Changes in Tear Eosinophil Cationic Protein (ECP) with Giant Papillary Excision in Atopic and Vernal Keratoconjunctivitis

Abstract

Abstract: : Purpose: It has been reported that excision of giant papillae is effective in allergic patients with corneal complications. Eosinophils are thought to be associated with the pathogenesis of corneal damage. ECP is a tissue damage protein which is secreted from activated eosinophils. Tear ECP levels in allergic patients are known to be related with the severity of clinical findings. We examined the pre and postoperative changes in tear ECP levels and the corneal findings of allergic patients who underwent papillary excision . Methods: Nine eyes of 8 patients (7 males and 1 female ) with a mean age of 17.7±10 years diagnosed as AKC or VKC were enrolled in this study. None of the patients had a history of contact lens use, history of ocular or systemic disease that would have altered the tear ECP levels. Those patients with giant papillae and corneal lesions refractory to conventional anti-allergic treatment underwent papillary excision. Tear samples were collected from each patient using a capillary micropipette before and after the surgery. ECP was measured using radioimmunoassay technique. Corneal findings such as erosion and ulcers were scored by slitlamp examination (0-4: 0=absent; 4=severe). Results: The mean pre and postoperative corneal finding scores were 3.71±0.48 and 1.57±1.13 points respectively (p<0.05).The mean pre and postoperative tear ECP levels were 1279 ±800 and 331±478 micrograms / mL respectively (p<0.05) Conclusions: Giant papillary excision had a favourable effect on corneal findings and tear ECP levels in AKC and VKC patients. Decreased postoperative tear ECP levels indicated that the number of activated eosinophils also decreased with papillary excision.

Keywords: cornea: tears/tear film/dry eye • cornea: clinical science • conjunctiva