Ophthalmology Department, Kabgayi Hospital, Muhanga, Rwanda.
Ophthalmology. 2012 Sep;119(9):1766-72. doi: 10.1016/j.ophtha.2012.03.041. Epub 2012 Jun 7.
We sought to describe the clinical presentation, effect on visual acuity, impact on school attendance, and access to appropriate eye care in children with vernal keratoconjunctivitis (VKC) in Rwanda (Central Africa).
Case-control study nested within a cross-sectional survey.
We examined 3041 children; 121 had VKC.
Primary schools were randomly selected and children were interviewed using a questionnaire on VKC-related symptoms. Data on health-seeking behavior and school attendance were recorded. Children received a full eye examination, including visual acuity using a LogMar E Chart.
Description of the clinical findings, unaided visual acuity, prior attendance for medical eye care, and the impact of VKC on school attendance.
Of the 121 children with VKC, 119 (98.4%) had only limbal disease. Ocular itching (n = 101; 83.5%) was the predominant symptom and this was seasonal in 66 children (65.4%), constant but with variable intensity in 18 (17.8%), and constant with constant intensity in 17 children (16.8%). Children with VKC were >6 times more likely to have corneal astigmatism >2 diopters in their worse eye (odds ratio [OR], 6.31; 95% confidence interval [CI], 3.26-12.26; P<0.001) than controls. Eight affected eyes had astigmatism >4 diopters or irregular astigmatism incompatible with autokeratometry. Although 4 eyes (1.7%) had uncorrected low vision from VKC-induced corneal astigmatism or keratoconus, only 1 child was visually impaired in both eyes. School nonattendance for an ocular reason during the last 3 months was 5 times more likely in children with VKC (n = 44; 36.4%) than among those without (n = 297; 10.2%; OR, 5.04; 95% CI, 3.40-7.47; P < 0.001). Repeating a school year or having ever dropped out of school was not more common among children with VKC than those without. Medical eye care had been sought by 54 (44.6%) children with VKC.
This survey of prevalence and treatment of VKC in an African community adds to the argument for better primary eye care, including a safe topical medication. Long-term follow-up of this cohort is required to ascertain the overall risk of sight-threatening complications.
我们旨在描述 vernal 角结膜炎（VKC）在卢旺达（中非）儿童中的临床特征、对视力的影响、对入学率的影响以及获得适当眼部护理的情况。
嵌套在横断面调查中的病例对照研究。
我们检查了 3041 名儿童；其中 121 名患有 VKC。
随机选择小学，对儿童进行与 VKC 相关症状的问卷调查。记录了寻医行为和入学率的数据。儿童接受全面的眼部检查，包括使用 LogMar E 图表进行视力检查。
描述临床发现、未矫正视力、以前的医疗眼科就诊情况以及 VKC 对入学率的影响。
在 121 名患有 VKC 的儿童中，119 名（98.4%）仅有角膜缘疾病。眼部瘙痒（n=101；83.5%）是主要症状，其中 66 名（65.4%）患儿的症状具有季节性，18 名（17.8%）患儿的症状为持续但强度可变，17 名（16.8%）患儿的症状为持续且强度恒定。患有 VKC 的儿童其最差眼的角膜散光>2 屈光度的可能性是对照组的 6 倍以上（优势比[OR]，6.31；95%置信区间[CI]，3.26-12.26；P<0.001）。8 只受影响的眼睛的散光>4 屈光度或不规则散光与自动角膜曲率计不兼容。尽管有 4 只（1.7%）眼睛因 VKC 引起的角膜散光或圆锥角膜导致未经矫正的低视力，但仅有 1 名儿童双眼视力受损。在过去 3 个月中，因眼部原因而不上学的儿童在 VKC 患儿（n=44；36.4%）中是对照组的 5 倍（n=297；10.2%；OR，5.04；95% CI，3.40-7.47；P < 0.001）。VKC 患儿中重读一个学年或辍学的情况并不比对照组更常见。有 54 名（44.6%）患有 VKC 的儿童寻求过医疗眼科护理。
本研究调查了非洲社区 vernal 角结膜炎的患病率和治疗情况，进一步证明了需要更好的初级眼部护理，包括安全的局部药物治疗。需要对该队列进行长期随访，以确定视力威胁性并发症的总体风险。
