Combined Papillectomy and Autologous Conjunctival Membrane Graft as Management of Giant Papillae for Severe, Refractory Palpebral Vernal Keratoconjunctivitis-A Case Report.

Abstract

Introduction: Vernal keratoconjunctivitis (VKC) is an allergic disease that predominantly affects young individuals, with a higher incidence among males. Traditionally seen as a condition of childhood that resolves at puberty, recent studies have shown persistent cases in some individuals, potentially influenced by hot and dry tropical environmental conditions. VKC is more prevalent in regions with a hot and humid climate and a high presence of airborne allergens, leading to significant morbidity and impacting the quality of life for affected individuals. Severe and chronic cases can lead to vision-threatening corneal complications, making effective management crucial. Although the clinical profile of VKC varies geographically, comprehensive studies in specific regions remain limited. Case Presentation: In this case report, we present an 18-year-old male patient with severe and refractory VKC. Despite initial treatments, including topical and oral medications, recurrent episodes occurred every 6 months, accompanied by giant papillae (GP) formation and corneal ulcers. The patient had a history of triamcinolone injection and papillectomy combined with amnion membrane transplantation, but presented with a refractory disease in a year. Surgical intervention involving papillectomy and autologous conjunctival membrane graft was performed, leading to a smooth upper tarsal conjunctiva during the 2-year follow-up period, without GP recurrence and maintaining a clear cornea. The patient's symptoms were effectively managed with topical medications. Conclusion: The management of VKC necessitates a comprehensive approach involving preventive measures, pharmacological treatment, and surgical interventions for refractory cases. This case highlights the potential benefits of surgical techniques, such as papillectomy and autologous conjunctival membrane graft, in managing severe and refractory VKC cases with a history of previous surgical procedure failure. However, it is essential to recognize that exposure avoidance and allergic control remain fundamental in VKC management. Further research and larger studies are required to validate the efficacy of these surgical techniques in managing VKC.