Annisa Devina Nur, Suharko Hernawita, Gaol Hasiana Lumban, Viona Viona
Pediatric Ophthalmology and Strabismus JEC Eye Hospitals and Clinics, Jakarta, Indonesia.
Orbital, Oculoplastic, and Reconstructive JEC Eye Hospitals and Clinics, Jakarta, Indonesia.
Case Rep Ophthalmol Med. 2024 Aug 5;2024:9973441. doi: 10.1155/2024/9973441. eCollection 2024.
Vernal keratoconjunctivitis (VKC) is an allergic disease that predominantly affects young individuals, with a higher incidence among males. Traditionally seen as a condition of childhood that resolves at puberty, recent studies have shown persistent cases in some individuals, potentially influenced by hot and dry tropical environmental conditions. VKC is more prevalent in regions with a hot and humid climate and a high presence of airborne allergens, leading to significant morbidity and impacting the quality of life for affected individuals. Severe and chronic cases can lead to vision-threatening corneal complications, making effective management crucial. Although the clinical profile of VKC varies geographically, comprehensive studies in specific regions remain limited. In this case report, we present an 18-year-old male patient with severe and refractory VKC. Despite initial treatments, including topical and oral medications, recurrent episodes occurred every 6 months, accompanied by giant papillae (GP) formation and corneal ulcers. The patient had a history of triamcinolone injection and papillectomy combined with amnion membrane transplantation, but presented with a refractory disease in a year. Surgical intervention involving papillectomy and autologous conjunctival membrane graft was performed, leading to a smooth upper tarsal conjunctiva during the 2-year follow-up period, without GP recurrence and maintaining a clear cornea. The patient's symptoms were effectively managed with topical medications. The management of VKC necessitates a comprehensive approach involving preventive measures, pharmacological treatment, and surgical interventions for refractory cases. This case highlights the potential benefits of surgical techniques, such as papillectomy and autologous conjunctival membrane graft, in managing severe and refractory VKC cases with a history of previous surgical procedure failure. However, it is essential to recognize that exposure avoidance and allergic control remain fundamental in VKC management. Further research and larger studies are required to validate the efficacy of these surgical techniques in managing VKC.
春季角结膜炎（VKC）是一种主要影响年轻人的过敏性疾病，男性发病率更高。传统上认为这是一种儿童期疾病，青春期会自愈，但最近的研究表明，在一些个体中存在持续性病例，可能受到炎热干燥的热带环境条件影响。VKC在气候炎热潮湿且空气中过敏原含量高的地区更为普遍，会导致严重发病并影响患者的生活质量。严重和慢性病例可导致威胁视力的角膜并发症，因此有效管理至关重要。尽管VKC的临床特征因地域而异，但特定地区的综合研究仍然有限。 在本病例报告中，我们介绍了一名18岁患有严重难治性VKC的男性患者。尽管进行了包括局部和口服药物在内的初始治疗，但每6个月仍会复发，伴有巨大乳头（GP）形成和角膜溃疡。该患者有曲安奈德注射和乳头切除术联合羊膜移植的病史，但一年后仍表现为难治性疾病。进行了包括乳头切除术和自体结膜移植的手术干预，在2年随访期间上睑结膜恢复平滑，无GP复发且角膜保持清晰。患者症状通过局部药物得到有效控制。 VKC的管理需要综合方法，包括预防措施、药物治疗以及针对难治性病例的手术干预。本病例突出了手术技术，如乳头切除术和自体结膜移植，在治疗有既往手术失败史的严重难治性VKC病例中的潜在益处。然而，必须认识到避免暴露和控制过敏在VKC管理中仍然至关重要。需要进一步研究和更大规模的研究来验证这些手术技术在治疗VKC中的疗效。
