Surgical Management of Corneal Sequelae of Vernal Keratoconjunctivitis.

Abstract

Purpose: Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, allergic ocular surface disorder affecting children and young adults, particularly in tropical climates. Corneal sequelae such as giant papillae (GP), shield ulcers, limbal stem cell deficiency (LSCD), and keratoconus (KC) often necessitate surgical intervention when medical therapy is inadequate. This review summarizes the current surgical strategies for managing VKC-related corneal complications and their outcomes.

Methods: comprehensive review of published literature was undertaken using PubMed, Scopus, and Google Scholar up to 2025. Studies focusing on the surgical management of GP, shield ulcers, LSCD, and KC in VKC were analyzed. Emphasis was placed on surgical indications, techniques, outcomes, and adjunctive measures.

Results: Surgical excision of refractory GP, combined with adjuvants such as mitomycin-C, amniotic membrane transplantation, or mucous membrane grafting, reduces recurrence and improves ocular surface stability. Shield ulcers benefit from early surgical debridement and amniotic membrane use to prevent scarring and neovascularization. LSCD secondary to VKC can be successfully managed with conjunctival autografts in partial cases, while total LSCD requires allogeneic simple limbal epithelial transplantation with systemic immunosuppression. Keratoconus associated with VKC is often severe and rapidly progressive. Corneal collagen cross-linking is effective when inflammation is controlled, while intrastromal corneal ring segments and keratoplasty (deep anterior lamellar keratoplasty preferred over penetrating keratoplasty) provide visual rehabilitation in advanced cases.

Conclusion: Surgical management is pivotal in addressing refractory corneal complications of VKC and in preserving long-term vision. Tailoring surgical intervention to disease severity, ensuring adequate control of ocular surface inflammation, and adopting a multidisciplinary approach integrating medical therapy, surgery, and immunomodulation are essential for optimal outcomes.