J Korean Ophthalmol Soc.  2010 Apr;51(4):492-497. 10.3341/jkos.2010.51.4.492.

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

• Choi W
• Lim SG
• Yoon KC

• KMID: 2213387
• DOI: http://doi.org/10.3341/jkos.2010.51.4.492

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.

Keyword

Combined treatment; Papillectomy; Triamcinolone; VKC

MeSH Terms

Blepharitis
Conjunctivitis, Allergic
Corneal Neovascularization
Eye
Humans
Hyperemia
Hypertrophy
Intraocular Pressure
Keratitis
Lacrimal Apparatus Diseases
Pruritus
Tears
Triamcinolone
Visual Acuity
Triamcinolone

Figure

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  Figure 1. Comparison of tear CCL11/Eotaxin level between before and 2 weeks after combined treatment.

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  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.

Reference

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