Kate Anahita, Jain Neha, Jakati Saumya, Basu Sayan
Cornea & Anterior Segment, L V Prasad Eye Institute, Vijayawada, IND.
Cornea & Anterior Segment, L V Prasad Eye Institute, Hyderabad, IND.
Cureus. 2022 Mar 12;14(3):e23089. doi: 10.7759/cureus.23089. eCollection 2022 Mar.
This report describes the clinical features and management in a case of vernal keratoconjunctivitis (VKC) with bilateral tarsal conjunctival keratinization. A 32-year-old male presented with VKC since childhood that had exacerbated in the eight years prior to presentation. Examination revealed partial limbal stem cell deficiency in both eyes, with keratinization of the superior tarsal conjunctiva. The corresponding areas of the cornea exhibited punctate keratopathy in both eyes. To address this, the patient underwent excision of the conjunctival keratinization in both eyes. The resultant bare areas were covered with conjunctival autografts (CAGs). Postoperatively, the grafts were well apposed, and there was no recurrence of keratinization observed during the period of follow-up of four years. Resolution of corneal epitheliopathy was also noted. Although keratinization can occur in eyes with VKC, it is usually limited to the bulbar conjunctival areas. This is the first report of tarsal conjunctival keratinization in such cases. Milder cases may be observed or managed with scleral contact lenses. In more severe forms, there is associated corneal epitheliopathy, which may progress to corneal vascularization and scarring. Surgical excision of the lesion is recommended in these eyes. Following excision, several options exist to cover the bare area, which include a CAG, an amniotic membrane, or an oral mucous membrane. Of these, a CAG is an autologous tissue that can be harvested with a simple surgical technique and yields stable long-term results. Thus, tarsal conjunctival keratinization is a rare complication of chronic VKC. Excision of the lesion followed by a CAG is a viable approach for treatment, which reestablishes and maintains a stable ocular surface.
本报告描述了一例伴有双侧睑结膜角化的春季角结膜炎（VKC）的临床特征及治疗情况。一名32岁男性自童年起患有VKC，在就诊前8年病情加重。检查发现双眼均存在部分角膜缘干细胞缺乏，上睑结膜角化。双眼角膜相应区域出现点状角膜病变。为解决此问题，患者接受了双眼结膜角化切除术。术后裸露区域用自体结膜移植片（CAG）覆盖。术后，移植片贴合良好，在4年的随访期内未观察到角化复发。同时也注意到角膜上皮病变有所缓解。虽然VKC患者的眼睛可能出现角化，但通常局限于球结膜区域。这是此类病例中睑结膜角化的首例报告。较轻的病例可使用巩膜接触镜观察或处理。在更严重的情况下，会伴有角膜上皮病变，可能进展为角膜血管化和瘢痕形成。对于这些眼睛，建议手术切除病变。切除病变后，有多种方法可覆盖裸露区域，包括CAG、羊膜或口腔黏膜。其中，CAG是一种自体组织，可通过简单的手术技术获取，并能产生稳定的长期效果。因此，睑结膜角化是慢性VKC的一种罕见并发症。切除病变后进行CAG移植是一种可行的治疗方法，可重建并维持稳定的眼表。
