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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.
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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 (?2 = 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.
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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 <10 mm was observed in 45.45% of PAC, 43.47% of SAC, and 10% of VKC patients, respectively. Conclusion: This study revealed a high prevalence of DED in patients with AC. Among the different types of AC patients, PAC had the highest percentage of DED followed by SAC and least in VKC, respectively.
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Purpose: To evaluate dry eyes in children with vernal kerato?conjunctivitis (VKC) and correlate it with symptoms, clinical findings, and ocular surface analysis (OSA) parameters. Methods: Children with clinically diagnosed VKC underwent complete ophthalmological examination, Schirmer’s testing, modified ocular surface disease index (OSDI) scoring, Bonini grading, fluorescein tear?film break?up time (TBUT), VKC – Collaborative Longitudinal Evaluation of Keratoconus (CLEK) scoring, and OSA. Children with a TBUT of < 10 s were defined to have dry eyes. The above?mentioned parameters were compared between dry eye and non?dry eye VKC children. Results: The mean age of the 87 children included in the study was 9.1 ± 2.9 years. Dry eyes were seen in 60.9% [95% confidence interval (CI); 51% to 71%]. The mean TBUT was 13.4 ± 3.8 and 5.9 ± 1.9 s in non?dry and dry eye groups, respectively (P < 0.001). The mean value of Schirmer’s test was 25.9 ± 9.8 and 20.8 ± 8.6 mm in the non?dry and dry eye groups, respectively (P = 0.01). The two groups did not differ in their OSDI scores, Bonini grading, and CLEK scores. The OSA parameter of non?invasive break?up time (NIBUT) was 8.3 ± 3.2 s in non?dry eye group and 6.4 ± 2.9 s in dry eye group, P = 0.008. The lower lid Meibomian gland (MG) loss was 7.4% in non?dry eye group and 12.2% in dry eye group, P = 0.028. Other OSA parameters did not differ significantly among the two groups. Conclusion: Dry eyes are seen in two?thirds of pediatric VKC. Evaluation of dry eyes should be incorporated in their clinical evaluation. Among OSA parameters, NIBUT and lower lid MG loss are associated with dry eyes in pediatric VKC patients.
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Introducción: La alergia es el desorden más común del sistema inmunitario. En las últimas décadas, la prevalencia de las enfermedades alérgicas ha aumentado de forma considerable en todos los países. Objetivo: Describir el contexto actual de la alergia ocular para la realización de un diagnóstico precoz, una identificación temprana de los subtipos, un adecuado manejo terapéutico y un control de la severidad. Métodos: Se realizó una búsqueda sistemática de la literatura científica de mayor impacto con el uso de las palabras clave. Se limitó la búsqueda por tipo de diseño (revisiones, series de casos, estudios descriptivos, analíticos y experimentales, metaanálisis). No se tuvo en cuenta el idioma de la publicación. Las bases de datos utilizadas fueron: PubMed, Ebsco Host, Lilacs y Science Direct. Se identificaron y se evaluaron 114 artículos, de los cuales se seleccionaron 24 por su pertinencia para el estudio. Conclusiones: La alergia ocular es uno de los trastornos oculares más comunes encontrados en las consultas pediátricas y oftalmológicas. Si bien en la mayoría de los casos se trata de formas leves, estas pueden interferir en la calidad de vida del paciente. Es importante que estos pacientes con manifestaciones oftalmológicas de alergia se remitan al alergólogo para detectar otra patología, que, asociada al padecimiento alérgico, origine los síntomas que suelen ser graves, con una duración y frecuencia importantes(AU)
Introduction: Allergy is the most common disorder of the immune system. In recent decades, the prevalence of allergic diseases has increased considerably in all countries. Objective: To describe the current context of ocular allergy in order to make an early diagnosis, an early identification of subtypes, establish an adequate therapeutic management and control of severity. Methods: A systematic search of the scientific literature with the highest impact was performed using keywords. The search was limited by type of design (reviews, case series, descriptive, analytical and experimental studies, meta-analysis). The language of the publication was not taken into account. The databases used were: PubMed, Ebsco Host, Lilacs and Science Direct. A total of 114 articles were identified and evaluated, of which 24 were selected for their relevance to the study. Conclusions: Ocular allergy is one of the most common ocular disorders encountered in pediatric and ophthalmology consultations. Although in most cases these are mild forms, they can interfere with the patient's quality of life. It is important that these patients with ophthalmologic manifestations of allergy are referred to the Allergist to detect other pathology, which associated with the allergic condition originate the symptoms that are usually severe, with a significant duration and frequency(AU)
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Humans , Keratoconjunctivitis/etiology , Review Literature as Topic , Databases, BibliographicABSTRACT
Purpose: Management of allergic eye disease is seldom straightforward and often challenging. We conducted an online survey to elicit opinions on the preferred practice pattern in the treatment of allergic eye disease. Methods: An online survey questionnaire was sent to all practicing ophthalmologists using social media platforms. The respondents were asked about their clinical experience and preferred treatment in various scenarios such as mild?moderate vernal keratoconjunctivitis (VKC), chronic VKC, refractory VKC, steroid responders, giant papillae, and shield ulcer. Respondents were asked about the newer molecule (alcaftadine) and reservations regarding systemic immuno?suppressants and ordering allergy tests in their practice. Results: Ninety ? one participants responded to the survey. About 57.1% of ophthalmologists reported coming across more than 10 cases per week in their practice. The most common age group was 5–10 years (61.1%), but adult onset VKC was also reported at 41.6% (1–2 per month), 37.1% (3–5 per month), and 13.5% (more than 10 per month). The disease is perennially present (36.7%), and a mixed form has been reported by 47.8% of ophthalmologists. Dual?acting agents were preferred by 40% in mild?moderate clinical variants. Topical steroids in slow tapering dosage were preferred by 86.7% in their prescription. Tacrolimus 0.03% was preferred by 65.9% and given for at least 3 months of continuous usage by 47.6% of ophthalmologists. High?dose topical steroids were preferred for giant papillae (67.8%) and Shields ulcers (68.3%) in our survey. Supratarsal steroid injection was preferred by 50% in treating refractory VKC in our survey. Conclusion: Allergic eye disease is a common yet annoying disease. The signs and symptoms can vary from subtle, innocuous forms to devastating variants affecting vision and day?to?day work. This survey aims to elicit responses from clinicians spreading across different geographical areas and compares responses based on experience in practice
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Ocular surface inflammatory disorder (OSID) is a chronic ocular disease caused by systemic disorders or involving the local immune system.OSID induces persistent inflammatory reaction in the ocular adnexal connective tissues which in turn give rise to tear hypertonicity and ocular surface epithelial damage, leading to dry eye formation or progression.Common immune-related ocular surface diseases include vernal keratoconjunctivitis, Sj?gren syndrome, graft versus host disease, dry eye and immune-related corneal disease, all of which can significantly impact the visual function and quality of life of patients.Current treatments including the use of artificial tears and glucocorticoid eye drops are not always effective and have the risk of adverse events.Cyclosporine A (CsA) is a commonly utilized immunosuppressant that has a strong immunomodulatory effect, but its clinical application is somewhat limited due to the low permeability of its current ophthalmic dosage form.The development of CsA ophthalmic agents has changed the treatment strategy for OSID.The development of 0.1% CsA cationic emulsion has significantly improved the efficacy and safety of topical CsA treatment, which is worth the attention.In order to rationally apply 0.1% CsA cationic emulsion to OSID, ophthalmologists should fully understand the immune-related pathogenesis of each OSID and comprehend the curative effect, indication, application methods and adverse events of topical CsA treatment.
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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 P<0.05), and no differences in TBUT, SⅠt and NIKTMH results(all P>0.05). However, there were statistical significance in corneal optical density in different corneal depth and diameter ranges(all P<0.05). After 1mo of treatment, there was no significant difference in intraocular pressure between the two groups(16.21±2.90mmHg vs. 16.05±2.75mmHg, P>0.05), 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.
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Purpose: To evaluate the effectiveness of a modified therapeutic protocol used for vernal keratoconjunctivitis (VKC) based on severity as per Bonini grading system. Methods: This was a prospective observational clinical study conducted with 123 eyes of 63 patients. A meticulous clinical examination was performed, and data was documented in all the cases. Patients on known systemic atopy and antiallergic therapy were excluded from the study. Eyes with a clinical diagnosis of VKC were segregated based on Bonnini’s grading system. A treatment protocol was created depending on the grade of VKC. Therapeutic responses were documented at 3 weeks, 3 months, 6 months, 12 months, and 24 months. Grading of the eyes was performed in each visit. Results: The mean age of the patients was 8.85 years with a standard deviation of 4.48 years. Males were predominant, and 95.24% had bilateral manifestation. The palpebral component was the most common form of manifestation. Itching was the most common manifestation, followed by congestion, discharge, and papillae in a decreasing order. Also, 68% of patients were in grade 2, 14% in grade 3, 12% in grade 1, and the rest were in grade 4. Following the treatment protocol, 70% showed signs of significant improvement in grade by the end of 6 weeks, reaching 90% at the end of 6 months (P = 0.074) and 92% at the end of 12 months (P = 0.002). Also, 52.4% versus 77.8% of patients had no recurrence in the pre? versus posttreatment protocol and it was statistically significant (P = 0.001). Conclusion: Grading of VKC gives a clear evaluation of the severity and progression of the condition. Besides, significant improvement in the grades was observed with fewer incidences of recurrences following execution of the therapeutic protocol. Hence, it is essential to maintain a treatment protocol in our clinical practice to provide grade?based therapy and monitor accurate changes in the clinical condition
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Aim To study topographic findings in patients with established vernal keratoconjunctivitis (VKC). Materials and methods In a hospital based cross sectional study, 112 eyes of age group 11-22 years with established case of VKC were selected for topography. Result In 112 eyes with VKC; 69.64% (78 eyes) had significant history of eye rubbing. 14.28% (16 eyes) had Kmax values >=47.2D , 85.71%(96 eyes) had Kmax values <47.2D. 19.64%(22 eyes) had I-S Difference >=1.2D ; 80.36%(90 eyes) had I-S Difference <1.2D. Topographical patterns observed included 49.11%(55eyes) with round pattern, 20.54%(23 eyes) with oval shaped, 9.82%(11 eyes) with symmetric bowtie, 6.25%(7 eyes) with asymmetric bow tie with skewing of radial axis, 5.36%(6 eyes) with inferior steepening, 6.25%(7 eyes) with irregular pattern, 0.89%(1 eye) with crab claw pattern. ConclusionHigh occurrence of keratoconus-like topographic pattern seen in patients of VKC. Topographic analysis should be performed in all cases of VKC.
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Purpose: To study the occurrence of vernal keratoconjunctivitis (VKC) as an ocular manifestation of human immunodeficiency virus (HIV) in pediatric patients. Methods: A retrospective study was done on the observations of cases of HIV?positive children. All seropositive patients from the Anti?Retroviral Therapy clinic were referred to the department of ophthalmology for evaluation. Retrospective correlation of CD4 count with active cases of VKC was done. All patients underwent a comprehensive ophthalmic evaluation including visual acuity, slit lamp and dilated fundus examination. Results: A total of 72 children were included, 70 males and 2 females. Of these, 63 (87.5%) had VKC, three (4.2%) had cataract, two (2.8%) had cytomegalovirus retinitis retinitis, and four (5.5%) had no ophthalmic findings. Conclusion: There is a an evident association of HIV, VKC cases, and reduced CD4 count. More research is required on this topic.
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Purpose: To report the clinical outcomes and histopathological and immunohistochemistry (IHC) features in eyes with the sequelae stage of vernal keratoconjunctivitis (VKC). Methods: Investigative study of corneal samples obtained following surgical intervention for vision restoration in four eyes of three patients with VKC. Patient 1 (an 11?year?old boy) had deep anterior lamellar keratoplasty in both eyes, Patient 2 (a 24?year?old male) underwent superficial keratectomy followed by penetrating keratoplasty, and Patient 3 (a 22?year?old male) underwent penetrating keratoplasty. The corneal samples retrieved after surgical intervention were assessed for histology features and immunohistochemistry (IHC) studies. Results: The grafts were clear till the follow?up of 2–18 months. Histopathology of all four corneal samples showed epithelial hyperplasia, absent Bowman layer, thick hyalinized stromal lamellae, vascularization, and chronic inflammatory cells such as lymphocytes and plasma cells. IHC showed strong expression of CK 3 in both eyes of Patient 1 and no expression in Patients 2 and 3. The marker for limbal stem cells, ABCG2, was absent in all four samples; however, p63? was expressed strongly in Patients 2 and 3, moderately in the right eye of Patient 1, and marginally expressed in the left eye of Patient 1. Conclusion: The eyes in the sequelae stage of VKC (having corneal scarring and 360° hypertrophied limbus) can be managed favorably with keratoplasty and amniotic membrane transplantation without allogenic/cadaveric stem cell transplantation. The expression of transient progenitor cells in the scarred corneas of VKC patients in the sequelae stage suggests that the limbal stem cell dysfunction is more likely partial and self?renewal of limbal stem cells is a plausibility in these eyes
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Vernal keratoconjunctivitis (VKC) is a chronic, bilateral allergic conjunctivitis common in school children.VKC is classified into palpebral-conjunctival type, limbal type and mixed type primarily based on clinical findings.Most allergic conjunctivitis does not impair vision, however, VKC probably causes visual impairment because of the involvement of cornea besides conjunctiva.Corneal lesions of VKC would lead to amblyopia in younger children.The term "vernal" in VKC indicates a seasonal onset, but 20%-60% patients are found onset throughout the year.In addition, misdiagnosis and improper treatment often lead to persistence or recurrence of VKC and other complications.Previous study has suggested that VKC is a hypersensitivity disease involved both type I and type IV, however, recent researchers found that immune factor, genetic factor and endocrine factor show close associations with the pathogenesis of VKC.The diagnosis of VKC depends on the clinical symptoms, pathological findings, infiltration of dendritic cells by laser scanning confocal microscopy and allergen tests.The treatment of VKC mainly focuses on symptom relief.In addition to anti-allergy, anti-inflammation and artificial tears, immunosuppressor has become a new trend.The pathogenesis and treatment progress of VKC are reviewed.
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Background: Vernal keratoconjunctivitis (VKC) is a recurrent, bilateral, external, ocular inflammation primarily affecting young adults living in warm dry climates. The objectives of the research was to compare the two ophthalmic solutions of olopatadine hydrochloride (0.1%) and epinastine hydrochloride (0.05%) on clinical signs of vernal keratoconjuntivitis and to determine side effects of both the drugs.Methods: The study was carried out in 40 patients who attended the out-patient department (OPD) Ophthalmology, Darbhanga Medical College and Hospital, Laheriasarai from July 2007 to December 2008. Forty patients with symptoms of VKC (ocular itching, ropy discharge, papillary hypertrophy, gelatinous thickening and horner-trantas spots were selected and included in our study.Results: Mean score of palpebral hyperemia at 0, 14, 28 and 42 days in olopatadine treated eye were 2.1, 1.4, 0.8 and 0.4 respectively having p value <0.01, and <0.01 and <0.05 respectively, while mean score at same stages in placebo eye were 2.1, 2, 1.9, and 1.5 having value >0.05. Epinastine treated group mean score of palpebral hyperemia were <0.01 and <0.01 respectively in epinastine treated eye whereas in placebo treated eye, mean score were 2.1, 2.0, 1.8 and 1.6 respectively having p value >0.05 in all stages. Statistically insignificant reduction at day 14 while very significant reduction at day 28 and 42 was observed in epinastine treated eye as compared to placebo.Conclusions: The present study had shown that both olopatadine and epinastine were effective in treating clinical signs of VKC as compared to placebo.
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Background: Patient with vernal keratoconjunctivitis faces significant morbidity, which affects quality of life or; moreover, it can lead to vision threatening, corneal complication in severe cases and chronic cases coupled with potential iatrogenic side effects. Aim of this study to assess the demography, clinical features and quality of life of patients with vernal keratoconjunctivitis in a centre in South India.Methods: General objective is to access the health related-quality of life and demographic study of VKC patients in a tertiary eye care hospital in south India. KINDL questionnaire with 30 questions is used for 30 paediatric patients. Percentage analysis for clinical assessment and interpretation method for questionnaire was used as statistical method.Results: In clinical assessment papillary reaction (96.66%), giant papillae (83.34%), Horner Trantas dots (20%), shield ulcer (13.35%), corneal erosions (43.33%), conjunctival congestion (76.68%). In case of vision 36.66% had normal vision, 56.67% had mild vision loss, 6.68% with moderate vision loss.Conclusions: VKC affects the health related quality of life of the patients significantly. The management of VKC should consider this aspect of health related quality of life, in addition to clinical parameters. From the assessment of KINDL questionnaire 30 samples 18 patients had high and 12 patients had average quality of life.
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Comparative evaluation of bepotastine besilate versus olopatadine and ketorolac combination onupper tarsal conjunctival brush cytology in patients of vernal keratoconjunctivitis. This studywas a prospective, open label, randomized, comparative clinical study. 100 patients of vernalkeratoconjunctivitis between 6 to 20 years of age of either sex willing to give informed consentwere enrolled in the study. In Group 1, 50 patients received Bepotastine besilate (0.15%) eyedrops twice daily for 8 weeks whereas in Group 2, 50 patients received Olopatadine (0.2%) andKetorolac (0.4%) combination eye drops twice daily for 8 weeks. Upper tarsal conjunctival brushcytology for eosinophil count was done in both the drug groups during the baseline and at 8th weekduring the treatment. It was found that after the 2 months of drug therapy, patients in both thegroups showed reduction in the eosinophil count. However, there was no statistically significantdifference between the two treatment groups at the baseline and at 8th week. There was 32%reduction in group A versus 28% reduction in group B in eosinophil count at the end of 8th weekcompared to baseline. Both bepotastine besilate versus olopatadine and Ketorolac combinationwere found to be effective in reducing the eosinophil count in patients of VKC.
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?AIM: To determine the vitamin D levels in vernal keratoconjunctivitis ( VKC) patients in Indian population.?METHODS:A total of 30 non-atopic healthy children and 30 children having VKC were included in the study. The serum vitamin D levels and the time spent outside was compared between the two groups ( P<0.05) .?RESULTS:The mean serum vitamin D level in the VKC group was significantly lower ( mean 19.17± 10.76 ng/mL) compared to the control group ( mean 31.19± 9.09 ng/mL) ( P = 0.0003 ) . The vitamin D levels were found to be deficient ( 10 - 20 ng/mL ) in 43.33％, whereas severe deficiency (<10 ng/mL ) was found in 20％ of the VKC patients. The deficiency of vitamin D correlated with the level of severity of VKC ( P<0.02) . The time spent outside in the VKC group was 1.07± 0.76h, whereas in the healthy subjects it was 2.08±0.72h (P<0.0001), and it showed a significant correlation with the serum 25 ( OH ) D3 levels ( r=0.478, P<0.001) .?CONCLUSION:The study shows that children with VKC had a significantly lower serum vitamin D levels as compared to the healthy children which correlated with time spent outside. The severity of VKC also correlated with the severity of vitamin D deficiency which suggests that vitamin D plays an important role in maintaining ocular surface health.
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@#AIM: To determine the vitamin D levels in vernal keratoconjunctivitis(VKC)patients in Indian population.<p>METHODS:A total of 30 non-atopic healthy children and 30 children having VKC were included in the study. The serum vitamin D levels and the time spent outside was compared between the two groups(<i>P</i><0.05).<p>RESULTS: The mean serum vitamin D level in the VKC group was significantly lower(mean 19.17±10.76 ng/mL)compared to the control group(mean 31.19±9.09 ng/mL)(<i>P</i>=0.0003). The vitamin D levels were found to be deficient(10-20 ng/mL)in 43.33%, whereas severe deficiency(<10 ng/mL)was found in 20% of the VKC patients. The deficiency of vitamin D correlated with the level of severity of VKC(<i>P</i><0.02). The time spent outside in the VKC group was 1.07±0.76h, whereas in the healthy subjects it was 2.08±0.72h(<i>P</i><0.0001), and it showed a significant correlation with the serum 25(OH)D3 levels(<i>r</i>=0.478, <i>P</i><0.001).<p>CONCLUSION:The study shows that children with VKC had a significantly lower serum vitamin D levels as compared to the healthy children which correlated with time spent outside. The severity of VKC also correlated with the severity of vitamin D deficiency which suggests that vitamin D plays an important role in maintaining ocular surface health.
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Purpose: To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC). Methods: Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups. Results: Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA <3/60). Post treatment marginal improvement in CDVA was found (P = 0.46). However, statistically significantly improvement was noticed in IOP (P < 0.00001). Conclusion: Injudicious use of steroids leads to vision threatening complications like ocular hypertension and glaucoma in children of VKC. Weak steroids like loteprednol or fluorometholone should be used instead of higher potency drugs. Vision and IOP should be monitored fortnightly in children using topical steroids to detect steroid responders at the earliest.
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Objective: Comparative evaluation of efficacy and safety ofBepotastine besilate versus Olopatadine and Ketorolaccombination in patients with vernal keratoconjunctivitis.Materials and Methods: This was a prospective, open label,randomized, comparative clinical study. Hundred patients ofvernal keratoconjunctivitis between 6 to 20 years of age ofeither sex willing to give informed consent were enrolled in thestudy. In Group 1, 50 patients received Bepotastine besilate(0.15%) eye drops twice daily for 8 weeks whereas in Group 2,50 patients received Olopatadine (0.2%) and Ketorolac (0.4%)combination eye drops twice daily for 8 weeks. Symptoms andsigns scoring of VKC were recorded on baseline and at thetime of follow up at 4 and 8 weeks. Safety assessments werealso done in both the drug groups during the study period forany serious adverse effects.Results: After the 2 months of drug therapy, patients in boththe groups showed improvement in the symptoms and signsscoring of VKC. However, there was no statistically significantdifference between the two treatment groups at 4th and 8thweek. Both the drugs were well tolerated without any seriousadverse effect.Conclusion: Both bepotastine besilate versus olopatadine andKetorolac combination ophthalmic solutions were found to beeffective in alleviating the clinical symptoms and signs of VKC.