Topographic Corneal Changes and Ocular Complications in Patients of Vernal Keratoconjunctivitis

Abstract

Introduction Vernal Keratoconjunctivitis(VKC) presents as a seasonally recurring, bilateral inflammation of cornea and conjunctiva. It occurs predominantly in males. VKC is basically the result of type 1 and type 4 hypersensitivity reactions. The characteristic and diagnostic signs of VKC are papillary hypertrophy, limbal thickening and conjunctival pigmentation. Sometimes VKC progresses to involve cornea leading to complications like Keratoconus, shield ulcer and neovascularization leading to visual impairment. Topography is one of the most common methods in practice for detecting keratoconus. This study carried out to determine corneal topographic changes, visual disturbance and ocular complication in vernal keratoconjuctivitis. Methods The prospective and observational study was carried out in the Department of Ophthalmology, Dhiraj Hospital, Piparia from May 2016 to September 2017. 50 patients were enrolled in the study. A thorough ophthalmic examination was done. Topography was performed to detect keratoconus. Results Among 50 with Vernal Keratoconjunctivitis (VKC), males comprised of 43 patients (86.00%) and females comprised of 7(14.00%) patients with mean age of presentation of 13.04±2.78 years. majority of patients are mixed form 25(50.00%) XI followed by a palpebral form 15(30.00%) and a limbal form 10(20.00%). Age of presentation was significantly similar in the mixed and a limbal form of VKC having an early presentation (9.3±4.2 years) and a palpebral form having a late presentation (14.00±4.2 years).Among 50 VKC subjects, keratoconus-like topography was present in 22 subjects (40.00%) 9 of whom had confirmed slit lamp signs. There was marked an increase in the topographic indices in VKC patients with keratoconus like topography as compared to VKC patients with normal topography. Complication due to VKC has seen in 26 patients (52.00%). Conclusion It was concluded that in the mixed form of VKC topographic changes and complication were more as compare to palpebral and limbal form of VKC. This study also shows that topography is more sensitive as compared to clinical examination and forme fruste keratoconus can be picked early on topography which diagnoses as normal by clinical examination.