Is there is an association between the presence of Staphylococcus species and occurrence of vernal keratoconjunctivitis?

Comparative profile of ocular surface microbiome in vernal keratoconjunctivitis patients and healthy subjects

PURPOSE

To compare ocular surface microbiome and its antibiotic sensitivity in vernal keratoconjunctivitis (VKC) with normal ocular surface.

METHODS

In this case-control study, thirty patients each with clinical diagnosis of VKC and age-matched controls with normal ocular surface were enrolled. Tear film samples were collected from each group and subjected to microbial evaluation with microscopy, conventional culture methods, and polymerase chain reaction (PCR). Microbial diversity and antibiotic sensitivity patterns were analyzed.

RESULTS

Most patients (67%) belonged to severe grades (3 and 4) of VKC, and allergic history could be elicited in 20%. On culture, bacteria were isolated in 50% of VKC patients and 47% of control group. Staphylococcus species were identified in 70% VKC group and 57% control group. S. aureus growth was seen in 52% and 21% of VKC patients and controls, respectively. S. pneumoniae was isolated only in controls (29%) (p<0.05). Confluent colonies (≥10 colonies/μl) were seen in 70% of VKC patients and 14% of controls (p<0.05). Fluoroquinolone resistance was more among higher grades of VKC (50%) (p<0.01) and was observed in 46% of VKC patients and 23% of control group (p<0.01). Both groups were negative for HSV-1 DNA and fungal growth.

CONCLUSION

Staphylococcus, the most common ocular surface flora, was predominant in VKC patients. Microbial analysis revealed similar microbial diversity in both groups. However, bacterial load was higher in VKC. Increased fluoroquinolone resistance was observed in VKC patients with more resistance among higher grades. Fungi and HSV-1 were not seen in VKC or normal ocular surface.

Understanding vernal keratoconjunctivitis in children

Background: Vernal keratoconjunctivitis (VKC) is a public health problem that mostly affects children in warm subtropical climates. Unfortunately, the causative factors of the disease are not clearly defined, thus posing a serious management challenge to healthcare providers. It is therefore argued that understanding the pathogenesis of the disease and how various inflammatory cells affect the conjunctiva and the cornea may assist in the management of the disease.Aim: As visual impairment and avoidable blindness are indicated, it is advisable for optometrists to understand the clinical presentation of this chronic condition in order to initiate appropriate interventions and/or immediate referrals where necessary.Methods: A thorough literature search was conducted on peer-reviewed publications on VKC and children. All material obtained were then studied and the information extracted was used to document relevant information required for understanding VKC amongst children.Results: The results in the studied material revealed that VKC was prevalent amongst children aged 2 to 18 years, affecting mostly male children of African and Indian origins. Different strategies of management of the disease have been proposed, including but not limited to explaining to parents the nature of the disease, environmental strategies and preventive measures as well as possible surgical intervention.Conclusion: In view of the nature of this disease, healthcare providers should therefore seek to understand the history of the patient better when such patients present for their first consultation in order to develop a comprehensive management approach.

Vernal keratoconjunctivitis

Vernal keratoconjunctivitis (VKC) is a chronic allergic conjunctivitis that is most often seen in young, males. Although most types of allergic conjunctivitis do not affect vision, VKC is unusual in that damage to the cornea from the condition can result in vision loss. Although it is typically seasonal, year-round symptoms can be seen, which can lead to uncertain diagnoses being made. Although the pathophysiology of VKC is better understood in recent years, allowing more targeted therapies, management of these patients can still be very challenging, and complications can occur. As such, aggressive management of VKC is necessary, especially since vision loss in the amblyogenic age range can be permanent.