Combined medical and surgical treatment of severe vernal keratoconjunctivitis

Purpose: We report the efficacy of an alternative method of treatment for v ernal 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 corn eal complications. The patients were evaluated for symptoms and for signs, including conjunctival changes, corneal limbal infiltrates, vascularization , reduction of epitheliopathy, meibomitis, visual acuity, intraocular press ure, 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 pati ents (P < .01) had significantly improved following treatment. Histological examination showed significant inflammatory cell decreases 4 weeks after s urgery (P < .05). Conclusion: Surgery plus topical drug therapy may be useful in treating pat ients with very severe VKC. (C) 2000 Japanese Ophthalmological Society.