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Tear Tryptase in Vernal Keratoconjunctivitis
Khalid F. Tabbara, MD
Arch Ophthalmol. 2001;119:338-342.
Objectives To determine the tear level of tryptase (a marker of mast cell activation)
in vernal keratoconjunctivitis (VKC) before and after treatment. In addition,
eosinophil counts in conjunctival scrapings and ocular surface temperature
before and after treatment were studied.
Patients and Methods A total of 20 patients, 7 years or older with VKC, were included in
this study. Tear samples for tryptase determination were collected before
and 2 weeks after treatment with 4% disodium cromoglycate eyedrops and 0.1%
fluorometholone eyedrops. In addition, conjunctival scrapings were obtained
for microscopic evaluation, and measurement of the ocular surface temperature
was performed before and 2 weeks after treatment. One patient was excluded
because the patient did not receive topical treatment. Control tear samples
were collected from 20 normal control patients for tryptase determination.
Results There were 19 patients with VKC (17 males, 2 females). The age range
was 7 to 17 years with a mean age of 9 years. The mean number of eosinophils
prior to initiation of therapy was 11.37 eosinophils with a range of 1 to
34 per high-power field. Following treatment, the mean number of eosinophils
was 3.42 eosinophils per high-power field with a range of 0 to 11 (P<.01). The mean ocular surface temperature for the right eye before
treatment was 35.56°C (range, 34.46°C-36.50°C) and after treatment
was 33.53°C (range, 31.13°C-35.40°C). For the left eye, the mean
ocular surface temperature before treatment was 35.49°C (range, 34.86°C-36.16°C)
and after treatment was 33.88°C (range, 32.40°C-35.53°C). The
ocular surface temperature was found to decrease significantly following treatment
(P<.001). The levels of tryptase in tears of patients
with VKC were determined before and after treatment. The mean level was 16.77
ng/mL (range, <5-115 ng/mL). Following treatment with topical 4% disodium
cromoglycate and 0.1% fluorometholone eyedrops, the mean level of tryptase
decreased to 7.29 ng/mL (range, <5-44.1 ng/mL) (P<.05).
Conclusions Patients with severe VKC had high levels of tryptase in tears. Following
treatment, the level of tryptase in tears decreased significantly.
From the Department of Ophthalmology, College of Medicine, King Saud
University, and The Eye Center, The Eye Foundation for Research in Ophthalmology,
Riyadh, Saudi Arabia. I have no proprietary interest in any of the materials
used in this study.
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