Shimokawa Asami, Ikeda Aya, Harada Kazuhiro, Takahashi Rie, Huang Jane, Tsukahara-Kawamura Tomoko, Ozaki Hiroaki, Uchio Eiichi
Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan.
Clin Ophthalmol. 2024 Aug 23;18:2339-2347. doi: 10.2147/OPTH.S472826. eCollection 2024.
Vernal keratoconjunctivitis (VKC) is a refractory ocular allergic disorder that mainly affects boys. Long-term follow-up has been rarely reported for VKC. We investigated the long-term clinical outcome of VKC to identify relevant clinical features of prognostic value based on follow-up for a median of 70 months.
In total, 45 consecutive patients clinically diagnosed with VKC aged 4 to 12 years at onset at the Department of Ophthalmology of Fukuoka University Hospital were included. Patients were treated with immunosuppressive eye drops without simultaneous corticosteroid eye drops, except for the occurrence of exacerbations. Collated variables were gender, age at onset, clinical score of ocular lesions (conjunctival giant papillae, limbal edema and corneal epithelial lesions) at the first visit, and clinical score of atopic dermatitis (AD) at baseline. Cumulative cure rate was estimated using Kaplan-Meier method. A binomial logistic predictive model was used to determine the most reliable clinical predictors of VKC outcome.
The observation period ranged from 24 to 188 months, with median of 70 months. Among the 45 cases enrolled, all non-cured cases (14 cases) observed clinically were complicated by AD. Cumulative cure rate was 74.5% and 84.9% at eight- and ten-year follow-up, respectively. Ten-year cumulative cure rates of cases with and without AD were 50.5% and 100%, respectively, and a significant difference was found between these cumulative cure curves. Binomial regression analysis revealed that AD and gender were significantly related to worse outcome, and this binomial regression model had high sensitivity and specificity.
This study demonstrated that th eclinical outcomeof VKC might be predicted by several factors that can beobtained in the early clinical phase. Information on the long-term prognosis of VKC patients might play an important role for precision medicine for VKC in childhood.
春季角结膜炎（VKC）是一种难治性眼部过敏性疾病，主要影响男孩。关于VKC的长期随访报道很少。我们对VKC进行了长期临床结局研究，以基于中位70个月的随访确定具有预后价值的相关临床特征。
总共纳入了45例在福冈大学医院眼科临床诊断为VKC且发病时年龄在4至12岁的连续患者。除病情加重外，患者接受免疫抑制眼药水治疗，不同时使用皮质类固醇眼药水。整理的变量包括性别、发病年龄、首次就诊时眼部病变（结膜巨大乳头、角膜缘水肿和角膜上皮病变）的临床评分以及基线时特应性皮炎（AD）的临床评分。使用Kaplan-Meier方法估计累积治愈率。采用二项逻辑预测模型确定VKC结局最可靠的临床预测因素。
观察期为24至188个月，中位时间为70个月。在纳入的45例病例中，所有临床观察到的未治愈病例（14例）均合并AD。八年和十年随访时的累积治愈率分别为74.5%和84.9%。有AD和无AD病例的十年累积治愈率分别为50.5%和100%，这些累积治愈曲线之间存在显著差异。二项回归分析显示，AD和性别与较差结局显著相关，该二项回归模型具有较高的敏感性和特异性。
本研究表明，VKC的临床结局可能由早期临床阶段可获得的几个因素预测。VKC患者的长期预后信息可能对儿童VKC的精准医学发挥重要作用。
