Atopic keratoconjunctivitis: long-term results of medical treatment and penetrating keratoplasty / Ceratoconjuntivite atópica: resultados a longo prazo do tratamento clínico e da ceratoplastia penetrante

ABSTRACT Purpose: To evaluate the long-term outcomes of medically or surgically treated patients with atopic keratoconjunctivitis (AKC). Methods: Charts of 16 patients with AKC (32 eyes) observed between 1996 and 2013 were reviewed retrospectively. Outcome measures included demographic features, follow-up duration, and biomicroscopic findings at the first and most recent visits. The corrected distance visual acuity (CDVA; in decimal units) was evaluated at the initial visit and the 1-, 6-, and 12-month follow-up visits. Results: In the medically treated group (25 eyes of 15 patients), the median follow-up duration was 3 (range, 1-9) years, and the median CDVA values were 0.01 (0.001-1.0) at the first visit and 0.01 (0.001-0.8) at the most recent visit (p=0.916). In the penetrating keratoplasty (PK) group (7 eyes of 6 patients), the median follow-up duration was 7 years (range, 1-11), and the median CDVA increased from 0.01 (0.001-0.01) to 0.2 (0.001-0.7) postoperatively (p=0.043). Conclusion: Whereas most AKC patients maintained a useful CDVA with medical treatment, PK may be required in some cases. Despite the frequent occurrence of complications, PK can significantly improve the CDVA.

RESUMO Objetivo: Avaliar os resultados a longo prazo em ceratoconjuntivite atópica (AKC) pacientes que foram tratados clinicamente ou cirurgicamente. Métodos: Os prontuários de 16 pacientes (32 olhos) com AKC, que foram acompanhados entre 1996 e 2013 foram avaliados retrospectivamente. As medidas adotadas foram as características demográficas, tempos de seguimento, e resultados biomicroscópicos da visita inicial e da visita mais recente. A acuidade visual corrigida para distância (CDVA), apresentada em unidades decimais, foi avaliada na visita inicial e nas visitas do 1º mês, 6º mês e 1º ano de seguimento. Resultados: No grupo tratado clinicamente (25 olhos de 15 pacientes), a mediana do tempo de seguimento foi de 3 anos (variação, 1-9) e a CDVA média foi de 0,01 (0,001-1,0) na visita inicial e 0,01 (0,001-0,8) na visita mais recente (p=0,916). No grupo de ceratoplastia penetrante (PK) (7 olhos de 6 pacientes), a mediana de tempo de seguimento foi de 7 anos (variação, 1-11) e a CDVA média aumentou de 0,01 (0,001-0,01) para 0,2 (0,001-0,7) (p=0,043) no pós-operatório. Conclusões: Embora a maioria dos pacientes AKC mantém a CDVA útil com o tratamento clínico, alguns necessitam de PK a fim de obter CDVA útil. Embora as complicações pós-PK ocorrem com freqüência, a CDVA pode melhorar significativamente.

Atopic keratoconjunctivitis: long-term results of medical treatment and penetrating keratoplasty.

PURPOSE:: To evaluate the long-term outcomes of medically or surgically treated patients with atopic keratoconjunctivitis (AKC). METHODS:: Charts of 16 patients with AKC (32 eyes) observed between 1996 and 2013 were reviewed retrospectively. Outcome measures included demographic features, follow-up duration, and biomicroscopic findings at the first and most recent visits. The corrected distance visual acuity (CDVA; in decimal units) was evaluated at the initial visit and the 1-, 6-, and 12-month follow-up visits. RESULTS:: In the medically treated group (25 eyes of 15 patients), the median follow-up duration was 3 (range, 1-9) years, and the median CDVA values were 0.01 (0.001-1.0) at the first visit and 0.01 (0.001-0.8) at the most recent visit (p=0.916). In the penetrating keratoplasty (PK) group (7 eyes of 6 patients), the median follow-up duration was 7 years (range, 1-11), and the median CDVA increased from 0.01 (0.001-0.01) to 0.2 (0.001-0.7) postoperatively (p=0.043). CONCLUSION:: Whereas most AKC patients maintained a useful CDVA with medical treatment, PK may be required in some cases. Despite the frequent occurrence of complications, PK can significantly improve the CDVA.

Surgical resection of giant papillae and autologous conjunctival graft in patients with severe vernal keratoconjunctivitis and giant papillae.

PURPOSE: Giant papillae (GP) in patients with vernal keratoconjunctivitis (VKC) refractory to clinical treatment may cause serious corneal complications, such as shield ulcer. We propose a surgical treatment--resection of GP--in conjunction with free autologous conjunctival graft to treat severe cases of VKC with GP. METHODS: Six eyes of five patients with VKC, characterized by GP and shield ulcer refractory to clinical treatment, underwent surgical resection of GP associated with free autologous conjunctival graft. RESULTS: No recurrence of GP over the graft was observed during follow-up intervals ranging from 9 months to 27 months. Corneal shield ulcers healed during the first week after treatment and did not recur. CONCLUSIONS: Patients with refractory VKC and GP associated with corneal shield ulcer may benefit from resection of GP and autologous conjunctival graft.

Transplante autólogo de conjuntiva no tratamento da ceratoconjuntivite primaveril / Autologous conjunctival transplant in vernal keratoconjuntivitis treatment

Várias säo as opçöes de tratamento cirúrgico descritas para a forma palpebral severa de Ceratoconjuntivite Primaveril (CP), quais sejam, exérese das papilas do tarso superior, crioterapia, transplante de mucosa oral e transplante de tecido de veia safena1-4. Muitos destes procedimentos parecem ter efeito transitório e outros tornam-se limitados por dificuldades técnicas e complicaçöes. Apresentamos um procedimento cirúrgico alternativo, o transplante de conjuntiva bulbar para o tarso superior combinado com a exérese prévia das papilas, o qual realizamos em 3 olhos de 2 pacientes. Após um período de seguimento que variou de 7 a 16 meses, os pacientes permanecem assintomáticos, sem recidiva de úlcera corneana superior ou ceratite, o aspecto biomicroscópico do enxerto é normal e näo houve crescimento das papilas gigantes sobre o transplante. Acreditamos ser esta uma técnica cirúrgica segura e eficaz para os casos de CP refratários ao tratamento clínico, principalmente na vigência de ulceraçäo corneana.