Combined medical and surgical treatment of severe vernal keratoconjunctivitis

Purpose: We report the efficacy of an alternative method of treatment for vernal keratoconjunctivitis (VKC) that consists of excision of the palpebral conjunctiva, followed by supratarsal injection of corticosteroid and five times daily topical application of 0.05% cyclosporine A (CsA) and cromolyn sodium. Methods: We evaluated 10 patients with severe treat-resistant VKC with corneal complications. The patients were evaluated for symptoms and for signs, including conjunctival changes, corneal limbal infiltrates, vascularization, reduction of epitheliopathy, meibomitis, visual acuity, intraocular pressure, and pathologic evaluation, before and after treatment. Results: All patients showed marked improvement after 2 weeks of treatment. The symptoms (P < .01), signs (P < .02), and the visual acuity of all patients (P < .01) had significantly improved following treatment. Histological examination showed significant inflammatory cell decreases 4 weeks after surgery (P < .05). Conclusion: Surgery plus topical drug therapy may be useful in treating patients with very severe VKC. (C) 2000 Japanese Ophthalmological Society.