Tailored approach to the treatment of vernal keratoconjunctivitis.

Abstract

PURPOSE:

To develop a standardized clinical grading system for the management of patients with vernal keratoconjunctivitis (VKC) and to identify the risk factors associated with a worsened outcome of the disease, including decrease of visual acuity and ocular complications development.

DESIGN:

Retrospective cohort study.

PARTICIPANTS:

A total of 207 consecutive patients with VKC, referred to our Cornea and External Diseases Center from 1997 to 2007, were included in the study. A total of 110 of those patients were included in the follow-up study (range 1-10 years).

METHODS:

Classification and regression tree (CART) analysis was performed to separate the patients into 5 subgroups by therapeutic approach. Regression tree and multivariate logistic regression analyses were performed during follow-up to identify predictors of worse visual outcome.

MAIN OUTCOME MEASURES:

Age, gender, duration and course of disease, signs, symptoms, overall symptoms score, history of atopy, markers of allergy, best-corrected visual acuity, and therapy were collected at baseline and during follow-up. The number of relapses and number of patients with decreased visual acuity were also evaluated in the follow-up.

RESULTS:

A decision tree for VKC treatment was developed by CART analysis, and a new clinical grading system was proposed accordingly. Sixteen patients were classified as grade 0 (absence of symptoms and no therapy); 59 patients were classified as grade 1 (presence of symptoms without photophobia, occasional use of anti-allergic eye drop); 74 patients were classified as grade 2 (presence of symptoms including photophobia, daily anti-allergic treatment); 22 patients with superficial punctuate keratopathy (SPK) were classified as grade 3 (daily anti-allergic treatment associated with occasional topical steroid); and 36 patients were classified as grade 4 (diffuse SPK or corneal ulcer; pulsed high-dose topical steroid). A higher number of relapses and a higher baseline grade of VKC were the main predictor factors for worse visual outcome.

CONCLUSIONS:

This grading system allows for identifying the more severe forms of VKC that are at higher risk of recurrences, corneal ulceration, and worse final visual outcome.

FINANCIAL DISCLOSURE(S):

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

• Authors: Marta Sacchetti, Alessandro Lambiase, Flavio Mantelli, Velika Deligianni, Andrea Leonardi, Stefano Bonini
• Journal: Ophthalmology (Ophthalmology) Vol. 117 Issue 7 Pg. 1294-9 (Jul 2010) ISSN: 1549-4713 [Electronic] United States
• PMID: 20382430 (Publication Type: Journal Article)
• Copyright: Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-Allergic Agents
• Glucocorticoids

Topics

• Adolescent
• Adult
• Anti-Allergic Agents (therapeutic use)
• Child
• Child, Preschool
• Conjunctivitis, Allergic (classification, drug therapy, physiopathology)
• Decision Trees
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Glucocorticoids (therapeutic use)
• Humans
• Male
• Multivariate Analysis
• Recurrence
• Retrospective Studies
• Risk Factors
• Visual Acuity (physiology)