Curative effect of pterygium excision combined with free conjunctival flap transplantation on primary pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the curative effect of pterygium excision combined with free conjunctival flap transplantation on primary pterygium and the influence on tear film function.<p>METHODS:Totally 120 patients(126 eyes)with primary pterygium who were admitted to the hospital between January 2018 and October 2019 were selected as the research subjects. They were divided into two groups according to the random number table method. 62 cases(64 eyes)in the conjunctival transplantation group were treated with pterygium excision combined with free conjunctival flap transplantation. 58 cases(62 eyes)in the amniotic membrane transplantation group were treated with pterygium excision combined with amniotic membrane transplantation. The length of Schirmer's-Ⅰ test(SⅠt), tear film break-up time(BUT), corneal fluorescein staining(FL)scores, noninvasive Keratograph tear breakup time(NIBUT), determine tear river height(TMH)and conjunctival goblet cell count were determined before surgerry, at 3mo and 6mo after surgery. Patients' quality of life was evaluated with ocular surface disease index(OSDI), and the therapeutic effect and recurrence were evaluated at 6mo after surgery.<p>RESULTS: There was no significant difference in the average repair time of corneal epithelium or the duration of symptoms between the conjunctival transplantation group and the amniotic membrane transplantation group(<i>P</i>>0.05). At 6mo after surgery, the BUT \〖(11.11±2.77)s <i>vs</i>(10.01±2.41)s\〗, NIBUT \〖(10.01±1.52)s <i>vs </i>(9.52±0.98)s\〗 in conjunctival transplantation group was longer than that in the amniotic membrane transplantation group(<i>P</i><0.05), and the FL score was lower than the amniotic membrane transplantation group \〖(0.44±0.10)points <i>vs</i>(0.50±0.11)points\〗(<i>P</i><0.05). The conjunctival goblet cell counts in both groups were increased significantly after surgery(<i>P</i><0.05). At 3mo and 6mo after surgery, the counts in conjunctival transplantation group were larger than those in the amniotic membrane transplantation group \〖(311.41±58.45)/mm² <i>vs</i>(285.46±68.96)/mm²,(342.41±66.89)/mm² <i>vs</i>(314.41±70.12)/mm²\〗(<i>P</i><0.05). The OSDI scores of both groups were significantly decreased after surgery(<i>P</i><0.05), but there was no significant difference between groups(<i>P</i>>0.05). There was no statistically significant difference in the overall curative effect between the two groups(<i>P</i>>0.05). The recurrence rates in the conjunctival transplantation group and the amniotic membrane transplantation group were 6.3% and 6.5%, respectively(<i>P</i>>0.05).<p>CONCLUSION: Pterygium resection combined with autologous conjunctival flap transplantation is equivalent to amniotic membrane transplantation in terms of postoperative recovery and prevention of pterygium recurrence. Both can improve the stability of patients' tear film function.

Clinical analysis of dry eye and tear film stability in pterygium patients after autologous conjunctival flap transplantation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical analysis of dry eye and tear film stability in pterygium patients after autologous conjunctival flap transplantation. <p>METHODS: Totally 114 cases of 138 eyes with pterygium were selected and divided into 56 groups of 67 eyes in the traditional group and 58 eyes of 71 eyes in the experimental group. The SⅠt values and BUT values of the two groups were observed before, 1 and 3mo after the operation, FL value, eye surface temperature and dry eye score of the two groups after surgery.<p>RESULTS: The total effective rate of the traditional group was 83.6%, and the total effective rate of the experimental group was 95.8%. The difference between the two groups was statistically significant(χ2=5.207, <i>P</i>=0.022); there was no difference in the SⅠt value before surgery between the two groups(<i>P</i>>0.05 ), SⅠt values in the experimental group increased significantly at 1, 3mo after surgery compared with the traditional group(both <i>P</i><0.05); there was no difference in BUT values before surgery in the traditional and experimental groups(<i>P</i>>0.05), and at 1 and 3mo after surgery the BUT value in the group was significantly increased compared with the traditional group(both <i>P</i><0.05); there was no difference in the FL score between the traditional group and the experimental group before surgery(<i>P</i>>0.05).FL value was decreased in the experimental group campared to the traditional group 1, 3mo after surgery(All <i>P</i><0.05); there was no difference in eye surface temperature between the traditional group and the experimental group(<i>P</i>>0.05), and the dry eye score test group was significantly lower than the traditional group(<i>P</i><0.05).<p>CONCLUSION: Autologous conjunctival flap transplantation is superior to simple tendon resection, which can promote the recovery of tear film stability in patients with pterygium, and the dry eye symptoms of patients are significantly improved.

Clinical observation of autologous penetrating keratoplasty in the treatment of corneal blindness / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of autologous penetrating keratoplasty in the treatment of corneal blindness. <p>METHODS: Totally 8 patients with corneal blindness were treated by autologous penetrating keratoplasty in our hospital from 2014-01 to 2018-03. Using retrospective analysis, the patients were followed up for one year. To observe the intraoperative complications and postoperative conditions such as visual acuity, corneal transparency, and other were observed.<p>RESULTS: The uncorrected visual acuity of all the 8 patients was greater than 0.02 1wk after operation, and the rate of restoration of visual acuity was 100%(8/8). The corrected visual acuity of 5 patients(5-8)was more than 0.3 1mo after operation. The corrected visual acuity of 3 patients(3-8)with severe cataract before operation was improved to 0.08-0.2. One year later, all the corneal grafts in the recipient eyes were transparency and no recurrence of infection or secondary infection occurred in all 8 patients. <p>CONCLUSION: Corneal graft is easy to grow and there are no exclusion reactions, fewer postoperative complications after autologous corneal transplantation. So, corneal implants can remain transparent for a long time, and the surgery cost is lower. Autologous corneal transplantation can not only provide long-term useful vision for patients with monocular blindness combined with corneal blindness, but also reduce their financial burden and bring great benefits to patients.

Recubrimiento conjuntival en afecciones corneales / Conjunctival flap in corneal diseases

Objetivo: Determinar la eficacia del recubrimiento conjuntival en afecciones corneales. Métodos: Se realizó un estudio descriptivo retrospectivo de corte transversal, entre los años 2015 y 2017 en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. La muestra quedó conformada por 52 pacientes quienes asistieron a la consulta externa del Servicio de Córnea de la mencionada institución. Resultados: Predominó el sexo masculino con el 63,5 por ciento de los pacientes. El grupo etario comprendido entre los 50 y 59 años de edad representó el 26,9 por ciento. Entre las afecciones corneales, el mayor porcentaje correspondió al descemetocele (30,8 por ciento), seguido de las úlceras corneales (23,1 por ciento). La técnica más empleada fue el recubrimiento conjuntival total representada por el 46,2 por ciento de las cirugías realizadas. El 80,8 por ciento de los casos evolucionó a la cicatrización corneal. La complicación más frecuente fue la retracción del colgajo (9,6 por ciento). Conclusiones: Los recubrimientos conjuntivales resultan un simple y eficaz procedimiento quirúrgico en pacientes que no responden a tratamiento médico o perforaciones corneales menores o iguales a 3 mm. Es un procedimiento extraocular que puede realizarse de urgencia para disminuir el dolor y la inflamación y puede ser revertido para realizar cirugías con fines visuales en un segundo tiempo(AU)

Objective: To determine the effectiveness of the conjunctival flap to treat corneal diseases. Methods: Retrospective, descriptive and cross-sectional study was carried out from 2015 to 2017 at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology. The sample was made up of 52 patients who went to the outpatient Service of the Corneal Department of the institution. Results: Males represented 63.5 % of patients. The 50-59 y group represented 26.9 percent. Among the corneal diseases, descemetocele exhibited the highest percentage (30.8 percent) followed by corneal ulcers (23.1 percent). The most used surgical technique was the total conjunctival flap in 46.2 percent of surgeries. 80.8 percent of patients evolved into corneal scarring. The most frequent complication was flap retraction (9.6 percent). Conclusions: The conjunctival flaps represent a simple and effective surgical procedure in patients who do not respond to medical treatment or in corneal perforations equal or under 3 mm. This is an extraocular procedure that may be performed in emergency in order to release pain and inflammation and may be reversed later to perform surgeries aimed at visual problems(AU)

Clinical application of tarso-conjunctival flap in reconstruction of posterior eyeliddefects of eyelid tumors / 中华整形外科杂志

Objective@#To explore the application effect of tarso-conjunctival flap for one-stage repairing eyelid posterior defect after resection of eyelid tumors.@*Methods@#From June 2014 to December 2016, 33 patients with 33 cases of eyelid posterior tumors were treated, including 21 cases of Pigmented nevus of eyelid, 7 cases of eyelid basal cell carcinoma, 3 cases of eyelid adenocarcinoma and 2 cases of eyelid squamous cell carcinoma. Direct resection was performed for eyelid nevus, Mohs method (intraoperative delivery of frozen sections to control the cut edge) resection was performed for malignant tumors. According to the scope and location of the defect, the tarso-conjunctival flap was used to repair the posterior defect of the eyelid, and the eyelid anterior defect was treated with local flap transfer.@*Results@#All 33 patients were followed up for 3 to 24 months. In addition to the absence of eyelashes in the defect area, one case had mild blepharoptomy (1 mm) and recovered after self-recovery. The remaining cases had recovered in appearance and function of eyelid with no serious complications.@*Conclusions@#The flexible application of tarso-conjunctival flap can basically solve the problem of repairing eyelid posterior defect after resection of eyelid tumors. The operation method has clinical practical value.

Palliative surgery for refractory purulent corneal ulcer / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the clinical effect of scleral allograft combined with conjunctival flap autograft for refractory purulent corneal ulcer. <p>METHODS: Twenty patients(20 eyes)with purulent corneal ulcer admitted to our hospital during June 2015 to June 2017 were selected. The results showed that the drug treatment was not effective and could not be performed by penetrating keratoplasty, and then allogeneic scleral transplantation combined with conjunctival flap autograft covering was performed. A retrospective analysis was carried out. The intraoperative complications, postoperative scleral and conjunctival flap growth and postoperative complications of this palliative operation were observed. <p>RESULTS: Of the 20 patients, 18 had good growth of sclera and conjunctival flap, the cure rate was 90%. One case had bad healing of conjunctival flap and was cured by amniotic membrane transplantation; 1 case had enucleation because of severe vitreous cavity infection; 2 cases had lens prolapse, the incidence rate was 10%. Secondary glaucoma occurred in 3 cases with an incidence of 15%, which was cured by cryociliary surgery.<p>CONCLUSION:Scleral allograft combined with conjunctival flap autograft is a palliative operation. It is an effective way to control the corneal infection and maintain the appearance of the eyeball in the patients with severe purulent corneal ulcer, which is ineffective in drug treatment and unable to perform penetrating keratoplasty. It can replace the previous enucleation of the eye contents to control the infection. It can not only avoid the eye pain and psychological trauma caused by the loss of eyeball, but also save money for improving the appearance in the later stage.

Therapeutic effects of conjunctival flap covering combined with subconjunctival injection of fluconazole on patients with severe fungal corneal ulcer / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To analyze the clinical efficacy of conjunctival flap covering combined with subconjunctival injection of fluconazole on patients with severe fungal corneal ulcer.METHODS:Totally 50 cases with severe fungal corneal ulcer were collected in our hospital from January 2012 to December 2015.The cases were randomly divided into observation group and control group,25 cases in each group.All the cases were monocular sick.The control group took single drug treatment,but the observation group were given with conjunctival flap as an extra.The clinical efficacy,best corrected visual acuity and adverse effects rate were observed.And,the relapse of the two groups was followed for 1a.RESULTS:After 1 mo of treatment,the clinical curative effect of the observation group was significantly higher than the control group (P＜ 0.05),and corrected visual acuity of the observation group was higher than the control group (P＜0.05);the adverse reaction rate of the observation group was lower than the control group (P＜0.05).After 1a follow-up,the observation group only had 1 case of recurrence,control group had 8 cases with recurrence,the recurrence rate of the observation group was significantly lower than the control group (P＜0.05).CONCLUSION:The conjunctival flap combined with subconjunctival injection of fluconazole has good application value in severe fungal corneal ulcer patients,can effectively improve the clinical curative effect and the visual acuity,and can effectively reduce the incidence of adverse reactions and recurrence rate.

Autologous limbus conjunctival flap transplantation for pterygium accompaniedwith conjunctival cyst / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the efficacy of surgical excision combined with autologous limbus conjunctival flap transplantation in the treatment of pterygium accompanied with conjunctival cyst.METHODS: Totally 126 patients 188 eyes with pterygium were hospitalized in Department of Ophthalmology of Tongji Hospital of Huazhong University of Science and Technology during August 2013 and August 2015.The patients were divided into two groups: observation group (11 eyes of 11 patients) with pterygium accompanied with conjunctival cyst and control group (177 eyes of 115 patients) with primary pterygium.All patients underwent slit lamp microscope examination, anterior segment photography, and anterior segment optical coherence tomography(OCT).The size of pterygium was calculated by multiplying neck width and length of the covered corneal.All patients underwent excision combined with autologous conjunctival flap transplantation, and the resections were performed pathological section with hematoxylin and eosin staining.All patients were followed up postoperatively for 4-28mo.RESULTS: All cases in the observation group were confirmed by postoperative pathological examination.All cyst walls were complete, and containing single layer of epithelial cells.The mean size of pterygium of the observation group was 6.9±1.7mm2, and 6.3±1.8mm2 for the control group.There was no significant difference between the two groups (P>0.05).The mean postoperative healing time of observation group was 2.1±0.9d, and 1.9±0.8d for the control group.There was no significant difference between the two groups (P>0.05).Recurrence was seen in two eyes within the follow-up period in the control group, and no recurrence in the observation group.CONCLUSION: Surgical excision combined with autologous limbus conjunctival flap transplantation is a safe and effective treatment for pterygium accompanied with conjunctival cyst.

Effect of different types of pterygium surgery and on tear film in patients with type 2 diabetes mellitus / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the effect of three types of pterygium surgery and on tear film in patients with type 2 diabetes mellitus. ·METHODS:A total of 102 patients ( 102 eyes ) with pterygium combined with type 2 diabetes mellitus treated in our hospital from March 2013 to March 2016 were analyzed retrospectively. The patients were divided into three groups including the 34 cases ( 34 eyes ) with simple excision of pterygium ( resection group ) , pterygium excision combined with conjunctival flap transplantation in 34 cases (34 eyes, as conjunctival flap group ) and pterygium excision combined with limbal stem cell transplantation in 34 cases ( 34 eyes, as stem cell group ) . The wound repair time, complications, recurrence rate, uncorrected visual acuity (UCVA), tear film break-up time ( BUT ) and basal tear secretion test (SⅠt) were observed before, and 6 and 12mo after surgery in the three groups, respectively. ·RESULTS:The postoperative UCVA of the three groups was significantly higher than that preoperation ( P =0. 039, 0. 013, 0. 024 ), and there was no significant difference among the three groups ( P = 0. 317 ). The wound repair time was 5. 67 ± 1. 45d in the resection group, which was significantly higher than that in the conjunctival flap group (4. 18 ± 0. 76d) and the stem cell group (4. 09±0. 79 d) (P<0. 001), there was no significant difference between the conjunctival flap group and the stem cell group ( P = 0. 937 ). There were 4 cases in resection group reappeared, and the recurrence rate was 11. 8%, which was significantly higher than the other two groups ( P = 0. 037 ). There were 1 recurrences in the conjunctival flap group, and the recurrence rate was 2. 9%, while the patients in the stem cell group had no obvious recurrence. SⅠt and BUT increased significantly after operation (P<0. 05), especially in conjunctival flap group and stem cell group (P<0. 001). There was no significant difference between the conjunctival flap group and the stem cell group (P=0. 845, 0. 894). · CONCLUSION: Pterygium excision combined with conjunctival flap transplantation or limbal stem cell transplantation for the treatment of type 2 diabetic patients with normal blood glucose and tear film function has the similar effect, and is better than simple pterygium excision.

Value of autogenous conjunctival flap transplantation in the treatment of severe fungal corneal ulcer / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate effect of autogenous conjunctival flap transplantation in the treatment of severe fungal corneal ulcer. METHODS: A total of 83 cases ( 83 eyes ) with severe fungal corneal ulcer treated in our hospital from Jan. 2013 to Jan. 2016 were selected. Among them, 36 cases ( 36 eyes) were treated with drug therapy, and 47 patients(47 eyes ) were treated with autogenous conjunctival flap transplantation, two group did fungal culture and identification, observed the two groups treatment effect.RESULTS:The effective rate of surgical treatment group was 89%, significantly higher than that of drug treatment group, the difference was statistically significant ( P CONCLUSION: Autologous conjunctival flap transplantation in the treatment of severe fungal corneal ulcer has good curative effect. The operation is simple, worthy of recommendation method. Filamentous bacterial corneal ulcer without good drug therapy effect, surgical treatment should be performed in a timely manner to improve the curative effect.

Changes in infiltration of polymorphonuclear neutrophils in alkali-burned cornea of conjunctival flap covering / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the infiltration of polymorphonuclear neutrophils ( PMNs ) after conjunctival flap covering in alkali-burned cornea. ●METHODS: Rabbit cornea alkali-burned model was made, then 50 rabbits were randomly divided into the experimental group ( n=25 ) and the control group ( n=25 ) . At the same time the surgery of conjunctival flap covering was given to rabbits of the experimental group. The condition developing of alkali-burned cornea was observed by slit lamp biomicroscopy, and took photos in two groups. The infiltration of PMNs was identified by hematoxylin eosin ( HE) staining in different periods. ●RESULTS:The quantity of PMNs increased on the 3d, reached the lower level on 7d, shown a peak on the 14d, then decreased gradually. PMNs level of the experimental group was significantly lower than that in the control group, and the difference of 3, 14 and 21d was significant (P ●CONCLUSION: During the wound healing process, alkali - burned cornea has close relation with the infiltration of PMNs. The treatment of conjunctival flap covering for the severe alkali-burned cornea was found to have good effect.

Clinical observation of different surgical methods on dry eyes in patients with pterygium excision combined transplantation / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM: To observe the situations of different surgical methods on dry eyes in patients with pterygium excision combined transplantation. ?METHODS: Seventy-eight cases ofpterygium patients (81 eyes ) were randomly divided into three groups. Group A underwent pterygium excision combined large autologous conjunctival flap transplantation; group B underwent pterygium excision combined with small conjunctival flap;group C underwent pterygium excision combined with small conjunctival flap with autologous limbal stem cell. Repair of postoperative corneal epithelium, 1, 3mo preoperation and postoperation tear film break up time ( BUT ) and questionnaire of ocular surface disease index ( OSDl ) were observed among three groups, which caused the situation of dry eyes by pterygium and pterygium excision were evaluated. ?RESULTS: BUT: Group A was shorter than that in groups B and C at 15d postoperation (P0. 05). Postoperative dry eye ratio of group A was higher than that in groups B and C at 1mo postoperation ( P 0. 05 ) , but group C showed lower postoperative dry eye ratio. Corneal epithelium recover time of group A was longer than that in groups B and C (P0. 05), but group C showed a tendency to be shorter recover time. ? CONCLUSlON: Pterygium excision combined with small conjunctival flap and autologous limbal stem cell shows guickly corneal epithelium recover and low dry eye ratio and deserve to recommended.

Conjunctival Flap Surgery Using Calcium Plaque Scissors for Calcified Scleromalacia after Cosmetic Conjunctivectomy

PURPOSE: To research the advantage of using calcium plaque scissors in conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy. METHODS: We analyzed 55 eyes that had undergone conjunctival flap surgery for calcified scleromalacia occurring after cosmetic conjunctivectomy. Surgical blade was used in 30 eyes (Group 1) and calcium plaque scissors in 25 eyes (Group 2). Time after conjunctivectomy, plaque size, operation time and visual acuity before and after the flap surgery were analyzed and compared. Additionally, necessity of additional scleral surgery was evaluated. Optical coherence tomography (OCT) of the sclera was performed both pre- and postoperatively and the results were compared. RESULTS: An average of 3.9 +/- 1.0 years elapsed until conjunctival flap surgery and follow-up time was 5.2 +/- 3.8 months. Post conjunctivectomy time and plaque size were similar in both groups (p = 0.87 and 0.49, respectively). The surgery time in Group 2 was shorter than in Group 1 (17.5 +/- 6.3 minutes and 21.9 +/- 8.5 minutes, respectively, p = 0.20). Uncorrected visual acuity was similar in both groups before and after conjunctival flap surgery (p = 0.53 and p = 0.20, respectively). In Group 1, one sclera transplantation and three Ologen(TM) insertion surgeries were performed as an additional scleral surgery. Based on OCT, calcium plaque scissors were confirmed as a new surgical tool for calcium plaque removal with minimal scleral damage. CONCLUSIONS: Using calcium plaque scissors when performing conjunctival flap surgery for calcium plaque removal that occurred after cosmetic conjunctivectomy reduces the necessity of an additional scleral surgery and surgery time.

Short-Term Clinical Outcomes of Pterygium Treatment with Conjunctival Flap Advancement

PURPOSE: The present study reviewed the surgical outcomes of conjunctival flap advancement with pterygial tissue excision in primary and recurrent pterygium. METHODS: In a retrospective survey of 169 eyes of 169 patients who underwent pterygial tissue excision and conjunctival flap advancement surgery, after a three-month follow-up minimum, history of pterygium surgery, surgical outcomes, recurrence rates, and complications were evaluated. RESULTS: The study included 74 male and 95 female patients. The mean age was 56 +/- 11.93 years (range: 31-81 years). One hundred and forty eyes were considered as primary pterygium without history of surgery and 29 eyes were considered as recurrent pterygium. In the cases of primary pterygium, 139 eyes were treated after the surgery without recurrence (success rate: 99.2%) and one recurred case was localized to the sclera. Among the 29 eyes with recurrent pterygium, 26 eyes were treated without recurrence (success rate: 89.7%) and 3 recurred cases were localized to the sclera. There were no significant complications related to the surgical procedures. CONCLUSIONS: Conjunctival flap advancement surgery with pterygial tissue excision was an effective method in primary and recurrent pterygium treatment and showed low recurrence and minimal complications.

Recobrimento conjuntival em 360º e ceratectomia superficial na ceratite bolhosa em cão: relato de caso / Superficial keratectomy and 360º conjunctival flap for bullous keratopathy in a dog: a case report

A case of a two-year-old male Pinscher with a history of discomfort in the right eye was reported. The left eye had been enucleated by the referring veterinarian due to the same symptom with unsuccessful clinical treatment. The Schirmer tear test value was elevated and a decreased intraocular pressure was observed by applanation tonometry. Biomicroscopy revealed profuse corneal edema and keratoconus and fluorescein staining was negative. Gonioscopy and ophthalmoscopy did not provide any relevant data due to the corneal alterations. Bullous keratopathy was diagnosed. Surgery was performed in two steps: 1) superficial keratectomy and 360º conjunctival flap, and 2) superficial keratectomy to restore corneal transparency. Thirty days after the second superficial keratectomy, the third eyelid flap was removed. Conjunctivalization of the upper nasal quadrant of the cornea was observed. The axial portion of the cornea was transparent and vision was restored.

Relata-se o caso ocorrido em um cão, da raça Pinscher, com dois anos de idade e histórico de desconforto no olho direito. O olho esquerdo havia sido enucleado por outro profissional, por apresentar os mesmos sinais, cujo tratamento clínico instituído não lograra êxito. O valor do teste da lágrima de Schirmer encontrava-se aumentado e identificou-se diminuição da pressão intraocular à tonometria de aplanação. Observaram-se, à biomicroscopia, edema corneal profuso e ceratocone, e o teste da fluoresceína foi negativo. Gonioscopia e oftalmoscopia não lograram fornecer dados relevantes dadas as condições da córnea. Diagnosticou-se ceratite bolhosa. Optou-se pelo tratamento cirúrgico, que fora realizado em duas etapas: 1- ceratectomia superficial e "flap" conjuntival de 360º; 2- ceratectomia superficial para devolver transparência à córnea. Transcorridos 30 dias da segunda ceratectomia superficial, o "flap" de terceira pálpebra foi desfeito. Observou-se conjuntivalização do quadrante nasal superior da córnea, córnea clara no eixo visual e retorno da visão.

Scleral ulceration after vitreoretinal surgery.

Scleral ulceration after ocular surgery is a rare but serious complication. Determination of the underlying systemic and local causes is critical for treatment. An unusual case of ischemic scleral ulceration after vitreoretinal surgery in a diabetic patient is reported. Patient was successfully treated with a pedicle conjunctival graft.

Results of Scleral Allografting on Scleral Necrosis Following Pterygium Excision

PURPOSE: To emphasize the importance of conjunctival flap or amniotic membrane covering on the scleral allograft for scleral necrosis following pterygium excision. METHODS: Five eyes in four patients showed signs of impending perforation caused by scleral necrosis following pterygium excision, with strontium irradiation in four eyes and with instillation of mitomycin C in the other eye for preventing recurrence of pterygium. All cases were transplanted human sclera stored at -20 degrees C in Eye-Bank. Among them, the patient's own conjunctiva was used to cover the scleral allograft with interrupted sutures in four eyes, where in the other eye the scleral allograft was alternatively covered over by using human amniotic membrane stored at -70 degrees C. RESULTS: The results of all five cases were very successful without any complications during an average follow-up of 19 months (range 6~25 months). CONCLUSIONS: Based on the clinical experiences of these five cases, we concluded that the covering of the scleral allograft with conjunctiva or amniotic membrane is a very important procedure to ensure the successful viability of the scleral allograft, which is a natural structure of the conjunctiva and sclera.

Autogenous Temporalis Fascia Grafting and Conjunctival Flap Transposition in Scleromalacia after Pterygium Excision

PURPOSE: To evaluate the result and complications of autogenous temporalis fascia grafting and conjunctival flap transposition as a treatment of scleromalacia after pterygium excision. METHODS: We used autogenous temporalis fascia and conjunctival flap to treat scleromalacia of 9 patients(9 eyes) who underwent pterygium excision and checked the postoperative result and complications. RESULTS: We could keep the temporalis fascia graft without necrosis during follow-up examination. Pain, inflammation and scleral discoloration were disappeared after temporalis fascia grafting in all cases. Postoperative complications were included 2 cases of progression of cataract and 1 case of mild chamber inflammation. CONCLUSIONS: We obtained good surgical result of scleromalacia after pterygium excision by autogenous temporalis fascia grafting with conjunctival flap transposition.

Outcome of Fornix-Based Versus Limbus-Based Conjunctival Flaps in Trabeculectomy with Mitomycin C

PURPOSE: To compare the surgical outcome of limbus-based group with that of fornix-based group undergone trabeculectomy with mitomycin C (MMC). METHODS: 46 eyes of 42 patients with trabeculectomy with MMC who were observed for 6 months or more were included. A limbus-based conjunctival flap was used for 23 eyes of 21 patients, and a fornix-based conjunctival flap for the other 23 eyes of 21 patients. And the intraocular pressure (IOP), visual acuity and postoperative complications were checked. RESULTS: In the IOP control, there were no differences between two groups after surgery except 18 months. The IOP of the limbus-based group at 18 months was lower than that of fornix-based group (10.7 +/- 9.5: 14.8 +/- 11.2 mmHg, p=0.030). In the postoperative complications, the number of persistent hypotony in limbus-based group was more than that of fornix-based group (6: 1 eyes, p=0.048). There were no differences between two groups in the success rates without additional medication, but the success rates of fornix-based group with additional medication at 12 months were higher than those of limbus-based group (44.4: 77.3%, p=0.033). Also the cumulative success rates of fornix-based group with medication were higher than those of limbus-based group (p=0.040). CONCLUSIONS: Fornix-based conjunctival flap which has shown lower persistent hypotony and higher success rates than that of limbus-based conjunctival flap is recommendable for trabeculectomy with MMC.

Complications in cataract surgery from the use of alpha-chymotrypsin

In this study 143 eye undergoing cataract extraction are divided into two categories in one group, (69 eyes), Quimotrase was used; in the other group the enzyme was not used. The same surgical technique was done in each group except that the lens was delivered by the sliding method in the first group and by the tumbling method in the latterThe complications in each group are classified, analysed and compared. In brief, during the surgery, complications were minimized with the use of Quimotrase. However, in the early postoperative period, there were more complications encountered when this enzyme was used. Moreover, Quimotrase was helpful in cases of immature cataract especially at the ages of 40 to 60. It was not of much use in the age group 80 to 90, and proved even harmful when the cataract was hypermature. (Summary)