Recurrence Rates of Amniotic Membrane Transplantation, Conjunctival Autograft and Conjunctivolimbal Autograft in Primary Pterygium

PURPOSE: To compare the recurrence rates and complications with amniotic membrane transplantation (fibrin glue group and suture group), conjunctival autograft and conjunctivolimbal autograft in excision of primary pterygium. METHODS: Among 121 eyes of 115 patients with a minimum follow-up period of 12 months, 33 eyes of 31 patients underwent amniotic membrane transplantation with fibrin glue (Group 1) and 29 eyes of 28 patients underwent amniotic membrane transplantation with sutures (Group 2). Twenty-eight eyes of 26 patients underwent conjunctival autograft (Group 3), and 31 eyes of 30 patients underwent conjunctivolimbal autograft (Group 4). Recurrence rates and complications were evaluated retrospectively. RESULTS: With a minimum of 12 months of follow-up, conjunctival recurrence was noted in seven eyes (21.2%) and six eyes (20.7%) in Group 1 and Group 2, respectively. Corneal recurrence occurred in one eye (3.0%) in Group 1 and in three eyes (10.3%) in Group 2 and no conjunctival or corneal recurrence were noted in Group 3 or Group 4. There was a statistically significant difference in conjunctival recurrence rates (p=0.003), but not in corneal recurrence rates (p=0.089) among the four groups. CONCLUSIONS: Although amniotic membrane transplantation preserved the superotemporal conjunctiva and was a technically easy procedure, it had high conjunctival recurrence rates. Conjunctival autograft and conjunctivolimbal autograft are technically demanding and time consuming, but they are more effective in preventing conjunctival recurrence compared with amniotic membrane transplantation.

Conjunctivochalasis Surgery: Amniotic Membrane Transplantation with Fibrin Glue

PURPOSE: We evaluated the effect of amniotic membrane transplantation with fibrin glue after redundant conjunctival resection. METHODS: After enchelon-shaped resection of inferior redundant conjunctiva, an amniotic membrane was transplanted using fibrin glue in symptomatic conjunctivochalasis. Conjunctiva was fixed to the episclera with 10-0 nylon. RESULTS: The subjects were 18 eyes of 9 patients (two males=4 eyes, seven females=14 eyes) with an average age of 67.9+/-7.7 years (range: 54-79 years). Mean operation time was 35.6+/-5.6 minutes/eye (range: 30-45 minutes/eye) and mean numbers of sutures were 8+/-0.76 (range: 7-9). The mean follow-up period was 10.4+/-3 months (range: 6-14 months) and the mean time to full epithelization was 14.5+/-3.4 days (range: 11-20 days). At postoperative days 1-2, the lower tear meniscus was reconstructed. There were no recurrences or any postoperative complications observed. CONCLUSIONS: Amniotic membrane transplantation after redundant conjunctival resection in conjunctivochalasis resulted in reconstruction of the lower tear meniscus with stable conjunctival surface and marked improvement of subjective symptoms. Operation time and early postoperative irritation symptoms could be reduced with the use of fibrin glue.

Pterygium Surgery: Wide Excision with Conjunctivo-Limbal Autograft

PURPOSE: To evaluate the efficacy of conjunctivo-limbal autograft after wide excision of primary and recurrent pterygia. METHODS: Twenty-one eyes of 18 patients with primary pterygium and 18 eyes of 18 patients with recurrent pteygium underwent conjunctivo-limbal autograft after wide excision of pterygium. All patients underwent follow-up for more than six months. Recurrence rates and complications were evaluated. RESULTS: With a minimum of six months of follow-up, fibrovascular tissue in the excised area, not invading the cornea, was noted in one eye (5.6%) in the recurrent pterygium group but no further surgical interventions for the cosmetic problem were needed. One eye (4.8%) showed wound dehiscence, three eyes (14.3%) showed subgraft hemorrhage, and one eye (4.8%) showed subconjunctival fibrosis at the donor site in the primary pterygium group, while two eyes (11.1%) showed subgraft hemorrhage, and one eye (5.6%) showed Tenon's Capsule granuloma at the donor site in the recurrent pterygium group. CONCLUSIONS: Conjunctivo-limbal autograft after wide excision of pterygium can be considered an effective treatment with low recurrence rates for both primary and recurrent pterygia.

Pterygium Surgery: Wide Excision with Amniotic Membrane Transplantation using Fibrin Glue

PURPOSE: To compare the efficacy and safety of fibrin glue and sutures for amniotic membrane transplantation after wide excision of primary pterygium. METHODS: Forty-three eyes of 37 patients underwent amniotic membrane transplantation for primary pterygium with a minimum follow-up period of six months. Twenty-three eyes of 18 patients underwent surgery with fibrin glue and 20 eyes of 19 patients underwent surgery with sutures. Recurrence rates, complications, operating time were evaluated. RESULTS: With a minimum of six-month of follow-up, fibrovascular tissue in the excised area, not invading the cornea (conjunctival recurrence), was noted in four eyes (17.4%) and fibrovascular tissue invading the cornea (corneal recurrence) was noted in two eyes (8.7%) in the fibrin glue group. Conjunctival recurrence was noted in five eyes (25%) and corneal recurrence was noted in one eye (5%) in the suture group. There was no significant difference in the recurrence rates between the two groups. Mean operating time in the fibrin glue group (25.2+/-3.5 minutes) was significantly shorter than in the suture group (40.5+/-3.6 minutes) (p=0.001, Students t-test). Complications included sub-amniotic membrane hemorrhage in three eyes (13%), and granuloma in one eye (4.3%) in the fibrin glue group, sub-amniotic membrane hemorrhage in four eyes (20%), granuloma in three eyes (15%), and wound dehiscence in one eye (5%) in the suture group. CONCLUSIONS: Using fibrin glue instead of sutures in amniotic membrane transplantation after wide excision of pterygium can be considered an effective treatment with shorter operating time and fewer complications, although there is no significant difference in recurrence rates.

Clinical Result of LASIK using Meditec Mel 60 in Myopia

We evaluated 206 eyes of 105 patients who recieved LASIK with Meditec Mel 60 excimer laser and followed up for at least 6 months. We used 6 mm optical ablation zone to every passible patients and excuted photorefractive ablation after making corneal hinge flap using a 160 micrometerplate. The range of refractive error was from -1.75D to -13.50D and patients were divided into 3 group according to their manifest refraction error(spherical equivalent): Group I(-10.25D, 14 eyes). Mean preoperative spherical equivalent was -3.81D in group I, -7.63D in group II and -12.56D in group III. Mean spherical equivalent after LASIK at 1 Month was +0.05+/-0.60D in group I, 0.00+/-0.74D in group II, -0.12+/-0.99D in group III and at 3 Months, -0.11+/-0.58D, -0.19+/-0.75D, -0.59+/-0.90D and at 6 months -0.21+/-0.59D, -0.34+/-0.78D, -1.11+/-0.86D respectively. In group I, 90.6% of eyes were within 1D of attemped correction at 6 Months as were 80.6% in group II and 46.0% in group III. Mean UCVA at 6 month after LASIK was 1.02 in group I, 0.90 in group II, 0.75 in group III and uncorrected visual acuity of 0.8 or better was achieved in 91.6% of 118 eyes in group I, 88.5% of 67 eyes in group IIand 76.9% of 13 eyes in group III. LASIK done experienced surgeon appears to be safe, accurate, efficient to correct myopic refractive error.

A Case of Acute Central Stromal Melting after LASIK

LASIK is an effective and exact procedure to correct myopic refractive error but fatal complication may be happened during making corneal flap using microkeratome. We report a patient who developed acute central stomal melting following LASIK on postoperative day 4. This complication was treated by lifting the flap and scraping the interface of corneal flap & central stroma with a metal blade. After 4 months, overcorrected hyperopic refractive error was retreated with excimer laser ablation and patient recovered successful visual acuity. The pathogenesis of this case is not completely understood. Corneal endothelium and central cornea stroma may be mechanically damaged due to excessive suction ring application during LASIK procedure. Interface epithelial ingrowth may be associated with early postoperative inflammation and infection of corneal flap may produce proteinase which melts corneal flap. If corneal flap melting happens after LASIK procedure, early surgical debridement of melting stroma and proper reattachment of the flap may be needed.

Q-Switched Nd:YAG laser Posterior Capsulotomy of the Aphakia and Pseudophakia Inserted with Posterior Chamber IOL

To get the pure clinical results of Yag Laser Posterior Capsulotomy, excluding all the possible factors that might affect the results of that, we performed posterior capsulotomies on after cataracts(118 eyes) by using Q-switched Nd:Yag laser from February 1987 to August 1989 and reviewed the results. Group A is composed of 68 surgical aphakic eyes and group B is composed of 50 Posterior chamber pseudophakic eyes. The results were as follows: 1. One eye in groupA and one eye in group B were congenital cataracts and the others were all adult and senile cataracts. 2. As a result of posterior capsulotomy, 59 eyes(86.8%) in group A and 42(84%) in group B were above 0.5 in corrected visual acuity. 3. On performing, the power setting was under 1.5mJ in 59 eyes(86.8%) in groupA and 40 eyes(80%) in group B. 4. Ocular complications developed in 35 eyes(51.5%) in group A and 15 eyes(30%) in group B. 5. Good preoperative ocular condition may predict good postoperative clinical results. 6. Less energy and pulses in operation combined with less occurrences of vitrous prolapse in group B might be associated with less development of postoperative complications in group B than in group A.

Clinical Results of Nd:Yag Laser Posterior Capsulotomy

From Feb. 1987 to Feb. 1988, 93 cases of the Q-switched Nd : Yag laser posterior capsulotomy by using of choherent Model 7900 were carried out and 80 cases(76 patients)had been followed up for more than 2 months. The results were as follows: 1. 72 aphakic eyes and 8 pseudophakic eyes(12 traumatic cataract and 11 congenital cataract and 57 adult and senile cataract) were followed. 2. Postoperative visual acuity of 0.7 or better was achieved in 54 eyes(67.5%) and 1.0 or better in 32 eyes(40%). 3. Complications were transient increased IOP 17 eyes(21.2%) and Vitreous pro lapses with anterior hyaloid rupture 15 eyes (18.7%) and anterior uveitis 2 eyes(2.5%) and cystoid macular edema 1 eyes(1.2%) and corneal edema 1 eyes(1.2%) but most cases were without permanent damages.