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Ocular surface pseudoepitheliomatous hyperplasia secondary to allergic eye disease: clinical features and management

Eye (2023)Cite this article

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Abstract

Purpose

To study the clinical characteristics and treatment outcomes of ocular surface pseudoepitheliomatous hyperplasia (PEH) associated with chronic vernal keratoconjunctivitis (VKC).

Methods

This retrospective study includes 39 eyes of 32 patients with VKC induced PEH who presented from 2016–2022. A database search was conducted for diagnosis of PEH, and data on clinical features, imaging characteristics, and treatment were analyzed.

Results

Of the 32 patients, 11 (34%) were children and adolescents, 21 (66%) were adults. PEH was common in males (72%) and ocular surface squamous neoplasia (OSSN) was the commonest referral diagnosis (43.7%). Mean age at presentation was 26.62 ± 10.18 (range: 6–52) years. While history of VKC was present in 21 patients, 11 were diagnosed with VKC at the time of diagnosis of PEH. The mean base/largest diameter was 5.2 ± 1.67 mm. Anterior segment optical coherence tomography (AS-OCT) showed irregular hyper-reflective epithelium, epithelial dipping, and sub-epithelial hyper-reflective lesion with shadowing in all lesions. Of the 31 eyes that received medical therapy, 21 (67%) and 10 (32%) eyes showed complete and partial resolution respectively with median time to resolution of 3(IQR:2–4) months. Eight eyes that underwent surgical excision showed complete resolution and one developed partial limbal stem cell deficiency.

Conclusion

Ocular surface PEH is a manifestation of chronic VKC which closely mimics OSSN. Detailed history-taking, examination for signs of allergy, and AS-OCT imaging can distinguish it from OSSN. It responds well to medical therapy and should be considered first-line therapy before planning any surgical intervention.

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Fig. 1: Various morphologies of ocular surface pseudoepitheliomatous hyperplasia (PEH) associated with Vernal keratoconjunctivitis (VKC).
Fig. 2: Imaging characteristics of Pseudoepitheliomatous hyperplasia (PEH).
Fig. 3: Histological characteristics of Pseudoepitheliomatous hyperplasia (PEH).
Fig. 4: Resolution of pseudoepitheliomatous hyperplasia with medical and surgical therapy.

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Data availability

Data available on request.

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Acknowledgements

The authors would like to acknowledge the support extended by Mr. Chenchu Naidu Gorrepati, Mr. Sreedhar Rao Boyinpally and Mr Tirupathy for their assistance during the processing of the histopathological specimens in the ophthalmic pathology laboratory, L.V. Prasad Eye Institute.

Funding

This work was funded by the Hyderabad Eye Research Foundation, Hyderabad, India. The sponsoring organization had no role in the design or conduct of this research. (Ethics Ref No LEC-BHR-R-06-23-1078).

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Authors and Affiliations

  1. Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India

    Ananya Nibandhe, Swapna Shanbhag, Sayan Basu & Pragnya Rao Donthineni

  2. The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India

    Swathi Kaliki

  3. Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India

    Saumya Jakati

  4. Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India

    Sayan Basu

  5. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India

    Sayan Basu

Authors
  1. Ananya Nibandhe
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  2. Swathi Kaliki
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  4. Swapna Shanbhag
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  5. Sayan Basu
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  6. Pragnya Rao Donthineni
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Contributions

Concept and design of study or acquisition of data or analysis and interpretation of data–AN, SJ, SB, SK, PRD. Drafting the article or revising it critically for important intellectual content- AN, SS, SJ, SB, SK, PRD. Final approval of the version to be published–AN, SS, SJ, SB, SK, PRD, The manuscript has been read and approved by all the authors, the requirements for authorship as stated above have been met, and each author believes that the manuscript represents honest work.

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Correspondence to Pragnya Rao Donthineni.

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Nibandhe, A., Kaliki, S., Jakati, S. et al. Ocular surface pseudoepitheliomatous hyperplasia secondary to allergic eye disease: clinical features and management. Eye (2023). https://doi.org/10.1038/s41433-023-02897-y

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