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Intravenous immunoglobulin (IVIg) in the management of severe refractory vernal keratoconjunctivitis
  1. L Derriman1,
  2. D Q Nguyen1,
  3. A V Ramanan2,
  4. A D Dick1,
  5. D M Tole1
  1. 1Bristol Eye Hospital, Bristol, UK
  2. 2Bristol Children's Hospital, Bristol, UK
  1. Correspondence to Dr L Derriman, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Buckinghamshire HP21 8AL; luciaderriman{at}

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Vernal keratoconjunctivitis (VKC) is a chronic, recurrent bilateral inflammatory disorder of the conjunctiva and cornea that affects mostly young males.

Inflammatory control and symptom prevention includes the use of first-line agents—mast cell stabilisers and antihistamines—and for more severe sight-threatening disease, topical ciclosporin A and systemic steroids are tried, and finally second-line immunosuppressive agents are utilised.

Ethnicity can be an important outcome determinant of atopic disease, independent of the external childhood environment.1 In our clinical experience, Asian patients, specifically those of Pakistani ethnicity, are less responsive to conventional therapies. The spectrum and phenotype of disease differs in tropical and temperate countries, with a dominance of B lymphocyte infiltration in tropical patients with VKC.2 VKC is potentially sight-threatening, with a risk of visual loss greater than 10% in tropical countries.3 4

We report a case study …

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