Management, Clinical Outcomes, and Complications of Shield Ulcers in Vernal Keratoconjunctivitis

• Published in: American journal of ophthalmology Vol. 155; no. 3; pp. 550 - 559.e1
• Main Authors: Reddy, Jagadesh C, Basu, Sayan, Saboo, Ujwala S, Murthy, Somasheila I, Vaddavalli, Pravin K, Sangwan, Virender S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2013; Elsevier Limited
• Subjects: Adolescent; Adult; Amnion - transplantation; Child; Child, Preschool; Clinical outcomes; Conjunctivitis, Allergic - complications; Corneal Ulcer - classification; Corneal Ulcer - etiology; Corneal Ulcer - therapy; Debridement; Epithelium, Corneal - physiology; Eye diseases; Female; Humans; Hypotheses; Male; Ophthalmology; Retrospective Studies; Surgery; Treatment Outcome; Visual Acuity - physiology; Young Adult
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2012.09.014

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.