Analysis of Clinical Characteristics in Phlyctenular Keratoconjunctivitis at a Tertiary Center

Dong Hyun Jo; Mee Kum Kim; Won Ryang Wee; Jin Hak Lee

doi:10.3341/jkos.2011.52.1.7

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Jo, Kim, Wee, and Lee: Analysis of Clinical Characteristics in Phlyctenular Keratoconjunctivitis at a Tertiary Center

Original Article

J Korean Ophthalmol Soc 2011;52(1):7-13.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.1.7

Analysis of Clinical Characteristics in Phlyctenular Keratoconjunctivitis at a Tertiary Center

Dong Hyun Jo, MD^1,², Mee Kum Kim, MD, PhD^1,², Won Ryang Wee, MD, PhD^1,², Jin Hak Lee, MD, PhD^1,^2,³

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

³Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

Address reprint requests to Mee Kum Kim, MD, PhD Department of Ophthalmology, Seoul National University Hospital #28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2665, Fax: 82-2-741-3187, E-mail: kmk9@snu.ac.kr

Received 3 May 2010 Revised 9 August 2010 Accepted 17 November 2010

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 report the clinical characteristics of patients with phlyctenular keratoconjunctivitis at a tertiary care center in Korea.

Methods

The authors of the present study retrospectively reviewed the medical records of 26 patients who were diagnosed with phlyctenular keratoconjunctivitis, identifying the age and sex at diagnosis, diagnosis of the referring clinic, laterality and location of the lesions, the results of bacterial cultures from the meibum, and treatment options.

Results

Eighteen patients (76.2%) were female, and the mean age at diagnosis was 18.4 ± 10.5 years. Nine patients (34.6%) showed evidence of bilateral diseases, and corneal lesions were observed in 27 eyes of 21 patients. Bacterial cultures from the meibum were performed for 17 patients, with the following results: 6 cases of Staphylococcus epidermidi s, 4 cases of Corynebacterium species, and 1 case of Propionibacterium acne. Neovascularization with corneal phlyctenules occurred from the inferior quadrant mostly. Twenty-four patients received the remission treatment of prednisolone acetate 1% eye drops and evidence of regression of new vessels was observed in all patients. Three patients (16.7%) experienced recurrence despite the maintenance treatment of cyclosporine 0.05% eye drops. Visual acuities improved significantly after the remission treatment, as compared to the initial visit.

Conclusions

The phlyctenular keratoconjunctivitis patients who visited the tertiary center in Korea showed similar findings regarding demographics, involvement of blepharitis, and identified microorganisms, as compared with patients in previous reports. However, corneal lesions involving the visual axis were frequent, suggesting that with proper diagnosis and treatment, improvement in visual acuities is possible.

Keywords: Blepharitis, Cornea, Keratoconjunctivitis, Korean, Phlyctenular keratitis

References

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Figure 1.

Diagram for definition of quadrant in analysis of involvement of phlyctenular keratitis.

Figure 2.

Age distributions of phlyctenular keratoconjunctivitis patients: 5 patients under age 10, 13 patients between 11 and 20, 6 patients between 21 and 30, and 2 patients over age 31, 40 and 50, respectively.

Figure 3.

Representative cases of phlyctenular conjunctivitis (A) and keratitis (B). A whitish elevated lesion with neovascularization from the conjunctiva across the limbus was a typical manifestation of phlyctenular keratitis (B).

Figure 4.

Visual acuity of phlyctenular keratitis patients. Visual acuity improved significantly after remission treatment in patients whose visual axes were threatened (P=0.028). Black line: Patients whose visual axes were threatened, gray line: All keratitis patients; dashed line: Patients whose visual axes were spared, asterisk (*): statistically significant (P<0.05).

Table 1.

Demographics and clinical manifestations of the patients who presented phylectenular keratoconjunctivitis

Clinical characteristics	Number of patients (%)
Female	69.2^*
Bilaterality	34.6^*
Corneal involvement	77.1^*
Visual axis involvement	40.7^†
Conjunctival involvement	22.9^*
Blepharitis	96.2^*
Allergic conjunctivitis	38.5^*

^* In 35 eyes of 26 patients

^† in 26 eyes of 21 patients with corneal involvement.

Table 2.

Initial suspicious impression of phlyctenular keratoconjunctivitis patients from the referring clinics

Impression by referring clinics	Number of Patients (%)
Corneal involvement	21 patients
Nonspecific keratitis	8 (38.1%)
Herpes keratitis	3 (14.3%)
Corneal ulcer	2 (9.5%)
Phlyctenular keratitis	2 (9.5%)
Vascular ingrowth / Corneal neovascularization	2 (9.5%)
Corneal opacity	1 (4.8%)
Lipid keratopathy	1 (4.8%)
Allergic conjunctivitis	1 (4.8%)
Not available	1 (4.8%)
Conjunctival involvement	5 patients
Conjunctival tumor	1 (20%)
Scleritis	1 (20%)
Nonspecific conjunctivitis	1 (20%)
Phlyctenular conjunctivitis	1 (20%)
Not available	1 (20%)

Table 3.

Quadrants of corneal neovascularization in phlyctenular keratitis (21 patients 27 eyes)

Quadrant	Number of Eyes (%)
Inferior	13 (48.1%)
Temporal	10 (37.0%)
Superior	3 (11.1%)
Nasal	1 (3.7%)

Table 4.

Microbiological profiles of the cultures from the meibum in 17 patients

Identified organisms	Number (%)
Staphylococcus epidermidis	6 (35.5%)
Corynebacterium species	4 (23.5%)
Propionibacterium acne	1 (5.9%)
Staphylococcus capitis	1 (5.9%)
No growth	7 (41.2%)

Table 5.

Clinical Manifestations according to the Positivity of Meibum Cultures

Clinical Manifestations	Positivity of meibum cultures		P value
Clinical Manifestations	Positive	Negative	P value
Visual acuity at initial visit (logMAR)	0.29 ± 0.30	0.16 ± 0.32	0.315
Visual acuity after remission treatment (logMAR)	0.14 ± 0.21	0.11 ± 0.28	0.740
Involvement of new vessels (hr)	2.93 ± 1.02	3.30 ± 2.17	1.000
Period between initial visit and remission (mon)	0.78 ± 0.30	0.64 ± 0.24	0.417

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