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Yukiko Sonomura, Norihiko Yokoi, Aoi Komuro, Hiroaki Kato, Chie Sotozono, Shigeru Kinoshita; The features and treatment effect of keratoepitheliopathy for meibomitis-related keratoconjunctivitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4890.
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© ARVO (1962-2015); The Authors (2016-present)
Meibomitis-related keratoconjunctivitis (MK) is characterized by the meibomitis as posterior marginal blepharitis with corneal epithelial abnormalities. In general, MK can be divided into two types: MK accompanied with phlyctenular keratitis, and MK accompanied with keratoepitheliopathy without presenting phlyctenular keratitis. In the latter type, keratoepitheliopathy is similar to superficial punctate keratopathy (SPK). Therefore, from the point of corneal epithelial damage, it is sometimes difficult to distinguish MK from dry eye. The purpose of this study was to investigate the characteristic features treatment effect of keratoepitheliopathy for MK.
This study involved 27 eyes of 18 MK patients (15 females and 3 males; mean age: 41.3 years). Keratoepitheliopathy, similar to SPK in appearance, was evaluated by National Eye Institute (NEI) score (maximum: 15 points), and characteristic features of keratoepitheliopathy different in appearance from SPK were investigated. In addition, NEI scores and visual acuity (VA) were compared pre and post treatment.
Keratoepitheliopathy seemingly characteristic to MK, yet different in appearance from SPK, was noted in 25 of the 27 eyes (93%). It was observed as fluorescein staining of the corneal epithelium that was granular and generally larger than that in SPK, and that abnormal staining coexisted with small dark spots surrounded by pooled fluorescein. In 19 eyes, the above-described keratoepitheliopathy was observed to be located within the pupillary zone, and probably due to the location, the VA in 15 eyes was less than 20/20. Our findings showed significant improvement in the NEI score for keratoepitheliopathy in MK (pre treatment: 5.5±3.0 points; post treatment: 1.6±1.7 points) (p<0.0001) and also in VA (p=0.006). All subjects were treated with clarithromycin in a small dose and antibiotic eye drops (erythromycin: 16 patients; levofloxacin: 1 patient; gatifloxacin: 1 patient).
In this study, we identified the characteristic features of keratoepitheliopathy in MK which are often associated with decreased VA. Also, the treatment of clarithromycin was found to be effective in combination with keratoepitheliopathy for MK.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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