Tarsoconjunctival flap in scleral necrosis: report of three cases / Retalho tarsoconjuntival em necrose escleral: relato de três casos

ABSTRACT To report a series of three cases (four eyes) of scleral necrosis after pterygium excision, in which the tarsoconjunctival flap technique was used as treatment. Three patients who progressed to scleral necrosis after surgical pterygium excision were selected. The first patient underwent excision using the bare sclera technique and developed scleral thinning in the immediate postoperative period. The second and third patients received beta irradiation and had late onset scleral necrosis. The tarsoconjunctival flap technique was performed by the same surgeon. Recovery was satisfactory from both anatomical and functional perspectives in all cases, and the technique was considered effective and safe. Although there are only few reports about this technique in the literature, it can be considered as a good alternative to treat scleral necrosis.

RESUMO O objetivo deste estudo foi relatar uma série de três casos (quatro olhos) de necrose escleral pós-exérese de pterígio, em que se utilizou como tratamento a técnica de retalho tarsoconjuntival. Foram selecionados três pacientes que evoluíram para necrose escleral após tratamento cirúrgico de exérese de pterígio: o primeiro caso após técnica de esclera nua, com evolução para afinamento escleral no pós-operatório imediato; o segundo e o terceiro fizeram uso de betaterapia e apresentaram necrose escleral tardiamente. A técnica de recobrimento tarsoconjuntival foi executada pelo mesmo cirurgião. A recuperação foi satisfatória em todos os casos, do ponto de vista anatômico e funcional, sendo eficiente e segura. Apesar das escassas menções na literatura, essa técnica pode ser considerada uma boa alternativa para tratamento da necrose escleral.

Idiopathic sclerochoroidal calcifications: Case report, metabolic causes and differential diagnosis / Calcificações esclerocoroidais idiopáticas: relato de caso, causas metabólicas e diagnóstico diferencial

Abstract Sclerochoroidal calcifications (SC) are a rare and benign ocular condition characterized by yellow-white irregular subretinal lesions usually found in the supero-temporal arcade of the midperipheral fundus in middle-aged elderly men. We present a clinical case of a 79- year-old patient who during a fundus examination presented raised whitish nodules in the supero-temporal arcade in the right eye. After performing optical coherence tomography, ultrasound, ocular computed tomography and laboratory analysis, she was diagnosed with idiopathic sclerochoroidal calcifications The pathogenesis of sclerochoroidal calcifications remains unclear but systemic conditions should be discarded. It is important to distinguish sclerochoroidal calcifications from other conditions such as tumors.

Resumo Calcificações esclerocoroidais (SC) são uma condição ocular rara e benigna caracterizada por lesões sub-retinianas irregulares amarelo-brancas, geralmente encontradas na arcada superotemporal do fundo médio-periférico em homens idosos de meia-idade. Apresentamos um caso clínico de uma paciente de 79 anos que durante exame de fundo apresentou nódulos esbranquiçados elevados na arcada superotemporal do olho direito. Após realizar tomografia de coerência óptica, ultra-sonografia, tomografia computadorizada ocular e análise laboratorial, ela foi diagnosticada com calcificações esclerocoroidais idiopáticas A patogênese das calcificações esclerocoroidais permanece incerta, mas as condições sistêmicas devem ser descartadas. É importante distinguir calcificações esclerocoroidais de outras condições, como tumores.

A new surgical technique for scleral fixation using a "knot ball" for scleral-fixated intraocular lenses: impact on clinical outcomes / Uma nova técnica cirúrgica para fixação escleral usando um "nó esférico" (knot ball) para lentes ntraoculares para fixação escleral: impacto nos resultados clínicos

ABSTRACT Purpose: Scleral fixation surgery is a pivotal procedure that depends on the availability of robust and innovative surgical fixation methods. There continues to be a need for innovation in suture fixation techniques, particularly for intraocular lens implantation. Methods: We conceived and designed a "knot ball" scleral fixation technique for suture burial in a retrospective sample of 108 patients with primary (n=40) or secondary (n=68) scleral-fixated intraocular lens. Importantly, our technique did not require additional scleral flap or tunnel procedures. We evaluated pre- and postoperative best-corrected visual aquity (BCVA) and postoperative complications. All data were analyzed and compared between groups. Results: The preoperative mean BCVA improved significantly in both groups using the "knot ball" fixation technique (p<0.01). The extent of the improvement in the best-corrected visual acuity and late complications one month post-surgery were not significantly different between the groups (p>0.05). These clinical outcomes were consistent with those described in the ophthalmology literature. Conclusion: A "knot ball" scleral fixation technique is reported; to the best of our knowledge, this is the first report of such a technique, which offers a less invasive and simplified surgical procedure for transscleral fixation of scleral-fixated intraocular lenses. Moreover, the technique appears to display similar effectiveness and safety compared with existing scleral fixation techniques. We suggest that the "knot ball" technique warrants further research focus and clinical evaluation in future studies.

RESUMO Objetivo: A cirurgia de fixação escleral é um procedimento fundamental que depende da disponibilidade de métodos robustos e inovadores de fixação cirúrgica. No entanto, existe uma necessidade de inovação nas técnicas de fixação de sutura, particularmente para a implantação de lentes intraoculares. Métodos: Concebemos e desenhamos uma técnica de fixação escleral utilizando um "nó esférico" para o encerramento da sutura em uma amostra retrospectiva de 108 pacientes com lente intraocular de fixação escleral (SF-IOL) primária (n=40) e secundária (n=68). Importante considerar que nossa técnica não exigiu procedimentos adicionais de aleta escleral ou de túnel. Observamos a melhor acuidade visual corrigida (MAVC) pré e pós-operatória e as complicações pós-operatórias. Todos os dados foram analisados entre os grupos. Resultados: A melhor acuidade visual corrigida média pré-operatória (logMAR) melhorou significativamente em ambos os grupos com a utilização da técnica de fixação do nó esférico (p<0,01). A extensão da melhora melhor acuidade visual corrigida e as complicações tardias, um mês após a cirurgia, não foram significativamente diferentes entre os grupos (p>0,05). Esses resultados clínicos foram, em geral, comparáveis aos publicados na literatura de oftalmologia. Conclusão: Até onde sabemos, a técnica de fixação escleral de "nó esférico" é relatada pela primeira vez na literatura e representa um procedimento cirúrgico promissor, menos invasivo e simplificado para a fixação transescleral de SF-IOLs. Além disso, a técnica parece exibir eficácia e segurança comparáveis às técnicas de fixação escleral existentes. Sugerimos que a técnica do nó esférico receba mais atenção e avaliações clínicas no futuro.

Escleritis posterior: a propósito de un caso / Posterior scleritis: a propos of a case

Las enfermedades inflamatorias de la esclera son infrecuentes. Involucran tanto la esclera como la epiesclera y se caracterizan por su cronicidad, dolor y por ser una causa potencial de ceguera. Su asociación con enfermedades sistémicas, frecuentemente de causa autoinmune, y la aparición de graves complicaciones oculares, conllevan una terapia sistémica agresiva con antinflamatorios no esteroideos, corticoesteroides y agentes inmunosupresores, los cuales se pueden utilizar solos o combinados. Presentamos el caso de un paciente masculino de 37 años de edad quien acudió al Cuerpo de Guardia por dolor ocular intenso, asociado a ojo rojo, disminución de la agudeza visual y cifras elevadas de tensión ocular del ojo derecho, a quien le fue diagnosticada una escleritis posterior.

The inflammatory diseases of the sclera are uncommon. They involve both the sclera and the episclera and are characterized by chronic nature, pain and potential cause of blindness. Their association with systemic diseases, frequently autoimmune ones, and the occurrence of serious ocular complications lead to applying aggressive systemic therapy with non-steroid antinflammatory drugs, corticosteroids and immunosuppressive agents, which can be administered alone or combined. This is a 37 years-old patient who went to the emergency service because he suffered intense ocular pain associated to red eyes, reduction of visual acuity and high ocular pressure values in his right eye. He was finally diagnosed with posterior scleritis.

Severe scleral dellen as an early complication of pterygium excision with simple conjunctival closure and review of the literature / "Dellen" escleral grave como complicação precoce de excisão de pterígio com fechamento conjuntival simples e revisão da literatura

We describe a patient with acute scleral dellen (SD) after pterygium excision with simple conjunctival closure. In addition, we present a PUBMED review on the medical literature on early SD after pterygium surgery. This case describes a 45-year-old man who presented with severe SD, 7 days after pterygium surgery with minimal cauterization of episcleral vessels and simple conjunctival closure. No other adjunctive therapy was used intraoperatively. The patient refused conjunctival flap coverage of the lesion. Therefore, medical treatment consisted of antibiotic ointment, patching, and daily follow-up. After 7 days, the patching was changed for intensive ocular lubrication. Five weeks later, the surrounding conjunctiva had completely covered the affected sclera. To the best of our knowledge, this is the first report of early SD following pterygium excision and simple conjunctival closure with no other adjunctive therapy. When performing pterygium excision with conjunctival coverage of the sclera, a close follow-up is recommended to rule out wound dehiscence and SD, even when surgical wound closure is considered to prevent SD. If this complication is detected, the treatment can be conservative.

Descrevemos um paciente com "dellen" escleral agudo (SD) após excisão de pterígio com fechamento conjuntival simples. Uma revisão adicional da literatura médica sobre SD precoce após a cirurgia de pterígio também é realizada. Este caso descreve um homem de 45 anos de idade, que apresentou SD grave, sete dias após a cirurgia de pterígio com cauterização mínima de vasos episclerais e fechamento conjuntival simples. Nenhuma outra terapia adjuvante foi utilizada no intraoperatório. O paciente recusou-se à cobertura de retalho conjuntival da lesão. Portanto, o tratamento médico consistiu em pomada antibiótica, oclusão e acompanhamento diário. Após sete dias, a oclusão foi mudada para a lubrificação ocular intensiva. Cinco semanas após, a conjuntiva cobriu completamente a esclera afetada. Ao melhor de nosso conhecimento, este é o primeiro relato de SD precoce após a excisão do pterígio e fechamento conjuntival simples com nenhuma outra terapia adjuvante. Ao realizar a excisão do pterígio com cobertura conjuntival da esclera, um acompanhamento frequente é recomendado para descartar a deiscência da ferida e SD. Se esta complicação for detectada, o tratamento pode ser conservador.

Injerto-parche de esclera en perforación corneana secundaria a queratitis periférica ulcerativa / Scleral graft patch in corneal perforation due to peripheral ulcerative keratitis

Objetivo: reportar un caso de perforación corneana manejado con injerto-parche de esclera. Diseño: reporte de caso. Discusión: las perforaciones corneanas requieren tratamiento quirúrgico urgente para reducir las complicaciones. Contamos con varias opciones de acuerdo al tamaño de la perforación incluyendo adhesivo tisular, transplante de membrana amniótica y queratoplastia penetrante. El injerto-parche de esclera es otra alternativa útil para el tratamiento de esta condición. Conclusiones: describimos el caso de una perforación corneana secundaria a queratitis ulcerativa periférica (QPU) asociada a Síndrome de Sjögren que fue manejada con un aloinjerto de esclera.

Objective: to report a case in which scleral patch graft was used to treat a corneal perforation. Design: case report. Discussion: corneal perforations require urgent management to reduce subsequent ocular morbidity. Depending on its size and location, treatment options include corneal gluing, amniotic membrane transplantation and corneal transplantation. Scleral patch grafting is another feasible alternative for treating this condition.Conclusions: We described a case of scleral allograft use in the management of corneal perforation due to peripheral ulcerative keratitis associated with Sjögren's syndrome.

The Development of Scleromalacia after Regional Conjunctivectomy with the Postoperative Application of Mitomycin C as an Adjuvant Therapy

A 40-year-old woman presented with ocular discomfort in both eyes that had persisted for several months. Six months ago, she had undergone a bilateral nasal and temporal conjunctivectomy using a bare scleral technique followed by a postoperative application of 0.02% mitomycin C (MMC) to treat her chronic hyperemic conjunctiva for cosmesis. Slit-lamp examination revealed that the patient had bilateral nasal and temporal scleral thinning, and a calcified plaque on her nasal conjunctiva. There was no episcleral tissue present around the wound area, and it was difficult to detect any normal conjunctival tissue in the adjacent area for covering the lesion. We believe that performing an aggressive conjunctival excision procedure followed with MMC application for cosmetic enhancement may be disastrous in certain cases.

Ulcera escleral secundaria a quemadura química por pila de reloj y cuerpo extraño retenido en fondo de saco conjuntival inferior: caso clínico / Scleral ulcer secondary to chemical burn caused by watch battery and retained foreign body in conjunctival sac inside. Case report

Introducción: Aproximadamente un tercio de las cegueras infantiles son debidas a los traumatismos, siendo la principal causa de déficit visual y ceguera monocular en ninos. caso clínico: Se reporta el caso de un preescolar masculino de 2 años de edad quien presentó úlcera escleral en ojo izquierdo secundaria a quemadura química por pila de reloj cuyo motivo de consulta fue contacto con detergente, con cicatrización dificultosa debido a cuerpo extraño mineral retenido en fondo de saco conjuntival inferior durante aproximadamente un mes, contando desde el ingreso al área pediátrica. conclusión: Se reporta un caso inusual de úlcera escleral. Hasta el momento no se han reportado otros casos de úlcera escleral secundaria a quemadura química por pila de reloj y por objetos retenidos en fondo de saco conjuntival inferior, resaltando el manejo diagnóstico y la demora en la extracción del cuerpo extraño, representando una emergencia oftalmológica.

Introduction: Approximately one-third of childhood blindness is due to trauma, representing the leading cause of visual impairment and monocular blindness in children. case report: The patient is a 2 year old preschool boy, who presented scleral ulcer in his left eye secondary to chemical burn caused by watch battery. The reason for seeking medical care was difficult healing caused by a mineral foreign body retained in the lower conjunctival sac after the patient came in contact with detergent one month before the pediatric consultation. Discussion: An unusual case of scleral ulcer was reported. So far, no other similar cases have been reported. The diagnosis process and the delay for the removal of the foreign body are emphasized in this serious ophthalmologic emergency.

Tratamento da úlcera escleral pós-cirurgia de pterígio e betaterapia por enxerto de esclera autóloga de espessura parcial / Partial thickness autologus scleral graft for treating scleral ulcers following pterygium excision and betatherapy

OBJETIVO: Avaliação dos resultados da utilização de enxerto de espessura parcial de esclera autóloga para o tratamento das úlceras esclerais profundas, como complicação tardia da exérese de pterígio associada à betaterapia. MÉTODOS: Foram tratados doze olhos de doze pacientes, nove femininos e três masculinos, com idade variando entre 48 e 82 anos, média 65,2 anos. RESULTADOS: Houve boa integração do enxerto em todos os casos, com resultado funcional e cosmético favorável e sem complicações. CONCLUSÃO: Várias técnicas de enxertia tem sido propostas para o tratamento da úlcera escleral: esclera e dura-máter homólogas, derme, cartilagem auricular e periósteo autólogos. No entanto, o procedimento com esclera autóloga apresenta reais vantagens em relaçâo aos enxertos empregados anteriormente. Não há referências na literatura quanto ao emprego de enxerto de esclera autóloga de espessura parcial para o tratamento da úlcera escleral.

OBJETICVE: The authors describes a surgical technique that utilizes autologus delaminated scleral graft for the management of deep scleral ulcers. METHODS: In this technique that were perfomed in 12 eyes of 12 patients, 9 female, 3 male, age from 48 to 82 years, mean age 65.2 years. RESULTS: Occurred good integration of the grafting in all cases without any complications. CONCLUSION: Many techniques have been proposed for the management of scleral ulcers: sclera and dura-mater, autologus derme, auricular cartilage and autologus periosteum.There is no reference in relation to autologus scleral grafting with partial thickness for the treatment of scleral ulcers, as proposed in this study.

Posterior scleral tuberculoma: case report / Tuberculoma escleral posterior: relato de caso

Posterior scleral tuberculoma formation is an extremely rare condition. The few reports on scleral involvement in tuberculosis refer to cases of anterior scleritis. In the present manuscript we describe a patient who had rheumatoid arthritis and developed a large posterior scleral tuberculoma. The lesion provoked retinal detachment and visual loss and was diagnosed only after enucleation due to a misdiagnosis of choroidal melanoma.

A formação de granuloma tuberculoso na esclera posterior é um evento extremamente raro. Os poucos relatos de acometimento escleral na tuberculose referem-se a casos de esclerite anterior. No presente trabalho é descrito um caso de granuloma escleral posterior em um paciente portador de artrite reumatóide. A lesão provocou descolamento da retina e perda visual e só foi diagnosticada após enucleação por suspeita de melanoma de coróide.

Macular Gradient Measurement in Myopic Posterior Staphyloma Using Optical Coherence Tomography

PURPOSE: To evaluate clinical characteristics and the macular gradient in myopic posterior staphyloma with time domain (TD) optical coherence tomography (OCT). METHODS: Sixty-four staphyloma eyes of 40 patients were examined. Macular gradient (tangent theta) and the location of staphyloma were assessed with OCT imaging. The macular gradient was measured at points 1 mm and 2 mm distant from the fovea. The relationships of the macular gradient with age, axial length, and spherical equivalent were analyzed. RESULTS: In 8 eyes (12.5%), the bottoms of the staphylomas were in the fovea, and there was no macular gradient. However, in the other 56 eyes (87.5%), the bottoms of the staphylomas were not in the foveal area, and macular gradients existed. Staphylomas were commonly located in the infero-nasal retinal area. The mean macular gradient (tangent theta) was 0.26 +/- 0.08 at 1 mm distance from the fovea and 0.28 +/- 0.10 at 2 mm. No significant relationships were observed between macular gradient and axial length, patient age, or spherical equivalent. CONCLUSIONS: TD OCT reveals staphyloma location. If the location is outside of the fovea, a macular gradient exists and can be measured by OCT. Axial length measurement error may occur in eyes with poor visual fixation and steep macular gradients.

Ocular prosthesis: patient rehabilitation : a case report.

The loss of the facial structures can have a physical, social and psychological impact on those affected .Maxillofacial prostheses which restore and replace stomatognathic and associated facial structures with artificial substitutes, aim to improve the patient aesthetics, restore and maintain health of the remaining structures and consequently provide physical and mental well being. Accurate impressions of these tissues facilitate a close adaptation of the custom prosthesis to the tissue bed resulting in better potential for movement by the patient. Treatment of such cases includes implants and acrylic eye prosthesis. Due to economic factors it may not be advisable in all patients. A custom-made ocular prosthesis is a good alternative. A case of a custom-made ocular acrylic prosthesis is presented here, which had acceptable fit, retention and esthetics.

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.

Uveal melanoma presenting as cataract and staphyloma.

Blind eyes can harbor a choroidal melanoma. We report a case of uveal melanoma presenting as staphyloma and complicated cataract in a 45-year-old female. The left eye was blind for six months. She underwent comprehensive ocular examination but fundus examination was precluded due to total cataract. The ultrasound of the eye showed a large mass filling the superior, nasal and inferonasal vitreous cavity with high surface reflectivity and low to moderate internal reflectivity. Magnetic resonance imaging (MRI) confirmed the diagnosis of choroidal melanoma. The patient underwent extended enucleation and histopathology was consistent with uveal melanoma.

Tumor indiferenciado da lâmina fusca / Undifferentiated tumor of the lamina fusca

Na reunião da Associação Pan-americana de Patologia Oftálmica, realizada em Los Angeles CA, 10 de Outubro de 1991, no DOHENY EYE INSTITUTE, C.O. Degrazia propôs o nome de LOFONEUROGONIOMA para um tumor solitário intra-ocular, indiferenciado, originado nas células da lâmina fusca, com células indiferenciadas de expressiva diferenciação para a linhagem schwannocítica, melanocítica e neuroendócrina. Em face do trimorfismo, o patologista pode ser conduzido para os diagnósticos de melanoma, schwannoma maligno ou outro tipo de tumor. O exaustivo estudo do tumor apresentado, através da microscopia eletrônica, da histoquímica e da imunohistoquímica permitiu a formulação da seguinte hipótese: uma célula indiferenciada em repouso, a lofoneurogô- nia, segue as linhagens melanocítica, schwannocítica e neuroendócrina. A diversidade de células dentro de um tumor, o continuus intratumor, responsável pela estrutura em mosaico de muitas neoplasias, além da multiclonalidade resultante de mitoses atípicas, pode ser explicada por essa hipótese. É dessa maneira que se torna compreensível a classificação de Callender para os melanomas intra-oculares nos tipos celulares fusiforme A, fusiforme B, epitelióide, fasciculado e misto, num verdadeiro continuus intertumores. Para justificar a designação proposta, e para enquadrar o caso num grupo taxonômico, foram usadas duas bases classificatórias: 1o ­ histogênica, isto é, correlacionar as células do tumor com as células normalmente existentes nas membranas oculares, no caso, a lâmina fusca; 2o ­ embriogênica isto é, delimitar um grupo de tumores cuja base, no desenvolvimento do embrião, é a crista neural (AU)

In the meeting of the Panamerican Association of Ophtalmic Pathology, held in the Doheny Eye Institute in Los Angeles, CA on Oct 10 1991, C.O. Degrazia proposed the name LOPHONEUROGONIOMA for an undifferentiated intraocular solitary tumor, originating from the cells of the lamina fusca, with undifferentiated cells of expressive differentiation for the schwannian, melanocitic and neuroendocrine lines. Because of the trimorphism, the pathologist may be led to the diagnosis of melanoma, malignant schwannoma or other type of tumor. The exhaustive investigation of the presented tumor through electronmicroscopy, histochemistry, and immunohistochemistry allowed the formulation of the following hypothesis: an undifferentiated cell at rest, the lophoneurogonia, follows the melanocitic, schwannian, and neuroendocrine lines. The diversity of cells inside a tumor responsible for the mosaic structure of many neoplasias, besides the multiclonality resulting from atypical mitoses, can be explained by this hypothesis. This also elucidates Callender's classification of intraocular melanomas in cell types fusiform A, fusiform B, epithelioid, fasciculated and mixed, in a true intertumor continuum. In order to justify the proposed designation, and to fit the case into a taxonomic group, two classificatory bases were used: first, a histogenic one, correlating tumor cells with normally existing cells; and second, embriogenic which bases is the neural crest (AU)

Histopathological study of ocular erythema nodosum leprosum and post-therapeutic scleral perforation: a case report.

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae , clinically present either as tuberculoid, borderline or lepromatous type. Erythema nodosum leprosum (ENL) is an acute humoral response in the chronic course of lepromatous leprosy. Although very severe ENL reactions are known in systemic leprosy, such severity is rare in ocular tissues. A leprosy uveitis patient suffered from a severe form of post-therapeutic ENL reaction which resulted in perforation of the globe at the site of preexisting subconjunctival leproma. Painful blind eye was enucleated. Histopathological study revealed infiltration of numerous polymorphs and macrophages packed with acid-fast bacilli in the conjunctiva, cornea, ciliary body, ora serrata and sclera. A profuse influx of neutrophils on a background of macrophages packed with M. leprae confirmed the ocular ENL reaction. This case is reported to alert the ophthalmologists to a rare ocular complication of ENL.

Pericardium Plug in the Repair of the Corneoscleral Fistula After Ahmed Glaucoma Valve Explantation

We report four cases in which a pericardium (Tutoplast(R)) plug was used to repair a corneoscleral fistula after Ahmed Glaucoma Valve (AGV) explantation. In four cases in which the AGV tube had been exposed, AGV explantation was performed using a pericardium (Tutoplast(R)) plug to seal the defect previously occupied by the tube. After debridement of the fistula, a piece of processed pericardium (Tutoplast(R)), measured 1 mm in width, was plugged into the fistula and secured with two interrupted 10-0 nylon sutures. To control intraocular pressure, a new AGV was implanted elsewhere in case 1, phaco-trabeculectomy was performed concurrently in case 2, cyclophotocoagulation was performed postoperatively in case 3 and anti-glaucomatous medication was added in case 4. No complication related to the fistula developed at the latest follow-up (range: 12~26 months). The pericardium (Tutoplast(R)) plug seems to be an effective method in the repair of corneoscleral fistulas resulting from explantation of glaucoma drainage implants.

Recurrence rate of pterygium following surgical excision with intraoperative versus postoperative mitomycin-C

To compare the rate of recurrence and complications of pterygium following surgical excision by applying 0.02% mitomycin-C intraoperatively or using topical 0.02% mitomycin-C drops postoperatively. Randomized clinical trial. Baqai Medical University Hospital, Department of Ophthalmology, from January 2001 to July 2005. Eighty-four eyes of 65 patients, aged between 20-70 years, with primary pterygium were randomly allocated into two groups using random tables. Patients with bilateral disease were treated with an interval of 10-14 days and randomized separately. In group-I, 0.02% mitomycin-C was applied intraoperatively for 3 minutes after pterygium excision. Group-II received mitomycin-C 0.02% eye drops twice a day for 2 weeks after pterygium excision. Patients were followed-up for pterygium recurrence for one year. Variables were compared for significance, using Pearson chi-square test. In Group I, recurrence of pterygium was seen in 4 [10.0%] eyes and superficial punctate keratitis in 4 [9.5%] eyes, while 8 [19.0%] eyes developed avascularization of sclera at the pterygium excision site. In group II, 8 [20.51%] eyes had pterygium recurrence [p=0.38], 13 [31.0%] eyes had superficial punctate keratitis and tenon cyst was seen in one [2.4%] eye. One [2.4%] eye in each group developed scleral thinning. There was no significant difference in pterygium recurrence rate intraoperatively or postoperative application of 0.02% mitomycin-C. Complications were comparatively less following application of intraoperative 0.02% mitomycin-C for 3 minutes

Role of intraoperative application of mitomycin C to prevent recurrence of pterygium after excision using bare sclera technique [a study of 50 patients at Abbasi Shaheed hospital]

The objective of our study was to prevent the recurrence of pterygium with application of intraoperative Mitomycin C following pterygium excision using bare sclera technique. This was an observational study and carried out at eye department Abbasi Shaheed Hospital Karachi. Fifty patients were studied over a period of 9 months. Patient information regarding visual aquity, intraocular pressure, retinoscopy condition of cornea, conjunctiva and retina were recorded on a predesigned performa. Patients were admitted in the ward and operated in sterilized operation the-atre environment. Mitomycin C was applied on bare sclera in a concentration of 0.02% [0.2 mg/ml] for 2.5 minutes and irrigated with copious amount of normal saline afterwards. Patients were discharged next day on mild steroid like flouromethalone and an antibiotic ointment. Follow-up was done on first week, one month, 3 months and six months. Rate of recurrences and postoperative complications were noted down. There were 72% male and 28% female patients .Most common presenting age group was between 30-40 years of age [42%]. Primary pterygia included in the study were 90% [45 patients] and recurrent were 10% [5 patients]. Recurrence rate in primary pterygia was 6.6% [3 patients] and in recurrent pterygia 20% [1 patient]. No major complication was recorded. It was concluded that intraoperative application of Mitomycin C on bare sclera is safe and effective in preventing the recurrence of pterygium after excision provided potential complications of Mitomycin C are sufficiently addressed

Bilateral scleromalacia in a case of congenital erythropoietic porphyria.

A 25-year-old woman presented with gradual dimness of vision in the left eye with history of recurrent cutaneous bullae, photosensitivity and passage of red coloured urine. Examination revealed cataract and high intra-ocular pressure in left eye and symmetrical areas of scleral thinning in both eyes. Systemic features of the patient pointed towards congenital erythropoietic porphyria, which was established by laboratory investigations.