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Choi, Lim, and Yoon: Effect of Treatment With Excision of Papillae and Supratarsal Triamcinolone Injection on Refractory Vernal Keratoconjunctivitis
Original Article

J Korean Ophthalmol Soc 2010;51(4):492-497.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.4.492

Effect of Treatment With Excision of Papillae and Supratarsal Triamcinolone Injection on Refractory Vernal Keratoconjunctivitis

Won Choi, MD, Seong-Gyu Lim, MD, Kyung Chul Yoon, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea

Address reprint requests to Kyung Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Medical School and Hospital #671 Jae-Bong Street, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 5 August 2009       Accepted 15 December 2009

Copyright © 2010 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the therapeutic effect of the combined treatment of excision of the papillae and a supratarsal injection of triamcinolone on refractory vernal keratoconjunctivitis (VKC).

Methods

Twenty-three eyes of 14 patients with refractory vernal keratoconjunctivitis were included. Patients were treated with the combined excision of papillae and supratarsal injection of triamcinolone. Best corrected visual acuity (BCVA), intraocular pressure, symptoms of itching, tearing, discomfort, secretion and epiphora, and signs including limbal hypertrophy, hyperemia, papilla size, keratitis, corneal neovascularization and blepharitis were evaluated before and two weeks, four weeks, and eight weeks after treatment. The CCL11 level in the tears of each eye were analyzed before and two weeks after treatment.

Results

The mean scores of subjective symptoms and objective signs as well as BCVA were significantly improved two weeks after treatment. CCL11 levels in the tears were 389.5±474.9 pg/ml before treatment and were undetectable two weeks after treatment. Improvement of symptom and sign parameters was maintained up to eight weeks after treatment. However, seven eyes (30.4%) recurred within two weeks after treatment.

Conclusions

Combined excision of the papillae and a supratarsal injection of triamcinolone may be effective in the treatment of refractory VKC.

Keywords: Combined treatment, Papillectomy, Triamcinolone, VKC

References

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Figure 1.
Comparison of tear CCL11/Eotaxin level between before and 2 weeks after combined treatment.
jkos-51-492f1.tif
Figure 2.
Photographs of the right superior tarsal conjunctiva in a 11-year-old boy with severe vernal keratoconjunctivitis. (A-D) Compared with baseline (A), tarsal papillae significantly improved at 2 weeks (B), 4 weeks (C), and 8 weeks (D) after resection of papillae and supratarsal injection of triamcinolone.
jkos-51-492f2.tif
Table 1.
Grading of symptoms and signs in vernal keratoconjunctivitis patients15
Grades 0 1 2 3
Symptoms        
Itching No Occasional Frequent Constant
Tearing Normal Sensation of fullness s of Infrequent spilling of tears Constant spilling of tears over the
  tear the conjunctival s sac over the lid margin lid margin
Discomfort Absent Mild Moderate Severe
Discharge No Small amount of mu coid Moderate amount of mucoid Eyelids tightly matted together on
    discharge discharge, presence of awakening, warm soaks necessary
      crust upon awakening to clean eyelids during day
Photophobia No Mild Moderate, necessitating Extreme photophobia, even with
      dark glasses dark glasses
Signs        
Limbal hypertrophy No One quadrant Two quadrants Three or more
Bulbar conjunctival hyperemia Absent Mild Moderate Severe
Keratitis (superficial epithelial keratitis, erosion, shield ulcer) No One quadrant Two quadrants, macro erosion Three or more quadrants, vernal ulcer
Neovascularization of cornea No new vessel Neovascularization in 1 quadrant of cornea Neovascularization in 2 quadrants of cornea Neovascularization in 3 or more quadrants of cornea
Table 2.
Changes of subjective symptoms and signs after combined treatment with papillae excision and supratarsal triamcinolone injection in patients with refractory vernal keratoconjunctivitis
  Baseline Posttreatment 2 weeks Pos sttreatment 4 weeks Posttreatment 8 weeks
Itching 2.26±0.45 0.71±0.46* 0.54±0.66* 0.89±0.33*
Tearing 1.96±0.48 0.52±0.60* 0.31±0.63* 0.56±0.73*
Discharge 2.14±0.47 0.50±0.51* 0.54±0.78* 0.50±0.54*
Discomfort 2.26±0.62 0.67±0.48* 0.62±0.65* 0.56±0.73*
Photophobia 1.78±0.74 0.43±0.71* 0.23±0.60* 0.22±0.44*
Limbar hypertrophy 1.39±0.72 0.81±0.51* 0.69±0.63* 0.89±0.60*
Papillary reaction 2.91±0.42 0.95±0.69* 1.15±0.69* 1.15±0.99*
Conjunctival hyperemia 1.74±0.81 0.29±0.46* 0.23±0.44* 0.56±0.73*
Keratitis 2.52±0.79 0.62±0.81* 0.62±0.96* 0.78±0.83*
Neovascularization 0.87±0.69 0.48±0.81* 0.08±0.28* 0.11±0.33*

* P<0.05 compared with the baseline.

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