TY - JOUR
T1 - Management, clinical outcomes, and complications of shield ulcers in vernal keratoconjunctivitis
AU - Reddy, Jagadesh C.
AU - Basu, Sayan
AU - Saboo, Ujwala S.
AU - Murthy, Somasheila I.
AU - Vaddavalli, Pravin K.
AU - Sangwan, Virender S.
N1 - Funding Information:
All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest and none were reported. Publication of this article was supported by the Hyderabad Eye Research Foundation , Hyderabad, India. Involved in Design of study (J.C.R., V.S.S., S.B., S.I.M., P.K.V.); Conduct of study (J.C.R., U.S.S., S.B.); Collection (J.C.R.), management (V.S.S., S.I.M., P.K.V.), analysis (J.C.R., S.B.), and interpretation (J.C.R., S.B., U.S.S.) of data; and Preparation (J.C.R., V.S.S., S.B., S.I.M., P.K.V.), review (J.C.R., V.S.S., S.B., U.S.S., S.I.M., P.K.V.), and approval (J.C.R., V.S.S., S.B., U.S.S., S.I.M., P.K.V.) of manuscript.
PY - 2013/3
Y1 - 2013/3
N2 - Purpose: To assess the clinical outcomes and complications of shield ulcers by various treatment methods. Design: Retrospective, interventional case series. Methods: setting: Cornea and anterior segment service of L.V. Prasad Eye Institute, India. study population: One hundred ninety-three eyes of 163 patients clinically diagnosed with vernal keratoconjunctivitis and shield ulcers. intervention: The treatment algorithm was based on the Cameron clinical grading of shield ulcers. Grade 1 ulcers received medical therapy alone. Grade 2 and grade 3 ulcers received either medical therapy alone or medical therapy combined with debridement, amniotic membrane transplantation (AMT), or both. main outcome measures: Re-epithelialization time and best-corrected visual acuity. Results: Grade 1 ulcers were seen in 71 (37%) eyes, grade 2 ulcers were seen in 79 (41%) eyes, and grade 3 ulcers were seen in 43 (22%) eyes. In the grade 1 group, re-epithelialization was seen in 67 (94%) eyes. In the grade 2 group, re-epithelialization was seen in 36 (88%) eyes that received medical treatment, in 20 (95%) eyes that underwent debridement, and in 17 (100%) eyes that underwent AMT. In the grade 3 group, re-epithelialization was seen in only 1 (1.7%) eye that received medical treatment, whereas it was seen in all eyes that underwent debridement and AMT. The mean best-corrected visual acuity after re-epithelialization of the shield ulcer was 20/30, 20/30, and 20/40 in the grade 1, grade 2, and grade 3 groups, respectively. Recurrence and secondary bacterial keratitis were seen in 28 (14.5%) and 20 (10%) eyes, respectively. Conclusions: Grade 1 shield ulcers respond well to medical therapy alone, whereas grade 2 ulcers occasionally may require additional debridement or AMT. Grade 3 ulcers, however, largely are refractory to medical therapy and require debridement and AMT for rapid re-epithelialization.
AB - Purpose: To assess the clinical outcomes and complications of shield ulcers by various treatment methods. Design: Retrospective, interventional case series. Methods: setting: Cornea and anterior segment service of L.V. Prasad Eye Institute, India. study population: One hundred ninety-three eyes of 163 patients clinically diagnosed with vernal keratoconjunctivitis and shield ulcers. intervention: The treatment algorithm was based on the Cameron clinical grading of shield ulcers. Grade 1 ulcers received medical therapy alone. Grade 2 and grade 3 ulcers received either medical therapy alone or medical therapy combined with debridement, amniotic membrane transplantation (AMT), or both. main outcome measures: Re-epithelialization time and best-corrected visual acuity. Results: Grade 1 ulcers were seen in 71 (37%) eyes, grade 2 ulcers were seen in 79 (41%) eyes, and grade 3 ulcers were seen in 43 (22%) eyes. In the grade 1 group, re-epithelialization was seen in 67 (94%) eyes. In the grade 2 group, re-epithelialization was seen in 36 (88%) eyes that received medical treatment, in 20 (95%) eyes that underwent debridement, and in 17 (100%) eyes that underwent AMT. In the grade 3 group, re-epithelialization was seen in only 1 (1.7%) eye that received medical treatment, whereas it was seen in all eyes that underwent debridement and AMT. The mean best-corrected visual acuity after re-epithelialization of the shield ulcer was 20/30, 20/30, and 20/40 in the grade 1, grade 2, and grade 3 groups, respectively. Recurrence and secondary bacterial keratitis were seen in 28 (14.5%) and 20 (10%) eyes, respectively. Conclusions: Grade 1 shield ulcers respond well to medical therapy alone, whereas grade 2 ulcers occasionally may require additional debridement or AMT. Grade 3 ulcers, however, largely are refractory to medical therapy and require debridement and AMT for rapid re-epithelialization.
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U2 - 10.1016/j.ajo.2012.09.014
DO - 10.1016/j.ajo.2012.09.014
M3 - Article
C2 - 23218707
AN - SCOPUS:84873722592
VL - 155
SP - 550-559.e1
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
SN - 0002-9394
IS - 3
ER -