Journal List > J Korean Ophthalmol Soc > v.52(1) > 1009059

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

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.

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Figure 1.
Diagram for definition of quadrant in analysis of involvement of phlyctenular keratitis.
jkos-52-7f1.tif
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.
jkos-52-7f2.tif
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).
jkos-52-7f3.tif
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).
jkos-52-7f4.tif
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
Positive Negative
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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