Results
Eighteen patients with VKC (15 males and 3 females, mean age 10.7±5.7
years) were included in the study. Ten healthy subjects (6 males, 4
females, mean age 8±3years) were included as control group. Nine
patients with VKC (7 males, 2 females, mean age 9±2.3 years) were in the
active phase (group A) of VKC, 5 (4 males, 1 female, mean age 8.5±4.4
years) were in the quiescent phase (group Q) and 4 patients (4 males,
mean age 22±5 years) were included in the recovery group (R). Eleven
(61%) out of 18 patients showed positive skin prick test for
aeroallergens. Demographic and clinical characteristics of patients
included in this study are summarized in Table 1.
Patients with VKC showed significant decrease of tear sCD14 expression
when compared with healthy controls (0.58±0.27 a.u. vs 1±0.14 a.u.,
p<0.001). By comparing the different groups, patients with VKC
in the active phase showed a significant decrease of tear sCD14
(0.45±0.2 a.u.) when compared with healthy subjects (p<0.001)
and with both VKC group Q (0.87±0.16 a.u., p=0.005) and group R
(1.1±0.13, p<0.001). VKC group Q and group R (1.1±0.16) did
not show significant changes when compared with healthy controls.
(Figure 1A).
Conjunctival epithelium expression of CD14 showed similar results. In
fact, conjunctival CD14 expression was significantly decreased in
patients with VKC when compared with healthy subjects (0.7±0.29 a.u. vs
1±0.1 a.u., p=0.013). Patients with VKC group A showed significant
decrease of conjunctival CD14 (0.49±0.14 a.u.) when compared with
healthy subjects (p=0.001) and with VKC in both group Q (1.02±0.58 a.u.,
p<0.001) and R (1.18±0.02 a.u., p<0.001). Patients
with VKC in the quiescent phase and after VKC recovery did not show
significant difference in conjunctival expression of CD14, when compared
with healthy controls. (Figure 1 B)
Conjunctival epithelium expression of TLR-4 was significantly decreased
in patients with VKC when compared with healthy controls (0.4±0.27 a.u.
vs 1.06±0.07 a.u., p<0.001), while conjunctival expression of
TLR-9 did not show significant changes (0.82±0.4 a.u. vs 1±0.12 a.u.).
VKC patients in the active phase showed a significant decrease of both
TLR-4 and TLR-9 when compared with healthy controls (TLR-4: 0.17±0.03
a.u., p=0.028; TLR-9: 0.54±0.08 a.u., p=0.011) and with VKC group Q
(TLR-4: 0.65±0.12 a.u., p=0.004; TLR-9: 1.3±0.12 a.u., p<0001)
and VKC group R (TLR-4: 0.5±0.18 a.u, p=0.035; TLR-9: 1.1±0.08 a.u.,
p<0.001). (Figure 2 A, B)
VKC in the quiescent phase showed significant decrease of conjunctival
TLR-4 when compared with healthy controls (p=0.010) while TLR-9 was
significantly increased (p=0.025). VKC group R showed significant
decrease of TLR-4 (p=0.005) when compared with healthy subjects while
TLR-9 did not show significant changes.
In patients with VKC, the higher papillary reaction score was
significantly correlated with the lower expression of tear sCD14
(p=0.005, R=-0.779), and of conjunctival CD14 (p=0.049, R=-0.668), TLR-4
(p=0.015, R=-0.850) and TLR-9 (p=0.001, R=-0.891). Conjunctival
hyperemia scores were also significantly correlated with tear sCD14
expression (p=0.044, R=-0.767).
No significant difference were found between patients with vs without
other allergic diseases (tear sCD14: 0.63±0.29 a.u vs 0.75±0.36 a.u;
conjunctival CD14: 0.75±0.34 a.u vs 0.79±0.37 a.u, TLR-4: 0.43±0.30 a.u
vs 0.38±0.22 a.u, TLR-9: 0.88±0.42 a.u vs 0.82±0.35 a.u; respectively)
Six out of nine patients in the active group were treated with topical
Hydrocortisone 4 times daily and were evaluated after 7 days. All
patients showed improvement of signs and symptoms, with absence of
conjunctival hyperemia and corneal involvement and mild to absent ocular
symptoms. With except of tear sCD14 (0.48±0.17 a.u vs 0.51±0.16 a.u),
all the biological parameter evaluated showed decrease of conjunctival
expression however, only TLR-4 reached significant values when compared
with baseline (TLR4: 0.18±0.11 a.u vs 0.09±0.03 a.u, p=0.035; CD14:
0.46±0.1 a.u vs 0.29±0.17 a.u, TLR-9: 0.5±0.06 a.u vs 0.31±0.13).
(Figure 3)