J Korean Ophthalmol Soc.  2017 Aug;58(8):986-992. 10.3341/jkos.2017.58.8.986.

A Case of Intractable Vernal Keratoconjunctivitis Treated by Papillectomy and Amniotic Membrane Transplantation

• Song HJ
• Kwon JY
• Han JS
• Yang JH
• Kwon JW

• KMID: 2388189
• DOI: http://doi.org/10.3341/jkos.2017.58.8.986

Abstract

PURPOSE
To report a successful case of intractable vernal keratoconjunctivitis treated by papillectomy and amniotic membrane transplantation.
CASE SUMMARY
A 20-year-old female patient presented with repeated vernal keratoconjunctivitis in both eyes since the age of 14. Despite medical therapy, she developed severe itching, burning and foreign body sensations, and limbal nodules with mutiple giant papillae of the upper tarsal plate. Surgical resection of the giant papillae and amniotic membrane transplantation in her left eye was performed. One month later, the same procedure was performed in her right eye. The patient's symptoms then improved. Neither recurrence nor serious complication were observed during the 6 months follow up period after surgery.
CONCLUSIONS
In intractable vernal keratoconjunctivitis, papillectomy with amniotic membrane transplantation may potentially be a good treatment option for better clinical outcome and low recurrence rates.

Keyword

Amniotic membrane transplantation; Papillectomy; Vernal keratoconjunctivitis

MeSH Terms

Amnion*
Burns
Conjunctivitis, Allergic*
Female
Follow-Up Studies
Foreign Bodies
Humans
Pruritus
Recurrence
Sensation
Young Adult

Figure

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  Figure 1. Slit lamp photographs of the left eye. (A, B) At the initial presentation, there were superior limbal nodules and superior tar-sal papillae. (C, D) Despite medical therapy, there was no improvement. (E, F) 10 days after surgery, there was no more superior tarsal papillae with smooth surface. (G, H) 2 months after surgery, there was no recurrence with smooth superior tarsal plate and im-provement of superior limbal nodue.

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  Figure 2. Slit lamp photographs of the right eye. (A, B) At the initial presentation, there were superior limbal nodules and superior tarsal papillae. (C, D) Despite medical therapy, there was no improvement. (E, F) 10 days after surgery, there was part of amniotic membrane on superior tarsal conjunctiva with relatively smooth surface. (G, H) 1 months after surgery, there was no recurrence with smooth superior tarsal plate and improvement of superior limbus.

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  Figure 3. Surgical procedures of papillectomy with amniotic membrane transplantation. The giant papillae of upper tarsal plate was resected with vannas scissors (A). Amniotic membrane was placed, with epithelial side up, to cover the defect (B) and then attached by fibrin glue (C) and sutured continuously to the surrounding conjunctiva with 10-0 nylon (D).

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  Figure 4. Histopathologic findings. Histological examination of superior conjunctival giant papillae on right eye (A) and left eye (B). Both of them show thickened and irregular epithelium with marked lymphoplasmacytic and eosinophilic infiltration (H&E ×600).

Reference

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