VKC and 50 age-matched controls underwent MG imaging and lipid layer thickness (LLT) measurements with Lipiview II. Image J software was used to assess MG loss (meibograde) in both lids. All patients underwent dry eye evaluation comprising tear break-up time (TBUT), ocular surface staining (OSS), Schirmer I scoring, and meiboscoring (expressibility and quality of meibum secreted). Results: Meibograde, OSS score, and meiboscore was higher in cases (2.68 ± 0.96, 0.580 ± 1.07, and 0.56 ± 0.95 respectively) than controls (1.80 ± 0.67, 0.00 ± 0.00, 0.22 ± 0.47 respectively) (p < 0.001, 0.001, 0.025 respectively). LLT and TBUT was lower in cases (54.58 ± 9.43 nm and 4.92 ± 3.09 sec respectively) than controls (70.14 ± 22.50 nm and 12.02 ± 2.73 sec respectively) (both p's = 0.001). Both groups had comparable Schirmer I scores. Conclusion: Children with VKC have significant MG dropouts, deterioration in meibum quality and a thinner and less stable tear film. VKC patients are thus prone to a vicious cycle of inflammation attributable both to the allergic component and to deterioration in MG structure and function. Co-management of MG dysfunction warrants as much attention as the allergic component itself. [ABSTRACT FROM AUTHOR]

Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, inflammatory disease that affects both eyes, often with asymmetric severity, potentially causing major visual complications. The seasonal management of VKC can be challenging, especially when specialists with different diagnostic and therapeutic approaches need to be consulted. The aim of this expert panel was to reach a national consensus among pediatric allergologists and ophthalmologists on the diagnosis and treatment of VKC. This consensus was developed by an expert panel of 17 Italian pediatric allergologists and ophthalmologists with over a decade of experience. Ten statements on VKC diagnosis and treatment formulated after a thorough review of current literature were evaluated by the panelists. The level of agreement was quantitatively assessed using a 5-point Likert scale. Consensus was reached if ≥ 75.0% of panelists agreed to any given statement. The consensus emphasizes the importance of evaluation by multispecialty reference centers or experienced specialists for accurate diagnosis. Prompt diagnosis, especially during active phases, is crucial and should occur before corticosteroid therapy. The Bonini score from 2007 is the preferred tool for VKC assessment, although future revisions may be considered. Short cycles of topical corticosteroids should be preferred over prolonged use, even during immunomodulatory therapy. When cyclosporine fails, tacrolimus should be considered. Conclusion: This is the first consensus on the management of VKC that has gathered the expert opinions of both pediatricians and ophthalmologists. The outcome of this multidisciplinary effort provides a uniform approach to VKC diagnosis and treatment, thereby facilitating patient management across the country. What is Known: • Vernal keratoconjunctivitis (VKC) is a chronic recurrent ocular disease particularly prevalent in the pediatric population. • Despite its relevance, there is a lack of standardized approaches shared between pediatricians and ophthalmologists, leading to notable variations in clinical practice. What is New: • This expert panel, comprising 17 pediatric allergologists and ophthalmologists, has reached a national consensus to provide standardized guidance for VKC management. • The consensus emphasizes the importance of a multidisciplinary approach to managing VKC, ensuring consistent and effective patient care. [ABSTRACT FROM AUTHOR]

Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic ocular condition affecting school-age children, particularly in hot, allergen-rich regions. It presents with symptoms such as intense itching, tearing, foreign body sensation, and sticky discharge, causing discomfort and management challenges in resource-limited settings. VKC impacts public health significantly due to its high prevalence and effect on academic performance and school attendance. Method: This cross-sectional study included 1521 school children aged 6 to 16 years in Western Uttar Pradesh. Comprehensive eye examinations were conducted, and VKC was diagnosed based on conjunctival and limbal papillae. A structured questionnaire collected data on socio-demographic factors, medical care access, and VKC's impact on daily life and school attendance. Descriptive statistics and Pearson chi-square tests were used for analysis. Result: Of the participants, 242 (15.9%) had VKC, with a higher prevalence among boys (56.2%). Most cases were mild (66%), with 34% severe. Symptoms included itching, stinging, tearing, photophobia, and discharge. Severe VKC resulted in higher rates of constant eye rubbing and tear production. School absenteeism was significantly higher in severe cases (78%) compared to mild cases (47%) (P<0.001). Severe VKC also led to more frequent medical consultations (52% vs. 22%, P=0.01). Conclusion: VKC significantly affects school attendance and medical care utilization among children in Western Uttar Pradesh. Improved management practices, better access to medical care, and enhanced support systems are essential for affected children and families. [ABSTRACT FROM AUTHOR]

Background Vernal keratoconjunctivitis (VKC) is a chronic allergic condition affecting both eyes found predominantly in children and adolescents. Topical steroids are associated with an increase in intraocular pressure (IOP). Topical loteprednol etabonate (LE) and fluorometholone acetate (FA) have good efficacy and lesser side effects. Objectives The study was done to assess the efficacy and effect of topical LE and FA on IOP in VKC. Materials and Methods A nonrandomized interventional study was conducted among patients aged 6–20 years attending eye outpatient department with VKC. Patients were assessed on day 0 for signs and symptoms of VKC, and IOP measurement was done. They were divided into two groups and LE (0.5%) was administered in one group and FA (0.1%) in another along with olopatadine (0.1%) in both the groups. Follow-up examinations were done on day 7, 14, and 28 in both the groups. Results Out of 64 patients included in the study (32 in each LE and fluorometholone [FM] group), a moderate degree of VKC was the common type observed in both the groups. Both the groups showed a significant decrease in mean symptom and sign scores on day 7, 14, and 28 than the baseline score (P < 0.001). Mean IOP was not found to be significantly raised (P > 0.05) in the two groups on follow-up. Conclusion In patients with VKC, topical application of 0.5% LE and 0.1% FA is equally effective and safe without any significant rise of IOP.

Ocular allergies are a group of diseases that affect the surface of the eye and are usually accompanied by type 1 hypersensitivity reactions. Purpose: to evaluate the clinical manifestations of allergic conjunctivitis and compare the effectiveness and comfort of using epinastine 0.05 % and olopatadine 0.2 % in its treatment. Material and methods. The comparative study involved 106 people: 45 female students (42.4 %) and 61 male students (57.5 %), divided into 2 groups. Group I (64 people, 128 eyes) with seasonal allergic conjunctivitis (SAC) received olopatadine 0.2 %, 1 drop twice a day for 30 days, Group II (42 people, 84 eyes) with atopic keratoconjunctivitis (AKC) received epinastine 0.05 % (Epinepta®) 1 drop twice a day for 8 weeks. The condition of the ocular surface was assessed using the OSDI (Ocular Surface Disease Index), and the severity of allergic symptoms was assessed in points using the SCORAD index (scoring atopic dermatitis). The control group III consisted of 20 students with dry eye syndrome (DES) of mild severity (according to the OSDI index) caused by visual work on a computer, who used no medications at the time of the study. Results. After treatment, the decrease in mean OSDI and SCORAD scores was more pronounced in group II. Patients receiving epinastine 0.05 % reported significantly less ocular discomfort and itching than patients receiving the alternative drug (olopatadine 0.2 %). In both experimental groups, the Schirmer test showed a statistically significant increase in the volume of total tear production (p < 0.05) after the treatment, which was more pronounced in group II (Epinepta®). Conclusion. Epinastine 0.0 5% (Epinepta®) can effectively relieve the main symptoms of the disease due to its high affinity for histamine receptors, minimizing the risk of developing dry eye syndrome.

MicroRNAs (miRNAs) function as posttranscriptional regulators of gene expression by targeting specific messenger RNA (mRNA). This interaction modulates mRNA stability or translational efficiency, ultimately impacting the level of protein production. Emerging evidence suggests that miRNAs act as critical regulators in corneal diseases. These molecules finetune key processes like cell proliferation, differentiation, inflammation, and wound healing. We reviewed the literature to understand the role that miRNAs may play in the development of challenging and poorly understood corneal diseases. We focused on vernal keratoconjunctivitis, neurotrophic keratitis, keratoconus, Fuchs endothelial corneal dystrophy, and limbal stem cell deficiency. Furthermore, we explored currently studied agonists or antagonists of miRNAs that share similar pathways with ocular diseases and could be employed in ophthalmology in the future. The distinct miRNA expression profiles observed in different ocular surface pathologies, combined with the remarkable stability and relatively easy access of miRNA sampling in biofluids, present possibilities for the development of noninvasive and highly accurate diagnostic tools. Furthermore, comprehending miRNA's pathophysiological role could open new frontiers to a more comprehensive understanding of the pathophysiology underlying ocular surface diseases, thereby paving the way for the creation of novel therapeutic strategies. [ABSTRACT FROM AUTHOR]

Context: The aim of this study was to evaluate the effect of the application of 0.03% tacrolimus eye ointment in treating patients diagnosed with vernal keratoconjunctivitis (VKC) specifically within a tertiary care hospital setting. MATERIALS AND METHODS: From October 2019 to October 2021, a prospective observational study took place at the department of ophthalmology in a tertiary care center. The study involved 42 consecutive VKC cases that had not seen relief with antihistaminics, mast cell stabilizers, or topical steroids. When steroid is applied in VKC patient it leads to various complications. So, in steroid refractory VKC tacrolimus application is used. Treatment involved applying topical 0.03% tacrolimus ointment was an effective and safe treatment. The study assessed changes in symptoms and signs posttreatment and monitored potential complications at 1, 4, 7, 10, and 14 weeks into the treatment during follow-up sessions. Results: The mean age of the patients was 10.7 ± 3.3 years. Following the administration of 0.03% tacrolimus, all signs and symptoms such as itching, foreign body sensation, tearing, photophobia, papillae, conjunctival hyperemia, limbal edema, Horner-Trantas dots, as well as keratitis (superficial punctate keratitis) showed significant improvement (P < 0.001). Conclusion: The application of 0.03% tacrolimus has been found effective in reducing the symptoms and signs of VKC, particularly in cases refractory to steroids, with very few cases reporting minimal side effects. This study emphasizes the crucial role of tacrolimus in preventing the severe visual complications often linked to this disease.

Asami Shimokawa, Aya Ikeda, Kazuhiro Harada, Rie Takahashi, Jane Huang, Tomoko Tsukahara-Kawamura, Hiroaki Ozaki, Eiichi Uchio Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, JapanCorrespondence: Eiichi Uchio, Department of Ophthalmology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan, Tel +81 92 801 1011, Fax +81 92 865 4445, Email euchio@fukuoka-u.ac.jpPurpose: Vernal keratoconjunctivitis (VKC) is a refractory ocular allergic disorder that mainly affects boys. Long-term follow-up has been rarely reported for VKC. We investigated the long-term clinical outcome of VKC to identify relevant clinical features of prognostic value based on follow-up for a median of 70 months.Methods: In total, 45 consecutive patients clinically diagnosed with VKC aged 4 to 12 years at onset at the Department of Ophthalmology of Fukuoka University Hospital were included. Patients were treated with immunosuppressive eye drops without simultaneous corticosteroid eye drops, except for the occurrence of exacerbations. Collated variables were gender, age at onset, clinical score of ocular lesions (conjunctival giant papillae, limbal edema and corneal epithelial lesions) at the first visit, and clinical score of atopic dermatitis (AD) at baseline. Cumulative cure rate was estimated using Kaplan–Meier method. A binomial logistic predictive model was used to determine the most reliable clinical predictors of VKC outcome.Results: The observation period ranged from 24 to 188 months, with median of 70 months. Among the 45 cases enrolled, all non-cured cases (14 cases) observed clinically were complicated by AD. Cumulative cure rate was 74.5% and 84.9% at eight- and ten-year follow-up, respectively. Ten-year cumulative cure rates of cases with and without AD were 50.5% and 100%, respectively, and a significant difference was found between these cumulative cure curves. Binomial regression analysis revealed that AD and gender were significantly related to worse outcome, and this binomial regression model had high sensitivity and specificity.Conclusion: This study demonstrated that th eclinical outcomeof VKC might be predicted by several factors that can beobtained in the early clinical phase. Information on the long-term prognosis of VKC patients might play an important role for precision medicine for VKC in childhood.Keywords: vernal keratoconjunctivitis, cumulative cure rate, atopic dermatitis, immunosuppressive eye drops, binomial logistic analysis

Background: Vernal keratoconjunctivitis (VKC), a chronic and bilateral allergic eye condition, predominantly affects young males and is more prevalent in hot, humid regions with high allergen exposure. It manifests with itching, light sensitivity, burning sensations, and tearing. The three main clinical forms include limbal or bulbar, palpebral or tarsal, and mixed presentations. Aims and Objectives: This study aimed to describe the clinical patterns of VKC in children at a tertiary care hospital in Andhra Pradesh. Materials and Methods: This cross-sectional observational study was conducted in a hospital setting at the Department of Ophthalmology, SV Medical College in Tirupati, Andhra Pradesh, between January 2021 and January 2022. Ninety children aged 5–12 years with symptoms of allergic conjunctivitis were enrolled in the study. The Bonini grading system was used to grade the severity of the disease based on clinical manifestations at the time of initial presentation. Results: Mean age of disease onset was 8.6±2.3 years, with a male-to-female ratio (M: F) of 2.1:1. The majority of the subjects experienced seasonal occurrence 69 (77.0%), whereas 21 (23%) had perennial occurrence. The commonly reported symptoms included itching (83%), redness (73%), watering (73%), and discharge (47%). A significant number of patients (60, 69%) had a mixed type of disease that affected both the tarsal and bulbar conjunctiva. Conclusion: VKC predominantly affects young males, displaying a seasonal distribution and showing less allergic association, consistent with patterns observed in other tropical regions. Most patients had mild VKC at presentation, and a mixed-form pattern was most frequently observed.

Vernal keratoconjunctivitis is an allergic ocular surface disease mostly present with recurrent chronic inflammation, which usually affects children and adolescents and possibly results in corneal complications such as keratoconus. Keratoconus is a corneal disease characterized by a local cone-like corneal deformation. Previous studies have respectively put forward pathological mechanisms of vernal keratoconjunctivitis and keratoconus and the progressive risk factors, among which we find there's mutual mechanisms as well as cytokines' expression, including type I and IV hypersensitivity, inflammatory reaction, enzymatic changes, oxidative stress and mechanical injury. This review aims at summarizing the possible intrinsic mechanisms and cytokines exacerbating vernal keratoconjunctivitis patients corneas to keratoconus, so as to provide reference for the prevention and management in keratoconus caused by vernal keratoconjunctivitis.

Keratoconus (KC) is a ectatic corneal disorder with marked progression during childhood and puberty that may lead to severe visual loss. Prevalence of keratoconus is variable in different parts of the world. Environmental and ethnic factors and the cohort of patients selected for such studies may explain the wide variation in the reported rates. Family history, gender differences, asymmetry in the two eyes, association with ocular rubbing, and natural history of disease are discussed. Epidemiology of Keratoconus has been classically described as a noninflammatory pathology, characterized by a conical shape of the cornea, as a result of thinning and protrusion. The etiopathogenesis is still under research and it may be the final manifestation of diverse pathologic processes. With better understanding of the disease and new imaging modalities as well as the advent of refractive surgery, it is being diagnosed much more often and much earlier than in the past. Methods: It is a cross sectional study, conducted in our institute National Institute of Medical Sciences, Jaipur from January 2022 to June 2023 for a duration of 18 months, a total of 384 patients attending schools in Jaipur who were selected based on inclusion and exclusion criteria who underwent complete history talking and examination. These patients were subjected to corneal topography. Results: Out of 384 patients, 19 had keratoconus, 46 had VKC (Veneral keratoconjuctivitis), 40 had myopic astigmatism. Conclusion: The incidence of pediatric keratoconus in relation to number of pediatric patient assessed at our hospital was 0.26% and was noted to be higher in our study as compared to other published literature. This can attributed to higher incidence of VKC in the region. [ABSTRACT FROM AUTHOR]

Background: To study the levels of vitamin D serum levels in children with vernal keratoconjuctivits (VKC) and comparing vitamin D levels in after giving vitamin D supplements between intervention and control group. Methods: The study was conducted in population between 1 to 12 years in tertiary care hospital in North India. Amongst children with VKC, full ocular examination along with Boninis clinical grading of VKC and serum vitamin D levels were assessed. Whole study group was randomly divided into two groups. Intervention group had received vitamin D powder while control group kept under observation. Results: A total of 88 children received vitamin D supplementation and 39 kept in control group. Conclusion: Our study suggests that children in intervention group showed improvement in serum vitamin D levels with the clinical improvement in VKC grading too. [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the efficacy and safety profile of interferon α‑2b in vernal keratoconjunctivitis (VKC). Methods: In this prospective interventional study, VKC patients fulfilling the inclusion and exclusion criteria were included and their signs and symptoms were scored based on the Clinical Scoring System. Patients were treated with topical interferon α‑2b eye drop (1 MIU/ml) QID dosing for 6 weeks. Changes in symptoms and signs were evaluated at 2, 4, 8 weeks and 6 months after initiating treatment. A higher score meant severe disease, and a decline in score meant improvement in clinical signs and symptoms. Categorical variables were presented in number and percentage (%) and continuous variables as mean ± standard deviation (SD). Post‑medication total subjective symptom score (TSSS) and total objective sign score (TOSS) were compared with baseline, and a P- value of <0.05 was considered significant. Possible ocular and systemic complications were evaluated. Results: The study included 40 patients (32 male and eight female) with a mean age of 8.05 ± 2.33 years. Mean baseline TSSS and TOSS were 6.71 ± 0.564 and 6.59 ± 0.262, respectively, which reduced to 2.71 ± 0.011 (P = 0.040) and 2.96 ± 0.210 (P = 0.032), respectively, at 4 weeks and further reduced to 0.42 ± 0.552 and 0.47 ± 0.434, respectively, at 8 weeks. After 6 months of stopping the drug, mean TSSS and TOSS did increase to 2.80 ± 0.820 (P = 0.044) and 2.50 ± 0.520 (P = 0.030), respectively, but was still statistically significant improvement compared to the baseline. Also, no ocular or systemic side effects were observed anytime during the study period. Conclusion: Eye drop interferon α‑2b (1 million IU/ml) is a safe and effective option as first‑line monotherapy for VKC. No side effects and recurrence were observed for 6 months. [ABSTRACT FROM AUTHOR]

Background: Vernal keratoconjunctivitis (VKC), a chronic and bilateral allergic eye condition, predominantly affects young males and is more prevalent in hot, humid regions with high allergen exposure. It manifests with itching, light sensitivity, burning sensations, and tearing. The three main clinical forms include limbal or bulbar, palpebral or tarsal, and mixed presentations. Aims and Objectives: This study aimed to describe the clinical patterns of VKC in children at a tertiary care hospital in Andhra Pradesh. Materials and Methods: This cross-sectional observational study was conducted in a hospital setting at the Department of Ophthalmology, SV Medical College in Tirupati, Andhra Pradesh, between January 2021 and January 2022. Ninety children aged 5–12 years with symptoms of allergic conjunctivitis were enrolled in the study. The Bonini grading system was used to grade the severity of the disease based on clinical manifestations at the time of initial presentation. Results: Mean age of disease onset was 8.6±2.3 years, with a male-to-female ratio (M: F) of 2.1:1. The majority of the subjects experienced seasonal occurrence 69 (77.0%), whereas 21 (23%) had perennial occurrence. The commonly reported symptoms included itching (83%), redness (73%), watering (73%), and discharge (47%). A significant number of patients (60, 69%) had a mixed type of disease that affected both the tarsal and bulbar conjunctiva. Conclusion: VKC predominantly affects young males, displaying a seasonal distribution and showing less allergic association, consistent with patterns observed in other tropical regions. Most patients had mild VKC at presentation, and a mixed-form pattern was most frequently observed. [ABSTRACT FROM AUTHOR]

Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic ocular condition affecting school-age children, particularly in hot, allergen-rich regions. It presents with symptoms such as intense itching, tearing, foreign body sensation, and sticky discharge, causing discomfort and management challenges in resource-limited settings. VKC impacts public health significantly due to its high prevalence and effect on academic performance and school attendance. Method: This cross-sectional study included 1521 school children aged 6 to 16 years in Western Uttar Pradesh. Comprehensive eye examinations were conducted, and VKC was diagnosed based on conjunctival and limbal papillae. A structured questionnaire collected data on socio-demographic factors, medical care access, and VKC's impact on daily life and school attendance. Descriptive statistics and Pearson chi-square tests were used for analysis. Result: Of the participants, 242 (15.9%) had VKC, with a higher prevalence among boys (56.2%). Most cases were mild (66%), with 34% severe. Symptoms included itching, stinging, tearing, photophobia, and discharge. Severe VKC resulted in higher rates of constant eye rubbing and tear production. School absenteeism was significantly higher in severe cases (78%) compared to mild cases (47%) (P

Purpose: To compare the effectiveness of Fluorometholone 0.1% and Cyclosporine 0.05% in the treatment of vernal keratoconjunctivitis. Study Design: Quasi experimental study. Place and Duration of Study: Hayatabad Medical Complex, Peshawar from December 2020 to June 2021. Methods: This study includes 104 patients divided into 2 groups. Patients in Group A were given topical Fluorometholone 0.1% while group B were given topical Cyclosporine 0.05%. Signs and symptoms were graded from scale 0-10 at the start of treatment and then at day 7,14 and 30. Drug was considered effective if the final score was equal to or less than 3 at day 30. Results: Mean age of the patients was 9.96±2.722 years in group A and 10.02±2.790 years in group B. Mean baseline score was 6.90±0.721 in group A and 5.87±0.768 in group B. In group A, 45 (86.5%) patients showed effectiveness while in group B, 36 (69.2%) patients showed effective results. Fluorometholone gave superior results as compared to Cyclosporine in patients with severe disease i.e., baseline score ≥ 6. Systemic allergic associations were noted in44.2% patients in group A and 36.5% patients in group B. Conclusion: These findings suggest that Fluorometholone may be a preferable treatment option for vernal keratoconjunctivitis, particularly in cases of more severe disease. However, considerations regarding systemic allergic associations should also be taken into account when making treatment decisions. [ABSTRACT FROM AUTHOR]

Purpose To compare the effectiveness of using Cyclosporine A (CsA) eye drops with a concentration of 0.05% alone versus using eye drops containing both CsA of 0.05% concentration combined with autologous serum (AS) of 20% used together for treating vernal keratoconjunctivitis (VKC) which were moderate to severe. Methods A prospective comparative noninterventional case series was carried out at the Ophthalmology Department at Kafrelsheik University, involving 40 individual patients with moderate to severe VKC sorted into two groups; 20 patients using CsA 0.05% eye drops as group A and 20 patients in group B using eye drops of CsA 0.05% combined with AS eye drop of 20% concentration for treating VKC for 12 weeks, 4 times daily. Results According to the scores recorded for symptoms and signs, the difference detected statistically was of no significance among the two involved study groups as regards the baseline score (P=0.783, and 0.137, respectively). While the scores reported for the symptoms and signs were statistically lower significantly among group B other than observed among group A as determined at the 4th week (P=0.015, and 0.004, respectively), 8th week (P<0.001, for both), and 12th week (P=0.001, and 0.002, respectively). Regarding side effects of treatment, 12 patients had a burning sensation, eight of them in group A and four patients in group B, with not reach to significant level between the studied groups during the follow-up visits (P=0.382) Conclusions We concluded a higher efficacy of using combined eye drops of CsA 0.05% and AS 20% for treating VKC than CsA 0.05% eye drops alone. [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the efficacy and safety profile of interferon α-2b in vernal keratoconjunctivitis (VKC). Methods: In this prospective interventional study, VKC patients fulfilling the inclusion and exclusion criteria were included and their signs and symptoms were scored based on the Clinical Scoring System. Patients were treated with topical interferon α-2b eye drop (1 MIU/ml) QID dosing for 6 weeks. Changes in symptoms and signs were evaluated at 2, 4, 8 weeks and 6 months after initiating treatment. A higher score meant severe disease, and a decline in score meant improvement in clinical signs and symptoms. Categorical variables were presented in number and percentage (%) and continuous variables as mean ± standard deviation (SD). Post-medication total subjective symptom score (TSSS) and total objective sign score (TOSS) were compared with baseline, and a P- value of

Vernal keratoconjunctivitis (VKC) is a complex and multifactorial disease process that employs Th2 cell-mediated immunologic processes, which involves the overexpression of interleukin 4 (IL-4), IL-5, IL-9, IL-13, and IL-31, and the activation of mast cells that release IL-5 and CCL-11, recruiting eosinophils to the site of inflammation. The disease primarily affects young males and is more common in regions with warm climates. VKC is characterized by persistent and recurrent conjunctival inflammation that can adversely affect the patient's quality of life, and, when inadequately treated, may lead to a host of ocular complications, such as corneal shield ulcers and scarring. The major distinct forms of VKC include limbal or palpebral, which may occur in combination. The clinicopathological features of VKC include the presence of pseudogerontoxon, limbal gelatinous hyperplasia, and perilimbal hyperpigmentation. Topical immunomodulators are effective anti-steroidal options for controlling severe and chronic cases of VKC. This review will provide a brief overview of topical immunomodulators, including cyclosporin and tacrolimus, and will highlight the clinical manifestations, pathological mechanisms, and fibroproliferative changes in the conjunctiva that can result from recurrent disease. [ABSTRACT FROM AUTHOR]

Vernal keratoconjunctivitis (VKC) is a chronic, progressive, and potentially sight-threatening form of ocular inflammatory disease that primarily affects children and young adults. Prevalence varies by region, ranging from <2 per 10,000 in the United States to as high as 1,100 per 10,000 in parts of Africa. The rarity of VKC in developed countries can make differential diagnosis challenging, and treatment is often delayed until the disease is advanced, and symptoms are significantly impacting patients' quality of life. Although once viewed primarily as an immunoglobulin E-mediated condition, approximately 50% of patients with VKC do not exhibit allergic sensitization. It is now recognized that the immunopathology of VKC involves multiple inflammatory pathways that lead to the signs, symptoms, and conjunctival eosinophilic and fibroproliferative lesions that are a hallmark of the disease. We examine the evolution of our understanding of the immunopathology of VKC, the expanding VKC treatment armamentarium, the clinical implications of emerging treatment approaches, and future directions for VKC research and practice. [ABSTRACT FROM AUTHOR]

Background: Vernal Keratoconjunctivitis (VKC) has been determined to be highly prevalent in countries within the tropical climate region. However, little evidence from studies conducted within this region has been put forward to support this claim. Aim: To determine the prevalence and risk factors of VKC among a Ghanaian clinical cohort. Methods: A 3‐year case‐control study was conducted in a tertiary eye care institution, and medical records of patients who had been diagnosed of VKC between 2018 and 2021 were reviewed. Results: Medical records of 3800 patients were reviewed. Some 359 $359$ cases of VKC were identified, with a population prevalence rate of 9.45% $9.45 \% $. Males comprised 57.1% $57.1 \% $ of the population with VKC, with a male‐to‐female ratio of 1.33:1 $1.33:1$. The disease was more prevalent (40.8%) in children (≤ $\le $17 years), and the overall odds of incidence decreased by 10% for a unit increase in age. Age and sex‐adjusted models revealed significant positive associations between Keratoconus [aOR = 40.760, 95% CI –5.948 to 339.937], Rhinitis [cOR = 5.183, 95% CI –2.074 to 12.022] and VKC. However, the incidence of VKC was relatively less expressive among pterygium cases [cOR = 0.315, 95% CI –0.077 to 0.846]. Conclusion: VKC is highly prevalent among children and is often associated with comorbidities of atopic origin that exacerbate the impact of the disease among this vulnerable population. It is imperative that clinicians provide holistic care for children with VKC. [ABSTRACT FROM AUTHOR]

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Purpose: To analyse long‐term outcomes of standard cross‐linking (SCXL), accelerated cross‐linking (ACXL) and transepithelial cross‐linking (TCXL) in the treatment of progressive paediatric keratoconus regarding stability, safety and efficacy. Methods: This prospective multicentre randomized controlled trial included 97 eyes of 97 paediatric patients with stages I–III ABCD keratoconus grading system, who were randomized into three groups; SCXL group (control group, n = 32; 3 mW/cm2 × 30 min/5.4 J/cm2), ACXL (n = 33; 18 mW/cm2 × 5 min/5.4 J/cm2) and TCXL (n = 32; 18 mW/cm2 × 5 min/5.4 J/cm2). Subjective refraction, uncorrected and corrected visual acuity, keratometry and pachymetry measurements using corneal topography were recorded preoperatively and 1, 2 and 3 years postoperatively. Results: SCXL group exhibited significant successive improvements in the mean visual, refractive and keratometric parameters throughout the entire postoperative 3 years while ACXL group exhibited significant improvements in visual and keratometric parameters in the first postoperative year that remained stable in second and third postoperative years. TCXL group exhibited significant progressive deterioration in all mean parameters compared to SCXL and ACXL (p < 0.0001). Both SCXL and ACXL revealed final 100% success rate with good stability while TCXL revealed final 22% failure rate with keratoconus progression (p < 0.0001). Conclusion: SCXL and ACXL were comparable in halting keratoconus progression and achieved good stability and safety; however, SCXL was more efficient than ACXL as it yielded greater significant postoperative mean visual, refractive and keratometric improvements achieving smoother corneal remodelling. Both SCXL and ACXL were much superior to TCXL. SCXL is the best CXL treatment option for paediatric keratoconus while ACXL is a good and effective alternative. [ABSTRACT FROM AUTHOR]

Background: To study the levels of vitamin D serum levels in children with vernal keratoconjuctivits (VKC) and comparing vitamin D levels in after giving vitamin D supplements between intervention and control group. Methods: The study was conducted in population between 1 to 12 years in tertiary care hospital in North India. Amongst children with VKC, full ocular examination along with Boninis clinical grading of VKC and serum vitamin D levels were assessed. Whole study group was randomly divided into two groups. Intervention group had received vitamin D powder while control group kept under observation. Results: A total of 88 children received vitamin D supplementation and 39 kept in control group. Conclusion: Our study suggests that children in intervention group showed improvement in serum vitamin D levels with the clinical improvement in VKC grading too.

AIM:To observe the clinical effect of different concentration of fluorometholone eye drops on severe mixed vernal keratoconjunctivitis in children.METHODS: A total of 50 cases(100 eyes)of children with severe mixed vernal keratoconjunctivitis treated in the outpatient department of our hospital from March to September, 2022 were selected and randomly divided into two groups. Group A consisted of 25 cases(50 eyes)who were treated with 0.1% fluorometholone eye drops combined with 0.05% cyclosporine eye drops(Ⅱ), while 25 patients(50 eyes)in group B were treated with 0.02% fluorometholone eye drops combined with 0.05% cyclosporine eye drops(Ⅱ). After 1mo of treatment, SPEED questionnaire score, corneal fluorescein staining(FL)score, tear break-up time(TBUT), Schirmer I test(SⅠt), R-scan, non-invasive tear meniscus height(NIKTMH), corneal optical density and other ocular parameters of the two groups were observed, and the occurrence of adverse reactions were recorded.RESULTS: After 1mo of treatment, there were significant differences in SPEED score, FL score and R-scan results between the two groups(all P0.05). However, there were statistical significance in corneal optical density in different corneal depth and diameter ranges(all P0.05), and no obvious adverse reactions occurred during treatment.CONCLUSION: The 0.1% fluorometholone eye drops can effectively treat severe mixed vernal keratoconjunctivitis in children, and its effect is better than 0.02% fluorometholone eye drops.

Keyla Lebrón Gutiérrez,1 Sarah Thomas,1 Julia L Martin,2 Annegret Dahlmann-Noor3 1Moorfields Eye Hospital, London, UK; 2Santen SA, La Voie-creuse 14, 1202, Geneva, Switzerland; 3NIHR Moorfields Biomedical Research Centre, London, UKCorrespondence: Annegret Dahlmann-Noor, NIHR Moorfields Biomedical Research Centre, London, UK, Email annegret.dahlmann-noor@nhs.netBackground: One of the challenges of treating chronic ocular diseases like vernal keratoconjunctivitis (VKC), glaucoma, and ocular surface disease is patient adherence to topical medication. To support correct eye drop instillation, a variety of delivery aids have been developed for both single-dose and conventional multi-dose containers.Methods: To evaluate Dropaid™ Single-dose, an eye drop delivery aid designed for single-dose containers, a usability study was conducted on 30 parents and caregivers of patients with VKC. After assessing the ability to squeeze a single eye drop from the single-dose container onto the eye of a pediatric medical dummy, the delivery aid was evaluated using an 11-point Likert scale on a variety of characteristics: from “very difficult” (− 5) to “very easy” (+5).Results: The majority of participants rated the task of opening the single-dose units (SDUs), preparing, and positioning the Dropaid™ Single-dose device as “very easy”. When providing a single eye drop from the container, 87% of participants rated the Dropaid™ Single-dose device as either “very easy” or “easy”, with a median rating score of +5.0 (interquartile range [IQR], 4.0– 5.0). For general ease of use, 84% considered the delivery aid as either “very easy” or “easy”, with a median score of +4.0 (IQR, 3.0– 5.0). Most participants (93%) rated Dropaid™ Single-dose as either “very comfortable” or “comfortable” to hold, with a median score of +5.0 (IQR, 4.0– 5.0).Conclusion: The Dropaid™ Single-dose delivery aid demonstrated rapid learning and ease of use across all stages of application, including opening the container, eye drop administration, and handling comfort. Although designed for use with single-dose containers to help eye drop instillation in patients with VKC, Dropaid™ Single-dose may provide a wider utility across a range of other ocular diseases such as glaucoma and dry eye.Keywords: Dropaid, eye drop instillation, usability study, vernal keratoconjunctivitis, VKC

Hideaki Fujita, Tomohiro Ueno, Shuji Suzuki, Kazuhiro Harada, Tomoko Tsukahara-Kawamura, Hiroaki Ozaki, Eiichi Uchio Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, JapanCorrespondence: Eiichi Uchio, Department of Ophthalmology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan, Tel +81 92 801 1011, Fax +81 92 865 4445, Email euchio@fukuoka-u.ac.jpBackground: Vernal keratoconjunctivitis (VKC) is a refractory ocular allergic disorder that mainly affects boys. A few studies have attempted to develop a classification of subtypes of VKC. In this study, we investigated a computational approach called cluster analysis to separate VKC cases into groups based on clinically relevant characteristics.Methods: In total, 41 consecutive patients clinically diagnosed with VKC at the Department of Ophthalmology of Fukuoka University Hospital were included. Patients were treated with immunosuppressive eye drops without simultaneous corticosteroid eye drops, except for the occurrence of exacerbations. Collated variables were age at onset, clinical score of ocular lesions at baseline, clinical score of ocular lesions at final visit, clinical score of atopic dermatitis (AD) at baseline, frequency of exacerbations of VKC, serum total IgE level and peripheral blood eosinophil count.Results: VKC patients were grouped into three clusters by cluster analysis, and cluster 1, 2, and 3 comprised 25, 9 and 7 cases, respectively. There were differences in the incidence of complications of AD and age at onset among the clusters; therefore, we named the three clusters for better understanding as traditional VKC (cluster 1), early-onset atopic keratoconjunctivitis (AKC)/VKC (cluster 2) and puberty-onset AKC (cluster 3).Conclusion: We found in this study that VKC in childhood has three phenotypes which were previously unknown. Our findings may help to establish precision medicine by focusing on the phenotype of each case to develop individualized medicine to prevent exacerbations.Keywords: vernal keratoconjunctivitis, subtype, atopic dermatitis, atopic keratoconjunctivitis, cluster analysis

Abstract Background Vernal Keratoconjunctivitis (VKC) has been determined to be highly prevalent in countries within the tropical climate region. However, little evidence from studies conducted within this region has been put forward to support this claim. Aim To determine the prevalence and risk factors of VKC among a Ghanaian clinical cohort. Methods A 3‐year case‐control study was conducted in a tertiary eye care institution, and medical records of patients who had been diagnosed of VKC between 2018 and 2021 were reviewed. Results Medical records of 3800 patients were reviewed. Some 359 cases of VKC were identified, with a population prevalence rate of 9.45 %. Males comprised 57.1 % of the population with VKC, with a male‐to‐female ratio of 1.33 : 1. The disease was more prevalent (40.8%) in children (≤17 years), and the overall odds of incidence decreased by 10% for a unit increase in age. Age and sex‐adjusted models revealed significant positive associations between Keratoconus [aOR = 40.760, 95% CI –5.948 to 339.937], Rhinitis [cOR = 5.183, 95% CI –2.074 to 12.022] and VKC. However, the incidence of VKC was relatively less expressive among pterygium cases [cOR = 0.315, 95% CI –0.077 to 0.846]. Conclusion VKC is highly prevalent among children and is often associated with comorbidities of atopic origin that exacerbate the impact of the disease among this vulnerable population. It is imperative that clinicians provide holistic care for children with VKC.

Vernal keratoconjunctivitis (VKC) is a chronic, progressive, allergic ocular surface disorder that can lead to sight-threatening complications. VKC occurs primarily in children and generally resolves about the time of puberty; however, case series and retrospective analyses indicate that approximately 10% of patients with VKC are adults, and that a subset of adult cases develop after puberty. Consequently, two age-related variants of VKC have recently been described: early-onset VKC—which manifests during childhood and persists into adult life—and late-onset disease, which emerges de novo after puberty. Although the signs and symptoms of adult and childhood VKC are similar, adult VKC is a long-lasting disease characterized by severe inflammation and increased risk of conjunctival fibrosis, which may place adult patients at higher risk for sight-threatening complications and adverse impacts on daily life. This review discusses the epidemiology, signs, symptoms, immunopathogenesis of adult VKC variants, and highlights current gaps in research and management of patients with this condition.

We report a rare case of ocular surface squamous neoplasia (OSSN) masquerading as pseudoepitheliomatous hyperplasia in chronic vernal keratoconjunctivitis (VKC). A 24-year-old man presented with a history of bilateral VKC since childhood with a superior limbal mass in the right eye. There was a history of use of intermittent corticosteroids in the past. He underwent impression cytology followed by excision biopsy with wide margins (no touch technique), cryotherapy and amniotic membrane transplantation. Histopathological analysis confirmed the diagnosis of OSSN with mild to moderate dysplasia. This case highlights the importance of strong clinical suspicion and detailed cytological and histopathological examination for early detection and management of OSSN.

Vernal keratoconjunctivitis (VKC) is a bilateral ocular inflammatory disease with a conjunctival and corneal involvement and typical onset during childhood. Eosinophilic esophagitis (EoE) is a chronic disease characterized by eosinophilic inflammation of the mucosa (≥15 eosinophils/HPF) and symptoms of esophageal dysfunction. EoE and VKC are both immune-mediated diseases sharing a similar pathogenetic mechanism and a high association with other allergic diseases. Nevertheless, no data are currently available about their clinical association. We present 4 cases of concomitant diagnosis of vernal keratoconjunctivitis and eosinophil esophagitis suggesting that these conditions may coexist in the same patient more frequently than expected. Health care providers should be aware of the possibility of co-occurrence in their daily practice.

Keratoconus (KC) is a progressive, asymmetrical corneal disease, characterized by stromal thinning that leads to distortion, causing vision loss. The visual loss is secondary to corneal scarring, irregular astigmatism, and myopia. The prevalence of KC has been reported to differ in different parts of the world. The study aimed to determine the prevalence and profile of patients with KC presenting to a provincial hospital in KwaZulu-Natal, South Africa. A retrospective study design was used to review 412 clinical records of patients attending the McCord Provincial Eye Hospital (MPEH) during a five-year period (2016-2020). Data on age, race, refraction, clinical profile, treatment plan, and diagnosis were ascertained. The prevalence of KC in MPEH was found to be 13.7% with a mean age of 24.7±7.94 years. Black African and females had a higher frequency of KC compared to males and other ethnic groups. Most of the patients presented with a severe stage of KC and referral was the most common management. Central corneal thinning and Munson's sign were the most prevalent clinical signs. There was no statistically significant difference between the worse and better eye when comparing the clinical signs. The prevalence and clinical profile of patients with KC in this study was similar to that reported by previous studies and more in Blacks and females. Population based epidemiological studies are needed to determine the prevalence of KC in South Africa to enable early clinical interventions. [ABSTRACT FROM AUTHOR]

Background: One of the challenges of treating chronic ocular diseases like vernal keratoconjunctivitis (VKC), glaucoma, and ocular surface disease is patient adherence to topical medication. To support correct eye drop instillation, a variety of delivery aids have been developed for both single-dose and conventional multi-dose containers.Methods: To evaluate Dropaid™ Single-dose, an eye drop delivery aid designed for single-dose containers, a usability study was conducted on 30 parents and caregivers of patients with VKC. After assessing the ability to squeeze a single eye drop from the single-dose container onto the eye of a pediatric medical dummy, the delivery aid was evaluated using an 11-point Likert scale on a variety of characteristics: from "very difficult" (− 5) to "very easy" (+5).Results: The majority of participants rated the task of opening the single-dose units (SDUs), preparing, and positioning the Dropaid™ Single-dose device as "very easy". When providing a single eye drop from the container, 87% of participants rated the Dropaid™ Single-dose device as either "very easy" or "easy", with a median rating score of +5.0 (interquartile range [IQR], 4.0– 5.0). For general ease of use, 84% considered the delivery aid as either "very easy" or "easy", with a median score of +4.0 (IQR, 3.0– 5.0). Most participants (93%) rated Dropaid™ Single-dose as either "very comfortable" or "comfortable" to hold, with a median score of +5.0 (IQR, 4.0– 5.0).Conclusion: The Dropaid™ Single-dose delivery aid demonstrated rapid learning and ease of use across all stages of application, including opening the container, eye drop administration, and handling comfort. Although designed for use with single-dose containers to help eye drop instillation in patients with VKC, Dropaid™ Single-dose may provide a wider utility across a range of other ocular diseases such as glaucoma and dry eye. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the distribution of corneal and conjunctival epithelial dendritic cells (DCs) in vernal keratoconjunctivitis (VKC), allergic conjunctivitis (AC), and non-allergic controls to examine if the allergy type causes differences in immune cell activation. The prospective study included 60 participants: 20 with VKC, 20 with AC, and 20 non-allergic controls. In vivo confocal microscopy was performed on the right eye. The locations scanned included the corneal centre, inferior whorl, corneal periphery, corneal limbus, and bulbar conjunctiva. The DCs were counted manually, and their morphology was assessed for the largest cell body size, the presence of dendrites, and the presence of long and thick dendrites. The DC density was higher in VKC and AC compared to non-allergic group at all locations (p ≤ 0.01) except at the inferior whorl. The DC density in VKC participants was significantly higher than in AC at the limbus (p < 0.001) but not at other locations. Both the AC and the VKC group had larger DC bodies at the corneal periphery and limbus compared to the non-allergic group (p ≤ 0.03). The study found a higher proportion of participants with DCs exhibiting long dendrites at both the corneal periphery in AC (p = 0.01) and at the corneal centre, periphery, and limbus in VKC, compared to the non-allergic group (p ≤ 0.001). In conclusion, a higher DC density at the limbus may be a marker of more severe VKC. DCs with larger cell bodies and a greater proportion of participants with DCs displaying long dendrites can be potential markers to differentiate allergy from non-allergy, and more severe forms of allergy from milder forms. [ABSTRACT FROM AUTHOR]

Abstract Introduction The purpose of this short article is to report the clinical outcomes of topical 0.1% ciclosporin cationic emulsion (CsA-CE) used on label in children with vernal keratoconjunctivitis (VKC). Methods In this prospective, non-comparative, observational study children affected by active severe VKC were treated for at least 12 months with topical 0.1% CsA-CE. The drug was instilled in both eyes 4 times daily. Data collected from medical charts for the baseline visit (T0) and 1-year follow-up visit (T1) included symptomatic score (0–15), clinical score (0–15), side effects, rescue therapy (need and total number of courses with 0.1% dexamethasone 4 times daily for 5 days), ocular complications and tolerability (visual analog scale [0–100]). Results Data from 25 children (20 boys, 5 girls; mean [± standard deviation] age 8.40 ± 2.54 years) were included in the study. Of the 25 patients, 23 (92%) used 0.1% CsA-CE eye drops as per label recommendations, including four patients who had prematurely stopped using topical galenic CsA due to side effects. Symptomatic and clinical scores decreased significantly after treatment, with the mean symptomatic score decreasing from 9.76 ± 1.27 at T0 to 3.80 ± 1.08 at T1, and the mean clinical score decreasing from 9.20 ± 1.32 at T0 to 3.44 ± 1.00 at T1; both P

Biologics applying antibodies against IgE, IL-5, IL-5 receptor α, IL-4 receptor α, and IL-13 have dramatically improved recent treatment outcomes in allergic diseases including asthma, rhinitis, and atopic dermatitis. However, these drugs have not been approved for ocular allergic diseases such as allergic conjunctivitis, vernal keratoconjunctivitis, and atopic keratoconjunctivitis. Although the putative mechanisms suggest that these drugs should have beneficial effects in patients with ocular allergies and some studies have reported such beneficial effects, various adverse ocular symptoms have also been observed in clinical trials and off-label use studies. Since ocular allergic diseases have distinct pathogeneses, each biologic drug must be examined regarding specific effects on each ocular allergy. For example, IgE-mediated type 1 hypersensitivity plays a critical role in allergic conjunctivitis. By contrast, T cells and eosinophilic and non-IgE-mediated type 2 inflammation play important roles in vernal keratoconjunctivitis. Allergists must fully understand the effects of each drug on the eye. This review outlines both potential therapeutic and adverse effects of various biologics on allergic diseases of the eye.

Keratoconus (KC) is a progressive, asymmetrical corneal disease, characterized by stromal thinning that leads to distortion, causing vision loss. The visual loss is secondary to corneal scarring, irregular astigmatism, and myopia. The prevalence of KC has been reported to differ in different parts of the world. The study aimed to determine the prevalence and profile of patients with KC presenting to a provincial hospital in KwaZulu-Natal, South Africa. A retrospective study design was used to review 412 clinical records of patients attending the McCord Provincial Eye Hospital (MPEH) during a five‑year period (2016-2020). Data on age, race, refraction, clinical profile, treatment plan, and diagnosis were ascertained. The prevalence of KC in MPEH was found to be 13.7% with a mean age of 24.7±7.94 years. Black African and females had a higher frequency of KC compared to males and other ethnic groups. Most of the patients presented with a severe stage of KC and referral was the most common management. Central corneal thinning and Munson's sign were the most prevalent clinical signs. There was no statistically significant difference between the worse and better eye when comparing the clinical signs. The prevalence and clinical profile of patients with KC in this study was similar to that reported by previous studies and more in Blacks and females. Population based epidemiological studies are needed to determine the prevalence of KC in South Africa to enable early clinical interventions.

Vernal keratoconjunctivitis (VKC) is a chronic, bilateral corneal and conjunctival problem which typically presents in young individuals. VKC is characterized by itching, photophobia, white mucous discharge, lacrimation, foreign body sensation, and pain due to corneal involvement of shield ulcers. Vernal keratoconjunctivitis is categorized within ocular diseases. The diagnosis is clinical, as no sure biomarkers pathognomonic of the disease have yet been identified. The VKC therapy relies on different types of drugs, from antihistamines and topical steroids to cyclosporine or tacrolimus eye drops. In extremely rare cases, there is also the need for surgical treatment for the debridement of ulcers, as well as for advanced glaucoma and cataracts, caused by excessive prolonged use of steroid eye drops. We performed a systematic review of the literature, according to PRISMA guideline recommendations. We searched the PubMed database from January 2016 to June 2023. Search terms were Vernal, Vernal keratoconjunctivitis, and VKC. We initially identified 211 articles. After the screening process, 168 studies were eligible according to our criteria and were included in the review. In this study, we performed a systematic literature review to provide a comprehensive overview of currently available diagnostic methods, management of VKC, and its treatments. [ABSTRACT FROM AUTHOR]

Ocular surface diseases (OSDs) are significant causes of ocular morbidity, and are often associated with chronic inflammation, redness, irritation, discomfort, and pain. In severe OSDs, loss of vision can result from ocular surface failure, characterised by limbal stem cell deficiencies, corneal vascularisation, corneal opacification, and surface keratinisation. External and internal exposomes are measures of environmental factors that individuals are exposed to, and have been increasingly studied for their impact on ocular surface diseases. External exposomes consist of external environmental factors such as dust, pollution, and stress; internal exposomes consist of the surface microbiome, gut microflora, and oxidative stress. Concerning internal exposomes, alterations in the commensal ocular surface microbiome of patients with OSDs are increasingly reported due to advancements in metagenomics using next-generation sequencing. Changes in the microbiome may be a consequence of the underlying disease processes or may have a role in the pathogenesis of OSDs. Understanding the changes in the ocular surface microbiome and the impact of various other exposomes may also help to establish the causative factors underlying ocular surface inflammation and scarring, the hallmarks of OSDs. This review provides a summary of the current evidence on exposomes in various OSDs. [ABSTRACT FROM AUTHOR]

Purpose: Galectin-3 is a damage-associated molecular pattern (DAMPs), released from damaged or dying cells. In this study, we investigated the concentration and source of galectin-3 in the tears of patients with vernal keratoconjunctivitis (VKC) and evaluated whether the concentration of galectin-3 in tears represents a biomarker of corneal epithelial damage. Study design: Clinical and experimental. Methods: We measured the concentration of galectin-3 in tear samples from 26 patients with VKC and 6 healthy controls by enzyme-linked immunosorbent assay (ELISA). The expression of galectin-3 in cultured human corneal epithelial cells (HCEs) stimulated with or without tryptase or chymase was investigated by polymerase chain reaction (PCR), ELISA, and Western blotting. We also estimated the concentration of galectin-3 in the supernatants of cultured HCEs induced to necrosis. Finally, we investigated whether recombinant galectin-3 induced the expression of various genes related to cell migration or the cell cycle in HCEs by using microarray analysis. Results: High concentrations of galectin-3 were detected in the tears of patients with VKC. The concentration showed significant correlation with the severity of corneal epithelial damage. Stimulation of cultured HCEs with various concentrations of tryptase or chymase had no effect on the expression of galectin-3. However, high concentrations of galectin-3 were detected in the supernatants of necrotic HCEs. Recombinant human galectin-3 induced various cell migration- and cell cycle-related genes. Conclusion: The concentrations of galectin-3 in the tears of patients with VKC may represent a biomarker of the severity of corneal epithelial damage. [ABSTRACT FROM AUTHOR]

Background: Vernal keratoconjunctivitis (VKC) severely affects the quality of life of affected patients. The development of a shield ulcer is considered one of the most severe late-stage complications, which when untreated leads to irreversible vision loss. In this systematic review, we outlined the results of surgical treatments of corneal shield ulcers in VKC. Methods: We searched 12 literature databases on 3 April 2023 for studies of patients with VKC in which shield ulcers were treated by any surgical treatment. Treatment results were reviewed qualitatively. Assessments of the risk of bias of individual studies were made using the Clinical Appraisal Skills Programme. Results: Ten studies with 398 patients with VKC were eligible for the qualitative review. Two categories of surgical approaches were described: supratarsal corticosteroid injection and debridement with or without amniotic membrane transplantation. Almost all patients experienced resolution or improvement of their shield ulcers, regardless of treatment modality. Time to healing was faster with surgical debridement. A small proportion experienced recurrence and side effects. Conclusions: Surgical treatment for shield ulcers in VKC seems highly effective, but careful post-operative treatment and follow-ups are necessary due to the risk of recurrence and potential side effects. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of topical 0.1% cyclosporin treatment on topographic, pachymetric, and densitometric maps of the cornea in severe pediatric cases of vernal keratoconjunctivitis (VKC). Materials and Methods: Thirty eyes of 30 pediatric patients with severe VKC were included in this study. The symptom and sign scores of these VKC patients were calculated and examinations were performed before and 6 months after topical 0.1% cyclosporin treatment. Pre and post-treatment values of flat keratometry (K1), steep K (K2), maximum K (Kmax), central corneal thickness (CCT), corneal volume (CV), anterior, center, posterior and total densitometry values (in two corneal concentric zones: 0-2-mm and 2-6-mm) were compared. Results: The mean CCT and CV values decreased from 546.85±28.20 to 539.85±25.21 µm and 60.9±3.2 to 60.1±3.0 mm3, respectively (p<0.001, both of them). Keratometry values (K1, K2, and Kmax) did not change after treatment (p:0.787, p:0.464 and p:0.963, respectively). The anterior, center, and total densitometry values in the 0-2-mm and 2-6-mm concentric corneal zones were significantly decreased after treatment (p<0.001, for all values). Conclusions: In severe pediatric VKC patients, topical cyclosporine therapy provides reduction in densitometric (increased corneal transparency), CCT and CV values and also improves symptoms and findings. [ABSTRACT FROM AUTHOR]

Plain Language Summary Vernal keratoconjunctivitis (VKC) is a rare, underdiagnosed, chronic allergic eye disease that typically occurs in children and adolescents. If left untreated, VKC can significantly damage the eye, potentially leading to long-term complications, visual impairment and a reduced quality of life for the child and their family and/or caregivers. In the absence of established guidelines, this consensus programme set out to gather expert insights on best practices for assessing and managing VKC across Europe. A group of seven European ophthalmologists engaged in the consensus programme. A total of 47 recommendations were developed relating to the assessment, diagnosis, management, referral and follow-up of patients with VKC. These 47 recommendations underwent two rounds of review and were revised, if necessary, following expert input. Recommendations where ≥ 75.0% of experts agreed were considered as having reached consensus and were included as final recommendations. The experts agreed that VKC can be classified as mild, moderate or severe, and should be managed according to severity in a stepwise manner, with treatment intensity escalating as the disease severity increases. Timely diagnosis and treatment initiation appropriate to the severity of VKC are crucial to prevent sight loss and improve the quality of life of children with VKC. Ongoing treatment may be necessary to tackle the chronic inflammation associated with the disease and, therefore, reliance on steroid eye drops should be reduced to avoid an increased risk of well-known complications. The experts concluded that mild VKC can be assessed and managed in primary care, but patients with severe VKC, or with moderate-to-severe VKC that does not respond to treatment within 2–4 weeks, should be referred to a VKC specialist.

Purpose: The main objective of this study is to explore the efficacy of olopatadine 0.1% treatment in the resolution of symptoms of vernal keratoconjunctivitis (VKC) among the Indian population. Methods: This single-center, prospective cohort study involved 234 patients with VKC. Patients were treated with olopatadine 0.1%, twice daily for a period of 12 weeks and then followed up in 1st week, 4th week, 3rd month, and 6th month. The extent of relief in the symptoms of VKC was measured using total ocular symptom score (TOSS) and ocular surface disease index (OSDI). Results: In the present study, the dropout rate was 5.6%. Total of 136 males and 85 females with a mean age of 37.68 ± 11.35 years completed the study. TOSS score reduced from 58.85 to 5.06 and the OSDI score reduced from 75.41 to 11.2 with statistical significance (P < 0.01) from 1st week to 6th week after olopatadine 0.1% treatment. The data showed relief in subjective symptoms of itching, tearing, and redness, and relief in discomfort in functions related to ocular grittiness, visuals like reading, and environmental like tolerability in dry conditions. Further, olopatadine 0.1% was effective in both males and females, and patients across ages 18–70 years. Conclusion: Based on TOSS and OSDI scores, the findings of this study validate safety and tolerability as revealed by low adverse effects and moderate efficacy of olopatadine 0.1% in reducing VKC symptoms in a broader age group (18–70 years) of both genders.

Purpose: To evaluate presence of perilimbal pigmentation (PLP) in Indian patients with vernal keratoconjunctivitis (VKC). Methods: A cross sectional study was conducted from 2019 to 2020 at a tertiary eye care center in Western Maharashtra, India. In this study, 152 cases of VKC were identified. The presence, type, color, and extent of PLP were recorded. The incidence of presence of PLP was calculated. Its correlations with severity and duration of VKC were analyzed using Wilcoxon–Mann–Whitney U test and Chi square test. Results: Of 152 cases, 79.61% were males. Mean age at presentation was 11.4 ± 5.6 years. The characteristic PLP was present in 81 cases (53.29%; 95% confidence interval [CI]: 45.03%–61.42%; P < 0.001), of which 15 cases (18.5%) had this pigmentation in all the four quadrants. There was a significant difference between the groups with respect to quadrants involvement in terms of the extent of PLP in clock hours (χ2 = 73.85, P < 0.001). However, the extent did not correlate with age (rho = 0.08, P = 0.487), sex (P = 0.115), time since onset in months (rho = 0.03, P = 0.77), duration of VKC and type or color of PLP (P = 0.12). Conclusion: Perilimbal pigmentation seems to be a consistent clinical finding seen in a significant number of VKC cases. It may benefit ophthalmologists in treating VKC cases when the palpebral/limbal signs are elusive.

Purpose: Allergic conjunctivitis (AC) is commonly associated with dry eye. This study was conducted to assess the prevalence of dry eye in different subsets of AC patients. Methods: This observational, cross-sectional study, conducted in the Department of Ophthalmology of a tertiary center in north India, included 132 patients of AC. The diagnosis of dry eye disease (DED) was made on the basis of Ocular Surface Disease Index (OSDI), Schirmer's test, and tear film break-up time (TFBUT). Results: The prevalence of dry eye in AC patients was found to range between 31% and 36%. On OSDI scoring, 20.45% of patients had mild, 18.18% moderate, and 31.81% had a severe grade of DED, respectively. The mean OSDI score was noted to be significantly higher in patients with perennial allergic conjunctivitis (PAC) (29.82 ± 12.41), followed by seasonal allergic conjunctivitis (SAC) (25.35 ± 12.88), and least in the patients of vernal keratoconjunctivitis (VKC) (13.60 ± 8.63) (p < 0.0001), respectively. The TFBUT was found to be less than 10 s in 45.45% of PAC, 30.43% of SAC, and 20% of VKC patients, respectively. The difference between the mean TFBUT among the three groups was statistically insignificant (p = 0.683). Schirmer's test value of