Impact of the type of anterior lamellar reconstruction on the success of modified Hughes procedure / Impacto do tipo de reconstrução lamelar anterior no sucesso do procedimento de Hughes modificado

ABSTRACT Purpose: To determine the long-term functional and cosmetic outcomes in patients who underwent modified Hughes procedure with different types of anterior lamellar reconstruction for lower eyelid defects. Methods: This study included 58 patients who had undergone a modified Hughes flap for reconstruction of lower eyelids after tumor excision within a 10-year period. Data regarding patient demographics, size of eyelid defect, tumor pathology, surgical techniques, functional and cosmetic outcomes, and complications were recorded. Postoperative complications were evaluated according to the type of anterior lamella reconstruction (i.e., advancement flap or free skin graft). Multivariate logistic regression analysis was performed to identify risk factors affecting the success of the procedure. Results: The average size of the lower eyelid defect was 22 ± 6.3 mm (range: 11-30 mm). The anterior lamella was reconstructed with advancement flaps and full-thickness skin grafts in 36 (58.6%) and 24 (41.4%) patients, respectively. Mean follow-up time was 23.6 ± 11.9 months. Postoperative complications included trichiasis (three patients; 5.2%), ectropion (two patients; 3.0%), flap necrosis (one patient; 1.7%), flap dehiscence (one patient; 1.7%), infection (one patient; 1.7%), and eyelid margin erythema (one patient; 1.7%). The rates of complication and secondary surgery were similar among the different types of anterior lamellar reconstruction (p=768 and p=0.139, respectively). Success of the modified Hughes procedure was not significantly affected by any of the identified risk factors (p>0.05). Functional and cosmetic outcomes were 96.6% and 94.8%, respectively. Conclusion: Modified Hughes procedure is a safe and effective option for the reconstruction of small and large defects of the lower eyelid, regardless of the type of anterior lamella reconstruction (i.e., advancement flap or skin graft).

RESUMO Objetivo: Determinar os resultados funcionais e cosméticos a longo prazo de pacientes submetidos ao procedimento de Hughes modificado com diferentes tipos de reconstrução lamelar anterior para defeitos palpebrais inferiores. Métodos: Este estudo incluiu 58 pacientes que foram submetidos a um retalho de Hughes modificado para reconstrução das pálpebras inferiores após excisão do tumor durante um intervalo de 10 anos. Dados referentes à demografia dos pacientes, tamanho do defeito palpebral, patologia tumoral, técnicas cirúrgicas, resultados funcionais e cosméticos e complicações foram registrados. As complicações pós-operatórias foram avaliadas de acordo com o tipo de reconstrução da lamela anterior (ou seja, retalho de avanço ou enxerto de pele livre). A análise de regressão logística multivariada foi realizada para identificar os fatores de risco que afetam o sucesso do procedimento. Resultados: O tamanho médio do defeito da pálpebra inferior foi de 22 ± 6,3 mm (11-30 mm). A lamela anterior foi reconstruída com retalhos de avanço e enxertos de pele de espessura total em 36 (58,6%) e 24 (41,4%) pacientes, respectivamente. O tempo médio de acompanhamento foi de 23,6 ± 11,9 meses. Complicações pós-operatórias incluíram triquíase (três pacientes: 5,2%), ectrópio (dois pacientes: 3%), necrose de retalho (um paciente: 1,7%), deiscência de retalho (um paciente: 1,7%), infecção (um paciente: 1,7%) e eritema na margem palpebral (um paciente: 1,7%). As taxas de complicação e de cirurgia secundária foram semelhantes entre os diferentes tipos de reconstrução lamelar anterior (p=768 e p=0,139, respetivamente). O sucesso do procedimento de Hughes modificado não foi significativamente afetado por nenhum dos fatores de risco identificados (p>0,05). Resultados funcionais e cosméticos foram de 96,6% e 94,8%, respetivamente. Conclusão: O procedimento de Hughes modificado é uma opção segura e eficaz para a reconstrução de pequenos e grandes defeitos da pálpebra inferior, independentemente do tipo de reconstrução da lamela anterior (ou seja, retalho de avanço ou enxerto de pele).

The study of the use of a latex biomembrane and conjunctival autograft in rabbit conjunctiva wound healing / Estudo do implante de biomembrana de látex e auto-enxerto conjuntival em cicatrização de ferida conjuntiva de coelho

RESUMO Objetivo: Estudar o uso da biomembrana de látex e o transplante conjuntival autólogo na cicatrização conjuntival em coelhos. Métodos: Em nove coelhos albinos, neo-zelandeses, machos foram removidas áreas retangulares idênticas, do quadrante supero nasal, adjacente ao limbo, de ambos os olhos. As áreas desnudas da camada esclerótica nos olhos direitos foram recobertas com biomembrana de látex e a dos olhos esquerdos com enxerto conjuntival autólogo. Os animais foram sacrificados em grupos de três, aos 7, 14 e 21 dias após a cirurgia. Os tecidos do local cirúrgico, incluindo a córnea, foram fixados em formaldeído, antes de serem processados em parafina e corados com hematoxilina e eosina. A natureza e a intensidade da resposta inflamatória e o padrão de epitelização da superfície conjuntival foram avaliados sob microscopia óptica, em seções histológicas longitudinais, passando pelo centro dos espécimes anatômicos. Resultados: Até o décimo quarto dia pós-operatório, o grupo que recebeu a biomembrana apresentou reação inflamatória mais intensa do que o grupo com auto enxerto conjuntival. Aos 14 dias, os olhos com biomembrana apresentavam-se menos inflamados e com estroma mais espesso do que aos 7 dias. Aos 21 dias, a reparação conjuntival de ambos os grupos apresentavam características semelhantes. Conclusão: Apesar de apresentar uma cicatrização mais lenta, a biomembrana de látex se mostrou tão eficaz quanto o auto enxerto conjuntival na reconstrução da superfície ocular após três semanas de cicatrização pós-operatória. Devido as suas baixas toxicidade e alergenicidade, este material parece ser uma opção terapêutica promissora na reconstrução da conjuntiva.

ABSTRACT Purpose: To study a latex biomembrane and conjunctival autograft with regard to the promotion of conjunctival healing in rabbits. Methods: The study included nine male albino rabbits. In these rabbits, a rectangular area of the conjunctiva was surgically removed from the superonasal quadrant adjacent to the limbus in both eyes. The bare area of the sclerotic coat of the right eye was reconstructed with a latex biomembrane, and the corresponding site of the left eye was reconstructed with a conjunctival autograft. The animals were killed in groups of three at 7, 14, and 21 days after surgery. The tissues from the surgical site, including the cornea, were fixed in formaldehyde, and were then processed in paraffin and stained with hematoxylin and eosin. The nature and intensity of the inflammatory response and the epithelial pattern at the conjunctival surface were evaluated under optical microscopy with longitudinal histological sections through the center of the anatomical specimens. Results: Until the 14th postoperative day, the inflammatory reaction was greater in the biomembrane group than in the conjunctival autograft group. In the latex biomembrane group, inflammation was less intense and the stroma was thicker on the 14th postoperative day than on the 7th postoperative day. After three weeks, conjunctival healing in both groups showed similar characteristics. Conclusion: Although healing was slower with a latex biomembrane, tissue reconstitution was almost the same as that with a conjunctival autograft by three weeks. A latex biomembrane is as effective as a conjunctival autograft for the reconstruction of the ocular surface. Owing to the lack of toxicity and allergenicity, a latex biomembrane appears to be a promising therapeutic option for conjunctival reconstruction.

A comparison of two conjunctival rotation autograft techniques in primary pterygium surgery / Comparação de duas técnicas de rotação de auto-enxerto conjuntival na cirurgia de pterígio primário

ABSTRACT Purpose: To compare the effects of 90° and 180° conjunctival rotational autograft (CRA) techniques used in primary pterygium surgery. Methods: Forty-five patients were included in this retrospective study. Visual acuity (VA), corneal topography, and auto-refractometer measurements, as well as detailed biomicroscopic examinations, were performed preoperatively and postoperatively. During surgery, the pterygium tissue was excised then rotated 90° in Group 1 and180° in Group 2, after which it was sutured to the bare sclera. Pterygium recurrence was defined as corneal invasion ≥1 mm. Results: Group 1 consisted of 21 patients with a mean age of 45.1 ± 11.8 years, while Group 2 comprised 24 patients with a mean age of 47.9 ± 13.8 years. The pterygia in Group 1 were graded as more advanced than those in Group 2. A similar number of recurrences were observed in Group 1 (14.3%) and in Group 2 (16.7%). There was no statistically significant difference in terms of the preoperative and postoperative VA and astigmatism values between the two groups. There was a statistically significant improvement in the postoperative VA and astigmatism values in Group 1 and in the postoperative astigmatism values in Group 2. Although postoperative redness was more common in Group 1, no statistically significant difference was found between the groups. Conclusion: BothCRA techniques can be successful in patients for whom it is desirable to avoid a conjunctival autograft and for patients without high cosmetic expectations.

RESUMO Objetivo: Comparar os efeitos das técnicas de auto-enxerto rotacional de conjuntiva (CRA) de 90° e 180°, usadas na cirurgia de pterígio primário. Métodos: Quarenta e cinco pacientes foram incluídos neste estudo retrospectivo. Acuidade visual (AV) pré e pós-operatória, topografia da córnea, auto-refratometria e exames biomicroscópicos detalhados foram feitos. Durante a cirurgia, o tecido de pterígio foi excisado e o mesmo tecido foi girado 90° no Grupo 1 e 180° no Grupo 2, após o que foi suturado à esclera nua. A recorrência do pterígio foi definida como invasão da córnea ≥1 mm. Resultados: O Grupo 1 consistiu em 21 pacientes, cuja média de idade foi de 45,1 ± 11,8 anos e o Grupo 2 compreendeu 24 pacientes, cuja idade média foi de 47,9 ± 13,8 anos. O Grupo 1 teve maior frequência de pterígios classificados como mais avançada do que no Grupo 2. Um número similar de recorrências foi observado no Grupo 1 (14,3%) e no Grupo 2 (16,7%). Não houve diferença estatisticamente significativa em termos de valores pré e pós-operatórios de AV e astigmatismo entre dois grupos. Houve uma melhora estatisticamente significativa nos valores pós-operatórios de AV e astigmatismo no Grupo 1 e nos valores de astigmatismo pós-operatório no Grupo 2. Embora a vermelhidão pós-operatória tenha sido detectada mais comumente no Grupo 1, não foi encontrada diferença estatisticamente significante entre os grupos. Conclusão: Ambas as técnicas de CRA podem ser bem sucedidas em pacientes onde é desejável evitar um auto-enxerto conjuntival livre e para quem a expectativa de cosméticos não é alta.

Comparison of effects of different pterygium surgeries / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the clinical outcomes of pterygium excision followed by translocation of adjacent conjunctival autograft with stem cells or transplantation of conjunctival autograft with stem cells to treat and prevent the recurrence of pterygium.METHODS: Fifty patients (60 eyes) were divided into 2groups, and pterygium excision followed by translocation of adjacent conjunctival autograft with stem cells (group A) and pterygium excision followed by transplantation of conjunctiva autograft harvested from counter-side limbus with stem cells (group B) were performed respectively.The surgical time of each case was recorded.RESULTS: All the 50 cases (60 eyes) of pterygium were recruited. The epithelization of cornea and conjunctiva in all cases finished in 2-5d, During the follow-up of 6-12mo, pterygium reoccurred in 2 cases (1 in each group), with no difference in recurrence rate. The mean surgical time was 25± 8min for group A,43± 11min for group B, the difference being statistically significant (P＜0.05, t-test).CONCLUSION: Both methods, pterygium excision followed by translocation of adjacent conjunctival autograft with stem cells or transplantation of conjunctival autograft with stem cells are effective on treating and reducing the recurrence of pterygium. Compared with the latter, pterygium excision followed by translocation of adjacent conjunctival autograft with stem cells is simpler and easier to perform, and is preferred by the patients too.

Combining allogenic conjunctiva transplantation with amniotic membrane transplantation for conjunctiva alkali burns in early-stage / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the feasibility of combining small pieces of allo-conjunctiva transplantation (ACT) with amniotic membrane transplantation (AMT) to reconstruct ocular surface.METHODS: Bilateral superior bulbar conjunctiva of New Zealand white rabbits were burned by NaOH (1mol/L).After 24h, the right eye (experimental groups Exps) was performed AMT and ACT;the left eye (control groups Cons)was done merely ACT. The viability and function of allografts were identified by PAS staining and scanning electron microscope (SEM) of cytology impression (CI) every week after the operation.RESULTS: In Exps, no obvious rejection was observed.All grafts survived, extended and covered the conjunctival defect. The appearance of grafts, and the shape, number,and function of goblet cells recovered perfectly four weeks after the operation;however, in Cons, obvious rejection was found. Seven grafts were rejected and. symblepharon was observed in those eyes. The appearance of survival allografts were similar to the normal conjunctiva, with similar shape, number and function of goblet cells till the fifth week after the operation. The survival ratet was significantly higher in Exps than in Cons (P ＜0.05).CONCLUSION: ACT based on AMT can be considered a good way to reconstruct ocular surface for large area conjunctiva alkali burns in early-stage.