{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:15:15Z","timestamp":1740147315347,"version":"3.37.3"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,6,17]],"date-time":"2020-06-17T00:00:00Z","timestamp":1592352000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,6,17]],"date-time":"2020-06-17T00:00:00Z","timestamp":1592352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Ocular allergy is a common disease, especially in the pediatric population, with unpleasant and long-term consequences, including corneal complications and decreased visual acuity. This study reports two cases of corneal shield ulcer due to vernal keratoconjunctivitis, with good results of surgical debridement performed after failure of long-term clinical treatment. Furthermore, this study highlights that this therapeutic approach, although less common, is efficient in treating refractory cases that cause suffering in pediatric patients.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>The first patient was a 7-year-old Caucasian boy with chronic ocular allergy, especially photophobia, who had been treated with eye drops, antihistamine, and corticosteroids for 60\u2009days without success. Biomicroscopy of the right eye showed the presence of gelatinous limbus, giant papillae in the tarsal conjunctiva, and a shield ulcer measuring 6.0\u2009mm vertically and 2.7\u2009mm horizontally. Surgical debridement was performed, and the ulcer did not recur. The second patient was a 4-year-old Caucasian boy with chronic ocular allergy, especially itching and photophobia, who had been treated with eye drops for 1 year without success. Biomicroscopy of the left eye showed a shield ulcer, with a dense central corneal plaque, measuring 8\u2009mm vertically and 3.5\u2009mm horizontally. Surgical debridement of the ulcer was performed immediately because of the chronicity of the case and severity of the lesion, and the treatment was effective.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The treatment of shield ulcers caused by vernal keratoconjunctivitis in the two reported cases was curative and definitive by surgical debridement in the 7-month follow-up period. Therefore, the early debridement of shield ulcers refractory to drug treatment can considerably reduce the time of disease evolution and the probability of ocular complications caused by clinical treatment or disease chronicity. However, this approach is rarely described in the literature and needs to be included in the ophthalmologist\u2019s therapeutic arsenal.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13256-020-02407-8","type":"journal-article","created":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T23:04:16Z","timestamp":1592348656000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Surgical debridement of corneal shield ulcers in pediatric patients: two case reports and a review of the literature"],"prefix":"10.1186","volume":"14","author":[{"given":"Ricardo Alexandre","family":"Stock","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia Let\u00edcia Teixeira","family":"Lazzari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isadora Proner","family":"Martins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-7070","authenticated-orcid":false,"given":"Elcio Luiz","family":"Bonamigo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,6,17]]},"reference":[{"key":"2407_CR1","first-page":"25","volume":"66","author":"PBM De Botelho","year":"2003","unstructured":"De Botelho PBM, Marback P, De Sousa LB, Campos M, Vieira LA. Evaluation of anterior ocular segment complications in patients with allergic keratoconjunctivitis. Arq Bras Oftalmol. 2003;66:25\u20138.","journal-title":"Arq Bras Oftalmol"},{"key":"2407_CR2","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.jfma.2012.07.017","volume":"112","author":"HY Lin","year":"2013","unstructured":"Lin HY, Yeh PT, Shiao CS, Hu FR. Surgical management and immunohistochemical study of corneal plaques in vernal keratoconjunctivitis. J Formos Med Assoc. 2013;112:569\u201373.","journal-title":"J Formos Med Assoc"},{"key":"2407_CR3","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/1824-7288-39-18","volume":"39","author":"M La Rosa","year":"2013","unstructured":"La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S, et al. Allergic conjunctivitis: a comprehensive review of the literature. Ital J Pediatr. 2013;39:18.","journal-title":"Ital J Pediatr"},{"key":"2407_CR4","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/j.alit.2016.12.004","volume":"66","author":"E Takamura","year":"2017","unstructured":"Takamura E, Uchio E, Ebihara N, Ohno S, Ohashi Y, Okamoto S, et al. Japanese guideline for allergic conjunctival diseases. Allergol Int. 2017;66:220\u20139.","journal-title":"Allergol Int"},{"key":"2407_CR5","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.ajo.2012.09.014","volume":"155","author":"JC Reddy","year":"2013","unstructured":"Reddy JC, Basu S, Saboo US, Murthy SI, Vaddavalli PK, Sangwan VS. Management, clinical outcomes, and complications of shield ulcers in vernal keratoconjunctivitis. Am J Ophthalmol. 2013;155:550\u20139.e1.","journal-title":"Am J Ophthalmol"},{"issue":"3","key":"2407_CR6","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.survophthal.2018.12.001","volume":"64","author":"D Singhal","year":"2018","unstructured":"Singhal D, Sahay P, Maharana PK, Raj N, Sharma N, Titiyal JS. Vernal keratoconjunctivitis. Surv Ophthalmol. 2018;64(3):289\u2013311. https:\/\/doi.org\/10.1016\/j.survophthal.2018.12.001.","journal-title":"Surv Ophthalmol"},{"key":"2407_CR7","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s12948-017-0059-2","volume":"15","author":"MT Ventura","year":"2017","unstructured":"Ventura MT, Scichilone N, Paganelli R, Minciullo PL, Patella V, Bonini M, et al. Allergic diseases in the elderly: biological characteristics and main immunological and non-immunological mechanisms. Clin Mol Allergy. 2017;15:2.","journal-title":"Clin Mol Allergy"},{"key":"2407_CR8","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1097\/01.ico.0000178725.04070.87","volume":"25","author":"Z Ozbek","year":"2006","unstructured":"Ozbek Z, Burakgazi AZ, Rapuano CJ. Rapid healing of vernal shield ulcer after surgical debridement: a case report. Cornea. 2006;25:472\u20133.","journal-title":"Cornea."},{"key":"2407_CR9","doi-asserted-by":"publisher","first-page":"74","DOI":"10.4103\/1119-0388.172057","volume":"19","author":"I Mushtaq","year":"2016","unstructured":"Mushtaq I, Radakrishnan O, Magdum R, Arun S, Iqbal B, Malhotra J. Vernal keratoconjunctivitis with shield ulcer: a rare case report. Trop J Med Res. 2016;19:74\u20135.","journal-title":"Trop J Med Res"},{"key":"2407_CR10","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1590\/S1519-38292012000400010","volume":"12","author":"ACG Cruz","year":"2012","unstructured":"Cruz ACG, Sena CM, Tanure MAG, Boteon JE, Melo EM. Homeopathic treatment of children with shield ulcers of the cornea in vernal keratoconjunctivitis: case reports and bioethical dimensions. Rev Bras Saude Mater Infant. 2012;12:437\u201344.","journal-title":"Rev Bras Saude Mater Infant"},{"key":"2407_CR11","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1097\/ICO.0b013e31826a1e53","volume":"32","author":"P Guo","year":"2013","unstructured":"Guo P, Kheirkhah A, Zhou WW, Qin L, Shen XL. Surgical resection and amniotic membrane transplantation for treatment of refractory giant papillae in vernal keratoconjunctivitis. Cornea. 2013;32:816\u201320.","journal-title":"Cornea."},{"key":"2407_CR12","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1097\/01.ico.0000121710.58571.c4","volume":"23","author":"A Solomon","year":"2004","unstructured":"Solomon A, Zamir E, Levartovsky S, Frucht-Pery J. Surgical management of corneal plaques in vernal keratoconjunctivitis: a clinicopathologic study. Cornea. 2004;23:608\u201312.","journal-title":"Cornea."},{"key":"2407_CR13","doi-asserted-by":"publisher","first-page":"309","DOI":"10.2332\/allergolint.10-CR-0185","volume":"59","author":"K Fukuda","year":"2010","unstructured":"Fukuda K, Yamada N, Nishida T. Case report of restoration of the corneal epithelium in a patient with atopic keratoconjunctivitis resulting in amelioration of ocular allergic inflammation. Allergol Int. 2010;59:309\u201312.","journal-title":"Allergol Int"},{"key":"2407_CR14","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1177\/039463201202500326","volume":"25","author":"R Caputo","year":"2012","unstructured":"Caputo R, Pucci N, Mori F, De Libero C, Di Grande L, Bacci GM. Surgical debridement plus topical cyclosporine a in the treatment of vernal shield ulcers. Int J Immunopathol Pharmacol. 2012;25:775\u201380.","journal-title":"Int J Immunopathol Pharmacol"},{"key":"2407_CR15","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1016\/S0161-6420(95)30925-6","volume":"102","author":"JA Cameron","year":"1995","unstructured":"Cameron JA. Shield ulcers and plaques of the cornea in vernal keratoconjunctivitis. Ophthalmology. 1995;102:985\u201393.","journal-title":"Ophthalmology."},{"key":"2407_CR16","doi-asserted-by":"publisher","first-page":"244","DOI":"10.4103\/kjo.kjo_73_17","volume":"29","author":"S Das","year":"2017","unstructured":"Das S. Shield ulcer: a very rare presentation. Kerala J Ophthalmol. 2017;29:244\u20136.","journal-title":"Kerala J Ophthalmol"},{"key":"2407_CR17","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1590\/S0004-27492008000300029","volume":"71","author":"R Lamy","year":"2008","unstructured":"Lamy R, Dantas AM. Anatomical nomenclature in ophthalmology. Arq Bras Oftalmol. 2008;71:446\u201358.","journal-title":"Arq Bras Oftalmol"},{"issue":"6","key":"2407_CR18","doi-asserted-by":"publisher","first-page":"816","DOI":"10.4103\/ijo.IJO_929_17","volume":"66","author":"N Sharma","year":"2018","unstructured":"Sharma N, Singhal D, Maharana PK, Jain R, Sahay P, Titiyal JS. Continuous intraoperative optical coherence tomography-guided shield ulcer debridement with tuck in multilayered amniotic membrane transplantation. Indian J Ophthalmol. 2018;66(6):816\u20139. https:\/\/doi.org\/10.4103\/ijo.IJO_929_17.","journal-title":"Indian J Ophthalmol"},{"issue":"1","key":"2407_CR19","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3928\/1081-597X-19950101-09","volume":"11","author":"JA Cameron","year":"1995","unstructured":"Cameron JA, Antonios SR, Badr IA. Excimer laser phototherapeutic keratectomy for shield ulcers and corneal plaques in vernal keratoconjunctivitis. J Refract Surg. 1995;11(1):31\u20135.","journal-title":"J Refract Surg"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-020-02407-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-020-02407-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-020-02407-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T23:29:51Z","timestamp":1623886191000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-020-02407-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,17]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["2407"],"URL":"https:\/\/doi.org\/10.1186\/s13256-020-02407-8","relation":{},"ISSN":["1752-1947"],"issn-type":[{"type":"electronic","value":"1752-1947"}],"subject":[],"published":{"date-parts":[[2020,6,17]]},"assertion":[{"value":"18 February 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Written informed consent was obtained from the legal guardians of the patients for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patients\u2019 legal guardian(s) for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"70"}}