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Omalizumab Treatment of Vernal Keratoconjunctivitis

Enrico Heffler, MD, PhD1; Giuseppe Picardi, MD1; Maria Teresa Liuzzo, MD1; Maria Provvidenza Pistorio, BSc1; Nunzio Crimi, MD, PhD1
[+] Author Affiliations
1Unit of Respiratory Medicine and Allergology, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Policlinico–Vittorio Emanuele Hospital, University of Catania, Catania, Italy
JAMA Ophthalmol. 2016;134(4):461-463. doi:10.1001/jamaophthalmol.2015.5679.
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This report describes 2 patients with vernal keratoconjunctivitis without concomitant asthma who underwent systemic treatment with omalizumab.

Vernal keratoconjunctivitis (VKC) is a severe ocular, chronic, relapsing disease that can result in loss of visual acuity and blindness. Treatment with topical antihistamines, mast-cell stabilizers, corticosteroids, or even topical immunosuppressors (ie, cyclosporine or tacrolimus) frequently does not improve VKC symptoms, and partial control of symptoms with oral corticosteroids can induce severe adverse events with long-term use.1 Omalizumab is a humanized monoclonal antibody directed toward IgE and is approved for treating severe allergic asthma and severe chronic idiopathic urticaria.2

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Figure 1.
Clinical and Cytologic Results of Omalizumab Treatment

Changes in the visual analog scale (VAS) (range, 0 to 9; higher scores indicate worse symptoms) for ocular symptoms and in conjunctival eosinophil levels (bars) before and during omalizumab treatment in 2 patients with severe vernal keratoconjunctivitis. Both patients underwent subcutaneous treatment for 6 months. To convert eosinophil levels to a proportion of 1, multiply by 0.01.

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Figure 2.
Results of Conjunctival Cytologic Examination

Conjunctival scrape smears for cytologic examination were obtained from each patient at each visit. The eosinophil level in patient 1 was 68% before and 3% after omalizumab treatment; in patient 2, the eosinophil level was 51% before and 0% after omalizumab treatment (to convert eosinophil levels to a proportion of 1, multiply by 0.01) (May-Grünwald-Giemsa, original magnification ×1000).

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