{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T20:12:26Z","timestamp":1785787946184,"version":"3.56.0"},"reference-count":20,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2025,1,7]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To analyse the clinical and demographic profiles of patients with vernal keratoconjunctivitis (VKC) and propose a grading for VKC based on corneal status and symptom periodicity rather than disease activity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Retrospective observational study from January 2015 to January 2020 in India. VKC grading was based on past\/present clinical signs and frequency of symptoms rather than disease activity. The electronic medical records were screened and details of VKC patients diagnosed by cornea specialists were recorded and analysed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>1096 VKC patients with a mean age of onset of 7.05\u00b15.3 with 8.39% having adult onset were analysed. Symptoms included; itching (50.55%) and decreased vision (15.44%). Mixed VKC (52.04%) was the most common presentation with 49.1% having active disease. Complications included; keratoconus (18.43%), steroid-induced cataract (11.41%), glaucoma (10.95%) and limbal stem cell deficiency (5.29%). Dual-acting antiallergics (69.39%) were most commonly used, followed by topical immunomodulators.<\/jats:p>\n                  <jats:p>The patients were graded as, grade I: mild\u2014presence of mild and seasonal symptoms and\/or signs. Grade II: moderate\u2014presence of persistent symptoms\/and\/or signs without corneal involvement. Grade III: severe\u2014chronic persistent symptoms\/and\/or intermittent signs with corneal involvement or asymptomatic to mild symptoms with corneal pathognomonic signs. Grade IV: very severe\u2014chronic persistent symptoms and\/or corneal pathognomonic signs or active involvement\/complication or asymptomatic with complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>VKC is a chronic disease that often causes visual complications. The new grading system based on the cornea status and symptom periodicity rather than disease activity might help plan the management better.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bjo-2024-325762","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T13:21:38Z","timestamp":1738156898000},"page":"735-741","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Insights from 1096 clinical cases: pioneering a universal grading system for vernal keratoconjunctivitis management"],"prefix":"10.1136","volume":"109","author":[{"given":"Ambika","family":"Chandrasekar","sequence":"first","affiliation":[{"name":"Optometry, Elite School of Optometry, Chennai, India"},{"name":"Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4515-1374","authenticated-orcid":false,"given":"Shweta","family":"Agarwal","sequence":"additional","affiliation":[{"name":"C J Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav","family":"Chauhan","sequence":"additional","affiliation":[{"name":"C J Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhaskar","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"C J Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varsha Bhambani","family":"Chavda","sequence":"additional","affiliation":[{"name":"C J Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7903-9500","authenticated-orcid":false,"given":"Geetha","family":"Iyer","sequence":"additional","affiliation":[{"name":"C J Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"2025071523150914000_109.7.735.1","doi-asserted-by":"crossref","DOI":"10.1186\/s13052-019-0656-4","article-title":"Vernal Keratoconjunctivitis: an update focused on clinical grading system","volume":"45","author":"Zicari","year":"2019","journal-title":"Ital J Pediatr"},{"key":"2025071523150914000_109.7.735.2","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2007.117812"},{"key":"2025071523150914000_109.7.735.3","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2011.11-0291"},{"key":"2025071523150914000_109.7.735.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3038.2006.00427.x"},{"key":"2025071523150914000_109.7.735.5","doi-asserted-by":"publisher","DOI":"10.1097\/ACI.0b013e3282efb726"},{"key":"2025071523150914000_109.7.735.6","doi-asserted-by":"publisher","DOI":"10.4103\/0301-4738.179727"},{"key":"2025071523150914000_109.7.735.7","doi-asserted-by":"publisher","DOI":"10.2332\/allergolint.09-OA-0100"},{"key":"2025071523150914000_109.7.735.8","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2017-311171"},{"key":"2025071523150914000_109.7.735.9","doi-asserted-by":"publisher","DOI":"10.1177\/11206721221099778"},{"key":"2025071523150914000_109.7.735.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2011.09.018"},{"key":"2025071523150914000_109.7.735.11","unstructured":"World Health Organization . 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