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[Prognosis and treatment of Vernal keratoconjunctivitis in pediatric age: pilot study on 197 patients]
L Spadavecchia1, P Fanelli, R Tesse
1Dipartimento di Biomedicina Dell'Età Evolutiva, Clinica Pediatrica S. Maggiore, Università degli Studi di Bari, Bari, Italia2 . lspadavecchia@inwind.it
Insights
Topical 1% cyclosporine effectively treats severe vernal keratoconjunctivitis (VKC) in children. Early and long-term treatment with cyclosporine eye drops improves ocular symptoms and signs in pediatric VKC patients.
Area of Science:
- Ophthalmology
- Immunology
Background:
- Severe vernal keratoconjunctivitis (VKC) often requires potent treatments like corticosteroids or high-concentration cyclosporine.
- Understanding optimal therapeutic strategies for pediatric VKC is crucial for managing this chronic condition.
Purpose of the Study:
- To evaluate the efficacy of 1% topical cyclosporine in children with severe VKC.
- To identify factors influencing treatment response in pediatric VKC.
Main Methods:
- An open trial included 197 children with severe VKC treated with 1% topical cyclosporine for four months.
- Ocular symptoms and signs were assessed at baseline, 2 weeks, and 4 months.
- Skin prick tests, corneal endothelial cell evaluation, and serum IgE/cyclosporine levels were analyzed.
Main Results:
- Significant reduction in subjective symptoms and objective signs of VKC was observed after 2 weeks and 4 months (P<0.001).
- No detectable serum cyclosporine levels or damage to corneal endothelial cells were found.
- Earlier initiation and longer duration of cyclosporine therapy correlated with faster symptom and sign improvement.
Conclusions:
- 1% topical cyclosporine is effective for managing severe pediatric VKC.
- Initiating cyclosporine treatment early and continuing long-term appears most beneficial for symptom control and reducing inflammation.
Aim:
Corticosteroids and high-concentrated cyclosporine eyedrops have been used for treatment of severe vernal keratoconjunctivitis (VKC) cases. The purpose of our study was to verify the efficacy of 1% topical cyclosporine in improving severe form of VKC in childhood and investigate for factors affecting the response to therapy.
Methods:
We conducted an open trial involving 197 children with severe VKC, who received topical cyclosporine 1% for four months. Ocular subjective symptoms and objective signs were scored in all children at entry, two weeks and four months. Skin prick tests and microscope endothelial cells evaluation were also performed; serum IgE and cyclosporine levels were assessed.
Results:
The mean score values for severity of subjective symptoms and objective signs were significantly decreased after 2 weeks, and 4 months, compared with those at entry (P<0.001) in all children. Cyclosporine serum levels were not detectable at the end of therapy, nor were endothelial corneal cells damaged. Patients who started the therapy at the beginning of the disease and/or received long-term regimen of treatment with cyclosporine had a faster improvement of ocular signs and symptoms, compared to all other patients.
Conclusion:
Our findings suggest that 1% cyclosporine concentration administrated topically at the beginning of the disease and for a long-term period might be the most effective treatment to control symptoms and local inflammation in severe forms of VKC in childhood.
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