Seeing eye to eye: a modified Delphi method-based multidisciplinary expert consensus on the diagnosis and treatment of vernal keratoconjunctivitis.

Autor: Ghiglioni DG; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Pediatria Pneumoinfettivologia, Milan, Italy., Bruschi G; Department of Clinical Sciences and Community Health, Dipartimento Di Eccellenza 2023-2027, University of Milan, Milan, Italy., Chiappini E; Department of Health Sciences, University of Florence, Florence, Italy.; Pediatric Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy., Consales A; Department of Clinical Sciences and Community Health, Dipartimento Di Eccellenza 2023-2027, University of Milan, Milan, Italy. alessandra.consales@unimi.it., Allegri P; Ocular Inflammatory Diseases Referral Center Head, Rapallo Hospital, Genova, Italy., Aragona P; Department of Biomedical Sciences, University of Messina, Messina, Italy., Bonini S; Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy., Caputo R; Pediatric Ophthalmology Unit, Meyer Children's Hospital IRCCS, Florence, Italy., Cardinale F; Pediatric Department, Pediatric Hospital Giovanni XXIII, Azienda Ospedaliero-Universitaria Policlinic of Bari, Bari, Italy., Landi M; Department of Medical Sciences-Graduate School of Allergology and Clinical Immunology, University of Turin, Turin, Italy., Leonardi A; Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy., Marseglia GL; Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.; Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Mori F; Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy., Nebbioso M; Department of Sense Organs, Sapienza University of Rome, Rome, Italy., Nucci P; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.; Eye Clinic, IRCCS MultiMedica, Milan, Italy., Osnaghi S; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Pediatria Pneumoinfettivologia, Milan, Italy., Procoli U; Ophthalmology Complex Operative Unit, Children's Hospital Giovanni XXIII Azienda Ospedaliero-Universitaria 'Consorziale Policlinico', Bari, Italy., Villani E; Eye Clinic, IRCCS MultiMedica, Milan, Italy.; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy., Zicari AM; Department of Maternal Infantile and Urological Science, Sapienza University of Rome, Rome, Italy., Miraglia Del Giudice M; Department of Woman and Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy.
Jazyk: angličtina
Zdroj: European journal of pediatrics [Eur J Pediatr] 2024 Nov; Vol. 183 (11), pp. 5053-5061. Date of Electronic Publication: 2024 Sep 26.
DOI: 10.1007/s00431-024-05776-0
Abstrakt: Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, inflammatory disease that affects both eyes, often with asymmetric severity, potentially causing major visual complications. The seasonal management of VKC can be challenging, especially when specialists with different diagnostic and therapeutic approaches need to be consulted. The aim of this expert panel was to reach a national consensus among pediatric allergologists and ophthalmologists on the diagnosis and treatment of VKC. This consensus was developed by an expert panel of 17 Italian pediatric allergologists and ophthalmologists with over a decade of experience. Ten statements on VKC diagnosis and treatment formulated after a thorough review of current literature were evaluated by the panelists. The level of agreement was quantitatively assessed using a 5-point Likert scale. Consensus was reached if ≥ 75.0% of panelists agreed to any given statement. The consensus emphasizes the importance of evaluation by multispecialty reference centers or experienced specialists for accurate diagnosis. Prompt diagnosis, especially during active phases, is crucial and should occur before corticosteroid therapy. The Bonini score from 2007 is the preferred tool for VKC assessment, although future revisions may be considered. Short cycles of topical corticosteroids should be preferred over prolonged use, even during immunomodulatory therapy. When cyclosporine fails, tacrolimus should be considered.
Conclusion: This is the first consensus on the management of VKC that has gathered the expert opinions of both pediatricians and ophthalmologists. The outcome of this multidisciplinary effort provides a uniform approach to VKC diagnosis and treatment, thereby facilitating patient management across the country.
What Is Known: • Vernal keratoconjunctivitis (VKC) is a chronic recurrent ocular disease particularly prevalent in the pediatric population. • Despite its relevance, there is a lack of standardized approaches shared between pediatricians and ophthalmologists, leading to notable variations in clinical practice.
What Is New: • This expert panel, comprising 17 pediatric allergologists and ophthalmologists, has reached a national consensus to provide standardized guidance for VKC management. • The consensus emphasizes the importance of a multidisciplinary approach to managing VKC, ensuring consistent and effective patient care.
(© 2024. The Author(s).)
Databáze: MEDLINE
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