背景:春季角膜结膜炎(VKC)是一种罕见的,严重的过敏性眼病,通常发生在儿童和青少年中,这可能会对生活质量产生重大影响,并导致视力障碍。可能需要长期治疗以解决慢性炎症,并且由于并发症的风险,必须将局部皮质类固醇依赖性降至最低。需要统一的临床指导来辅助评估,欧洲VKC的诊断和管理。该专家小组(EUR-VKC小组)的目的是为参与VKC诊断和管理的初级保健医生和普通眼科医生提供明确的指导。
方法:召集了一个由7名欧洲眼科医生组成的专家组,并采用了改进的名义分组技术来制定VKC管理的关键建议。这些建议需要进行两轮投票,使用5分的李克特量表,以确定共识和每项建议的强度。共识设定在预定阈值≥75.0%的专家选择“强烈同意”或“同意”。
结果:共制定了47项关于VKC关键评估的建议,关于谁和何时引用的指导,以及治疗升级途径,长期随访,以及支持性护理和教育。所有建议在两轮后达成共识。该小组强调,及时的诊断和治疗开始与疾病严重程度相适应对于使VKC患者受益至关重要。有迹象(“危险信号”)表明严重VKC的患者,或持续轻度至中度VKC,治疗2-4周后无反应,应该转介给副专家。
结论:EUR-VKC小组提供评估建议,诊断,管理,VKC患者的转诊和随访。它还提供了一个框架,以促进初级保健医生之间的合作,普通眼科医生和子专家,以改善VKC患者的预后。
春季角膜结膜炎(VKC)是一种罕见的,诊断不足,慢性过敏性眼病,通常发生在儿童和青少年。如果不及时治疗,VKC可以显著损害眼睛,可能导致长期并发症,视力障碍和儿童及其家人和/或护理人员的生活质量下降。在没有既定准则的情况下,该共识计划旨在收集有关评估和管理整个欧洲VKC的最佳实践的专家见解。一组七位欧洲眼科医生参与了共识计划。共制定了47项与评估有关的建议,诊断,管理,VKC患者的转诊和随访。对这47项建议进行了两轮审查和修订,如有必要,以下是专家的输入。≥75.0%的专家同意的建议被认为已达成共识,并作为最终建议列入。专家们一致认为VKC可以归类为轻度,中度或重度,并应逐步根据严重程度进行管理,随着疾病严重程度的增加,治疗强度不断升级。根据VKC的严重程度及时诊断和治疗对于预防视力丧失和改善VKC儿童的生活质量至关重要。持续的治疗可能是必要的,以解决与疾病相关的慢性炎症,因此,应减少对类固醇滴眼液的依赖,以避免众所周知的并发症的风险增加.专家得出结论,可以在初级保健中评估和管理轻度VKC,但是有严重VKC的病人,或中度至重度VKC在2-4周内对治疗无反应,应该转介给VKC专家。
BACKGROUND: Vernal keratoconjunctivitis (VKC) is a rare, severe allergic ocular disease, typically occurring in children and adolescents, that can have a significant impact on quality of life and lead to visual impairment. Long-term treatment may be necessary to tackle chronic inflammation and topical corticosteroid dependency must be minimised due to the risk of complications. There is a need for unified clinical guidance to aid the assessment, diagnosis and management of VKC across Europe. The aim of this expert panel (the EUR-VKC Group) was to provide clear guidance for primary care physicians and general ophthalmologists involved in the diagnosis and management of VKC.
METHODS: An expert group of seven European ophthalmologists was convened and a modified nominal group technique used to develop key recommendations on VKC management. The recommendations were subject to up to two rounds of voting using a 5-point Likert scale to ascertain consensus and the strength of each recommendation.
Consensus was set at a predetermined threshold of ≥ 75.0% of experts selecting \'Strongly agree\' or \'Agree\'.
RESULTS: A total of 47 recommendations were developed relating to the assessment of key of VKC, guidance on who and when to refer, as well as treatment-escalation pathways, long-term follow-up, and supportive care and education. All recommendations reached
consensus after two rounds. The group emphasise how timely diagnosis and treatment initiation that is appropriate to disease severity are crucial to benefit patients with VKC. Patients with signs (\'red flags\') indicating severe VKC, or persistent mild-to-moderate VKC that is non-responsive following 2-4 weeks of treatment, should be referred to a sub-specialist.
CONCLUSIONS: The EUR-VKC Group provides recommendations on the assessment, diagnosis, management, referral and follow-up of patients with VKC. It also provides a framework to facilitate collaboration between primary care physicians, general ophthalmologists and sub-specialists to improve the outcomes for patients with VKC.
Vernal keratoconjunctivitis (VKC) is a rare, underdiagnosed, chronic allergic eye disease that typically occurs in children and adolescents. If left untreated, VKC can significantly damage the eye, potentially leading to long-term complications, visual impairment and a reduced quality of life for the child and their family and/or caregivers. In the absence of established
guidelines, this
consensus programme set out to gather expert insights on best practices for assessing and managing VKC across Europe. A group of seven European ophthalmologists engaged in the
consensus programme. A total of 47 recommendations were developed relating to the assessment, diagnosis, management, referral and follow-up of patients with VKC. These 47 recommendations underwent two rounds of review and were revised, if necessary, following expert input. Recommendations where ≥ 75.0% of experts agreed were considered as having reached
consensus and were included as final recommendations. The experts agreed that VKC can be classified as mild, moderate or severe, and should be managed according to severity in a stepwise manner, with treatment intensity escalating as the disease severity increases. Timely diagnosis and treatment initiation appropriate to the severity of VKC are crucial to prevent sight loss and improve the quality of life of children with VKC. Ongoing treatment may be necessary to tackle the chronic inflammation associated with the disease and, therefore, reliance on steroid eye drops should be reduced to avoid an increased risk of well-known complications. The experts concluded that mild VKC can be assessed and managed in primary care, but patients with severe VKC, or with moderate-to-severe VKC that does not respond to treatment within 2–4 weeks, should be referred to a VKC specialist.