Dahlmann-Noor Annegret, Bonini Stefano, Bremond-Gignac Dominique, Heegaard Steffen, Leonardi Andrea, Montero Jesús, Silva Eduardo D
National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust, University College London Institute of Ophthalmology, London, UK.
UCL Institute of Ophthalmology, London, UK.
Ophthalmol Ther. 2023 Apr;12(2):1207-1222. doi: 10.1007/s40123-023-00665-5. Epub 2023 Feb 15.
Vernal keratoconjunctivitis (VKC) is a rare, severe allergic ocular disease, typically occurring in children and adolescents, that can have a significant impact on quality of life and lead to visual impairment. Long-term treatment may be necessary to tackle chronic inflammation and topical corticosteroid dependency must be minimised due to the risk of complications. There is a need for unified clinical guidance to aid the assessment, diagnosis and management of VKC across Europe. The aim of this expert panel (the EUR-VKC Group) was to provide clear guidance for primary care physicians and general ophthalmologists involved in the diagnosis and management of VKC.
An expert group of seven European ophthalmologists was convened and a modified nominal group technique used to develop key recommendations on VKC management. The recommendations were subject to up to two rounds of voting using a 5-point Likert scale to ascertain consensus and the strength of each recommendation. Consensus was set at a predetermined threshold of ≥ 75.0% of experts selecting 'Strongly agree' or 'Agree'.
A total of 47 recommendations were developed relating to the assessment of key of VKC, guidance on who and when to refer, as well as treatment-escalation pathways, long-term follow-up, and supportive care and education. All recommendations reached consensus after two rounds. The group emphasise how timely diagnosis and treatment initiation that is appropriate to disease severity are crucial to benefit patients with VKC. Patients with signs ('red flags') indicating severe VKC, or persistent mild-to-moderate VKC that is non-responsive following 2-4 weeks of treatment, should be referred to a sub-specialist.
The EUR-VKC Group provides recommendations on the assessment, diagnosis, management, referral and follow-up of patients with VKC. It also provides a framework to facilitate collaboration between primary care physicians, general ophthalmologists and sub-specialists to improve the outcomes for patients with VKC.
春季角结膜炎（VKC）是一种罕见的严重过敏性眼病，通常发生于儿童和青少年，会对生活质量产生重大影响并导致视力损害。可能需要长期治疗以应对慢性炎症，并且由于存在并发症风险，必须尽量减少局部皮质类固醇的依赖。欧洲需要统一的临床指南，以协助对VKC进行评估、诊断和管理。该专家小组（欧洲VKC小组）的目的是为参与VKC诊断和管理的初级保健医生和普通眼科医生提供明确的指导。
召集了由七名欧洲眼科医生组成的专家组，并采用改良的名义小组技术来制定关于VKC管理的关键建议。这些建议使用5点李克特量表进行多达两轮投票，以确定共识以及每项建议的力度。共识设定为预先确定的阈值，即≥75.0%的专家选择“强烈同意”或“同意”。
共制定了47项建议，涉及VKC关键评估、转诊对象和时机的指导，以及治疗升级途径、长期随访、支持性护理和教育。所有建议在两轮投票后均达成共识。该小组强调，根据疾病严重程度及时进行诊断和开始治疗对于VKC患者获益至关重要。有迹象（“危险信号”）表明为重度VKC，或在治疗2 - 4周后仍无反应的持续性轻度至中度VKC患者，应转诊至专科医生处。
欧洲VKC小组提供了关于VKC患者评估、诊断、管理、转诊和随访的建议。它还提供了一个框架，以促进初级保健医生、普通眼科医生和专科医生之间的合作，从而改善VKC患者的治疗效果。
