Vernal keratoconjunctivitis (VKC) is a chronic bilateral ocular allergic disease affecting mainly children and adolescents. Perilimbal pigmentation (PLP) has been noted as a new sign of VKC in pigmented race of Asian and African origin. To analyze the etiology, clinical significance, and pathophysiology of PLP, and to explore the possible association between ultraviolet (UV) exposure and the presence of PLP in VKC. A PubMed search of articles between January 1983 and January 2024 on VKC with PLP was performed. PLP takes the appearance of spotty pigmentation in the interpalpebral conjunctiva. Activation and proliferation of the melanocytes in the limbus in the status of inflammation had been proposed as possible pathogenesis of PLP. However, the clinical significance of PLP in the process of VKC were still controversial. VKC with PLP were mostly seen in pigmented races in equatorial region with hot, dry climates and strong UV. The regionality of VKC patients with PLP and the interpalpebral distribution of pigmentation suggest possible association of PLP with UV. Elucidating this issue will help to prevent and treat this regional and racial specific VKC.
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Open Access
Review Article
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Open Access
Clinical Research
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To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C (MMC) in Southwest Chinese patients.
A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3y. A complete success for surgery is defined as a postoperative intraocular pressure (IOP) >5 and ≤21 mm Hg and 20% reduction of IOP compared to preoperative, without IOP-lowering medications. A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications. The primary outcomes were IOP, the number of IOP-lowering medications, and cumulative success rate. The secondary outcomes included best corrected visual acuity (BCVA), mean deviation (MD) of visual field, major complications, and risk factors for surgical failure.
A total of 325 eyes of 261 glaucomatous patients had been included in our study. Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9±12.0 to 16.4±5.7 mm Hg (P<0.0001) and 3.0±0.9 to 0.9±1.0 (P<0.0001), respectively, at the last visit. The cumulative complete success rate and qualified success rate were 77.8% and 92.0% at 1-year follow-up, and 47.2% and 77.7% at 3-year follow up. There were no significant differences in surgical outcomes between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG). In PACG patients, the success rates of trabeculectomy were comparable with those of phacotrabeculectomy. Hypertension (HR=1.904, P=0.011), encapsulated bleb (HR=2.756, P<0.001), and more preoperative topical medications (HR=2.475, P=0.008) were risk factors for surgical failure.
The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0% at 1-year, and 77.7% at 3-year follow up. Hypertension, encapsulated bleb, and more preoperative topical medications are associated with surgical failure.
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