Case Report – VKC – Disaster in KPK

Peshawar is the capital of the Pakistani province of Khyber Pakhtunkhwa. Looking at the burden of vernal keratoconjunctivitis (VKC) in this region over a year, we saw 1180 patients, of whom a large number were males (885, females 295). A majority of patients were young with 428 being less than 10 years and 492 between 10-20 years. There were 250 patients between 21-40 years and just 10 above 40 years of age. The severity of the disease was equally distributed, with 409 having mild (34.81 %) 388 having moderate (33.02 %) and 378 having the severe (32.17 %) form. Corneal complications of VKC included keratoconus seen in 311 patients (26.35%), corneal ulcers, corneal scars and acute hydrops. Glaucoma, cataracts and mechanical ptosis we other complications noted. A positive family history was noted in over half of the cohort (650, 55.08%) and 8% (103) had associated allergies. A majority of them had a corrected distance visual acuity in the range of 20/20 to 20/60 (81%). The most common used medications, with and without a prescription, included topical steroids and chloramphenicol.

The negative impact of VKC included poor quality of vision and poor quality of life. The chronic course of the disease in a young population entails high costs of medical and surgical treatment besides obstacles to education. The prolonged pain, photophobia, watering and discharge can be debilitating. Tackling the disease and its morbidity can be a challenge and we propose a 10-point agenda for the same

1. Local targeted research to identify common allergens
2. Prevent serious consequences by timely treatment of the disease.
3. Create public awareness about the disease to seek early advice.
4. Create awareness among ophthalmologist to use efficient, effective but relatively safe drugs and to not prescribe potent steroids without regular follow up.
5. To urge health authorities to prevent dispensing of topical steroids without a prescription.
6. To allow timely referral of very severe cases to tertiary care hospitals for advanced medical and surgical care.
7. Those requiring visual rehabilitation to be referred to appropriate centres for timely provision of visual aids.
8. Involving the government and NGOs to provide social and economic support to those requiring for long term treatment for serious ocular complications and sequelae of VKH.
9. Those requiring complex interventions for corneal ulcers/plaques/cataracts and glaucoma to be immediately referred to appropriate centres.

Prioritising those requiring keratoplasty for visual rehabilitation to help meet the challenges they face in their education and daily living.