Application of limbal stem cell transplantation fixed by corneal bandage lens in primary pterygium excision / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the application effect of limbal stem cell transplantation fixed by corneal bandage lens with no suture method in primary pterygium excision surgery.<p>METHODS:Selected 25 patients of 50 eyes with bilateral primary pterygium who were admitted into our hospital from January 2019 to December 2019 for prospective clinical study. Group A(25 eyes)were randomly chosen with one eye of a patient fixed with corneal bandage lens with no suture; and Group B(25 eyes)were chosen with the other eye of a patient using traditional suture method. The incision healing, patient comfort, surgical complications, and postoperative recurrence were observed in both groups after postoperative follow-up for 6mo.<p>RESULTS: The average operating time for Group A(13.5±2.1min)was significantly less than that of Group B(26.6±7.2min). The results of postoperative follow-up in 1d, 1, 2wk, 1, 3 to 6mo showed that the discomfort such as pain, photophobia, lacrimation, foreign body sensation and itching were lower in Group A than in Group B. The discomfort disappeared in both groups after 6mo. The stability of postoperative corneal rim stem cell transplants was favorable in Group A, and the complications one and three months after surgery were less than those in Group B.<p>CONCLUSION: The method of banded corneal rim stem cell conjunctival transplantation combined with corneal bandage lens is an effective procedure for the treatment of primary pterygium. It is simple, convenient, safe and effective, the postoperative comfort is good, the recurrence rate is low, compared with the traditional suture method, it can shorten the operation time and effectively reduce the patient's pains.

Meta-analysis of the efficacy of corneal bandage contact lens after pterygium excision / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the efficacy evaluation of the combined application of bandage contact lens after pterygium excision surgery by Meta-analysis.<p>METHODS: Randomized controlled clinical studies on combined application of corneal bandage contact lens after pterygium excision were retrieved from PubMed, Cochrane Library, Wanfang, VIP, CNKI and other databases from May 2014 to May 2020. Data were extracted and Meta-analysis was performed.<p>RESULTS:Totally 11 randomized controlled clinical studies were included, including 10 in Chinese and 1 in English, with 864 patients. Meta-analysis results showed that 1d postoperative \〖<i>MD</i>= -1.57, 95%<i>CI</i>=(-1.72, -1.41), <i>P</i><0.00001\〗, 2d postoperative \〖<i>MD</i>= -1.35, 95%<i>CI</i>=(-1.59, -1.11), <i>P</i><0.00001\〗, 7d postoperative \〖<i>MD</i>= -0.64, 95%<i>CI</i>=(-0.78, -0.50), <i>P</i><0.00001\〗 combined application of corneal bandage contact lens can better reduce the degree of ocular pain in patients; And 1d postoperative \〖<i>MD</i>= -1.23, 95%<i>CI</i>=(-1.51, -0.95), <i>P</i><0.00001\〗, 7d postoperative\〖<i>MD</i>= -0.44, 95%<i>CI</i>=(-0.50, -0.39), <i>P</i><0.00001\〗 combined application of corneal bandage contact lens can better promote the condition of corneal epithelium. <p>CONCLUSION:The bandage contact lens could markedly release pain response after pterygium excision surgery, promote corneal epithelium recovery, which is beneficial to reduce the symptoms of clinical discomfort.

Comparative measurement of intraocular pressure by Rebound and non-contact tonometry in patients wearing bandage contact lenses after pterygium excision / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the measurement of intraocular pressure(IOP)through a bandage contact lens with the “native” measurement by rebound tonometry and non-contact tonometry in patients after pterygium excision. <p>METHODS: Fifty consecutive patients(50 eyes)undergone pterygium excision(unilateral nasal, primary pterygium, horizontal length <4mm), and conjunctival autografting were included in this prospective study. IOP measurements were obtained by Rebound tonometry and non-contact tonometry in random order with(lens measurement)and without(native measurement)a bandage contact lens half a month after operation. We compared the mean values(validity parameter)and standard deviation(precision parameter)of the two individual measurements in each case using the paired t-test 14d after surgery. <p>RESULTS: With the rebound tonometry we detected statistically significant higher values in the contact lens measurements(18.20±3.19 <i>vs</i> 15.17±3.80mmHg in the native measurements; <i>P</i><0.001), a good correlation with <i>r</i>=0.884 and mean difference was 3.04±1.79mmHg; With the non-contact tonometry we detected statistically significant higher values in the contact lens measurements(15.74±3.23 <i>vs</i> 13.19±3.89mmHg in the native measurements; <i>P</i><0.001), a good correlation with <i>r</i>=0.876 and mean difference was 2.55±1.88mmHg. In the contact lens measurements and native measurements, we detected statistically significant higher values by Rebound tonometry than that by non-contact tonometry(<i>P</i><0.001), and mean difference was 2.46±1.45mmHg, 1.98±1.67mmHg. <p>CONCLUSION: The use of rebound tonometry and non-contact tonometry shows good consistency between lens measurement and native measurement. However, it should be noted that the average of the measurements over contact lens by rebound tonometry and non-contact tonometry were found to be higher than that in native measurement, and the average of the measurements with and without lens by rebound tonometer was found to be higher than what was measured by non-contact tonometry.

Comparative measurement of intraocular pressure by Rebound and non-contact tonometry in patients wearing bandage contact lenses after pterygium excision / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the measurement of intraocular pressure(IOP)through a bandage contact lens with the “native” measurement by rebound tonometry and non-contact tonometry in patients after pterygium excision. <p>METHODS: Fifty consecutive patients(50 eyes)undergone pterygium excision(unilateral nasal, primary pterygium, horizontal length <4mm), and conjunctival autografting were included in this prospective study. IOP measurements were obtained by Rebound tonometry and non-contact tonometry in random order with(lens measurement)and without(native measurement)a bandage contact lens half a month after operation. We compared the mean values(validity parameter)and standard deviation(precision parameter)of the two individual measurements in each case using the paired t-test 14d after surgery. <p>RESULTS: With the rebound tonometry we detected statistically significant higher values in the contact lens measurements(18.20±3.19 <i>vs</i> 15.17±3.80mmHg in the native measurements; <i>P</i><0.001), a good correlation with <i>r</i>=0.884 and mean difference was 3.04±1.79mmHg; With the non-contact tonometry we detected statistically significant higher values in the contact lens measurements(15.74±3.23 <i>vs</i> 13.19±3.89mmHg in the native measurements; <i>P</i><0.001), a good correlation with <i>r</i>=0.876 and mean difference was 2.55±1.88mmHg. In the contact lens measurements and native measurements, we detected statistically significant higher values by Rebound tonometry than that by non-contact tonometry(<i>P</i><0.001), and mean difference was 2.46±1.45mmHg, 1.98±1.67mmHg. <p>CONCLUSION: The use of rebound tonometry and non-contact tonometry shows good consistency between lens measurement and native measurement. However, it should be noted that the average of the measurements over contact lens by rebound tonometry and non-contact tonometry were found to be higher than that in native measurement, and the average of the measurements with and without lens by rebound tonometer was found to be higher than what was measured by non-contact tonometry.

Effect of Pterygium Surgery on Keratometry Readings

Introduction: In many case Pterygium is found to causeastigmatism. Study aimed to find the effect of pterygiumexcision on keratomerty readings.Material and Methods: The present Retrospective study wasdone on 50 eyes of 50 patients, who had primary pterygiumand underwent pterygium surgery during period of October2016 to October 2017 in a tertiary care hospital. Informationthat was reviewed included preoperative uncorrected and bestcorrected visual acuity, auto refraction, auto keratometry anddetailed anterior segment and posterior segment examination.Results: Mean astigmatism changed from preoperative 5.94 ±3.82 Diopters (D) to 1.30 ± 1.07 D on 30th post operative dayshowing 4.64 ± 2.75 D of change in astigmatism.Conclusion: Pterygium can be a cause of low vision secondaryto corneal astigmatism. Pterygium excision reduces cornealastigmatism significantly, which improves vision.

Comparison of Conjunctival Autograft versus Amniotic Membrane Graft in Primary Pterygium Surgery

Purpose: The purpose of this study is to evaluate and compare the effectiveness of conjunctival autograft transplantation andamniotic membrane graft transplantation in pterygium surgery.Materials and Methods: This was a randomized, parallel group, Single-center study included 60 patients. 30 patients ofwhich underwent pterygium excision followed by Conjunctival autograft transplantation. The other 30 patients also underwentpterygium excision with amniotic membrane graft transplantation. Follow-up was done for 6 months to evaluate the post-operativecomplaints, graft integrity, and complications associated with each procedure.Results: Post-operative discomfort and watering were less in amniotic membrane graft group (P = 0.13%). Further, in amnioticmembrane group, there was less transient graft edema (P = 0.22) and conjunctival hyperemia (P = 0.004). However, graft losswas more (P = 0.33) and so was the conjunctival granuloma formation (P = 0.45) in the amniotic membrane group.Conclusion: Amniotic membrane graft is as effective and safe as conjunctival autograft with no major complications.

Soft corneal contact lens for postoperative comfort in patients with recurrent pterygium function / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the effect of soft contact lens on the comfort of postoperative patients with recurrent pterygium. <p>METHODS: For 100 eyes of 98 patients after recurrent pterygium excision, the conjunctival implant with limbal stem cells from the upper part of the cornea was used, and the scleral surface of the operation area was transferred and covered. Fifty eyes were treated with corneal bandage lens for 5d(Group A)and 50 eyes were conventionally ensheathed(Group B). The time of corneal wound healing and various symptoms and signs were observed after operation. <p>RESULTS: Compared with Group B, 1d after pterygium, the symptoms and signs of corneal irritation in Group A were significantly less(<i>P</i><0.05), and the corneal epithelial healing was significantly faster and better(<i>P</i><0.05). <p>CONCLUSION: The corneal contact lens can obviously improve the early postoperative corneal irritation in patients with pterygium, promote corneal wound healing and relieve postoperative discomfort.

Application of bandage contact lens in pterygium excision combined with conjunctival transplantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the application and effect of bandage contact lens in pterygium excision combined with conjunctival transplantation (CAT).METHODS:In a prospective, randomized, controlled clinical study, 110 patients (110 eyes) diagnosed with primary pterygium were collected in PLA NO.474 Hospital from January 2015 to January 2016.The 110 patients enrolled in the study in turn, and divided into two groups by the odd and even number.The odd number divided into bandage contact lens group (CAT + bandage contact lens, n=55), while the even number divided into control group (CAT, n=55).Visual analog scale (VAS) and corneal irritation were evaluated on 1, 3 and 7d after operation.Cornea fluorescent staining testing was carried out on 3d after operation.Following-up all the patients with 1a at least observed the recurrence of pterygium.RESULTS:The score of VAS in bandage contact lens group less than that in control group on 1d (4.13±2.06 vs 5.80±1.93, t=4.391, P<0.001) and 3d (2.09±1.36 vs 3.65±1.65, t=5.422, P<0.001) after operation, while there was no significant difference between two groups on 7d (t=1.295, P=0.198) after operation.The corneal irritation in bandage contact lens group less than that in control group on 1d and 3d after operation (P<0.05), while there was no significant difference between two groups on 7d after operation (P=0.052).Cornea fluorescent staining testing area in bandage contact lens group was less than that in control group on 7d after operation (0.33±0.37mm2 vs 2.73±2.21mm2, t=7.921, P<0.01).There was no significant difference in recurrence rate between two groups after 1a operation (P=1.000).CONCLUSION:Bandage contact lens could significantly release pain and corneal irritation, promote the healing of the corneal epitheliums in the defected area, and increase the postoperative comfort level in patients after operation.

Effects of 1 g/L topical cyclosporine A in preventing pterygium recurrence after pterygium surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy of 1g/L topical cyclosporine A ( tCsA ) in preventing the recurrence of pterygium after pterygium excision and conjunctival flap rotation technique. ●METHODS:Fifty-eight patients (58 eyes) with primary pterygium were included in this prospective study. All eyes were operated with pterygium excision and conjunctival flap rotation technique, and divided into treatment and control group according to whether be treated with 1g/L tCsA eye drops after operation. The operated patients were followed up for 1y to assess the recurrence of pterygium. ●RESULTS: After surgery, the difference between the tCsA treatment and control group were statistically significant in the Schirmer l test results (9. 93 ± 1. 59mm/5min vs 8. 47±1. 53mm/5min, P ●CONCLUSION:tCsA eye drops are safe and effective for medical treatment to reduce rates of recurrence after pterygium surgery.

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.

Clinical effect of the application of microscopic pterygium resection combined with different concentration of mitomycin C / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To study the clinical effect of the application of microscopic pterygium resection combined with different concentration of mitomycin C ( MMC) . METHODS:A total of 110 cases of pterygium patients (120 eyes) were randomly divided into control group (58 eyes) and observation group (62 eyes) according to the odd and even number method. The control group adopted the pterygium resection combined 0. 3mg/mL MMC, and the observation group was given pterygium resection combined 0. 2mg/mL MMC. The cure rate and the recurrence rate, eyesight before and after the treatment, two groups of cornea and sclera wound healing situation, the incidence of postoperative complications were compared. RESULTS: The cure rate and recurrence rate of the control group was 84. 5% and 15. 5% respectively, and the observation group was 93. 6% and 6. 5% respectively, the differences were statistically significant (P0. 05). The cornea, sclera, wound healing time of the observation group were less than the control group, and there were statistical differences between the two groups ( P CONCLUSlON: The application effect of microscopic pterygium resection combined with MMC is remarkable, and the joint of 0. 2mg/mL concentration of MMC is more safe and effective, and is worth popularizing in clinical application.

A Comparative Study of the Effect of Fibrin Glue versus Sutures on Clinical Outcome in Patients Undergoing Pterygium Excision and Conjunctival Autografts

PURPOSE: To compare the effect of using fibrin glue or 10-0 nylon sutures on the clinical outcome of patients undergoing pterygium excision and conjunctival autografting. METHODS: We retrospectively reviewed the medical records of 52 eyes from 46 patients who underwent pterygium excision and conjunctival autografting and were followed up for more than 3 months. The operation duration, postoperative inflammation, complications, and recurrence rates were compared between groups of 20 patients (22 eyes) for whom fibrin glue was used (fibrin glue group) and 26 patients (30 eyes) for whom suturing was performed with 10-0 nylon (suture group) in pterygium excision and conjunctival autografting. RESULTS: The operation duration was 27.71 (5.22) minutes in the fibrin glue group and 43.30 (8.18) minutes in the suture group (p = 0.000). Seven days after the operation, the fibrin glue group showed milder conjunctival inflammation than the suture group (p = 0.000). Postoperative complications and corneal recurrence rates were not statistically different between the two groups. CONCLUSIONS: The use of fibrin glue in pterygium excision with conjunctival autografting is likely to be a more effective, safer procedure than suturing.

Clinical Features, Predisposing Factors, and Treatment Outcomes of Scleritis in the Korean Population

PURPOSE: To evaluate the clinical features, associated factors, and treatment outcomes of scleritis in the Korean population. METHODS: Medical records were retrospectively reviewed for 94 eyes of 76 patients with scleritis. Clinical features of scleritis, including systemic disease, presence of microorganisms, serologic markers, history of previous ocular surgery, and use of immunosuppressants were investigated and compared amongst the subtypes of scleritis. Treatment outcomes were evaluated using best corrected visual acuity (BCVA) and time to scleritis remission. RESULTS: Nodular scleritis was the most common form observed, followed by necrotizing scleritis with inflammation, diffuse scleritis, and necrotizing scleritis without inflammation, respectively. A total of 16 of 76 patients (21.1%) had connective tissue diseases. Eleven cases (14.5%) had infectious scleritis, of which bacteria (54.5%) and fungi (45.5%) were the causative microorganisms. Thirty-three patients (43.4%) had previous ocular surgery, mostly pterygium excision. Notably, a history of pterygium excision was significantly associated with development of necrotizing and infectious scleritis (odds ratio [OR], 399 and 10.1; p < 0.001 and 0.002, respectively). In addition, patients with necrotizing scleritis were more likely to have infectious scleritis (OR, 11.7; p = 0.001). BCVA after treatment and time to remission also showed significant differences among the different scleritis subtypes. Systemic immunosuppression was required in addition to steroids for treating diffuse and necrotizing scleritis. CONCLUSIONS: Careful taking of patient history including previous pterygium excision should be performed, especially in patients with necrotizing and infectious scleritis. In addition, evaluation of microbiological infection can be crucial for patients with necrotizing scleritis and history of pterygium excision.

Conjunctivolimbal Autograft Using a Fibrin Adhesive in Pterygium Surgery

PURPOSE: To evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium. METHODS: Thirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations. RESULTS: The mean patient age was 57.9+/-10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05+/-5.78 weeks. The mean surgery time was 18.04+/-5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive. CONCLUSIONS: The use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms . Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.

Use of Immunosuppressant in the Treatment of Surgically Induced Necrotizing Scleritis (SINS) after Pterygium Excision

PURPOSE: To assess the proper differential diagnosis and treatment of scleritis with scleral melt following pterygium excision. METHODS: A retrospective study through a review of medical records of 5 patients diagnosed with surgically induced necrotizing scleritis (SINS) after pterygium excision and treated with systemic immunosuppressant and steroid. RESULTS: All the patients responded to the treatment and showed significant improvement. CONCLUSIONS: Immunosuppressive treatment without surgical intervention is effective in resolution of SINS after pterygium excision.

4 Cases of Pseudomonas Scleritis after Pterygium Excision

It is known that the treatment of pseudomonas aeruginosa infection associated with scleral necrosis after pterygium excision is difficult. Pseudomonas scleritis were treated with systemic and topical antibiotics, debridement, scleral homograft,and conjunctival autograft in 3 cases of 4 cases. Another 1 case was transfered to other hospital with patient`s request after short medical treatment. The interval from pterygium operation to onset of pseudomonas scleritis ranged from 2 to 17 years with an average of 10 years. In all cases with operation, the graft was stabilized after mean time of 42 days (ranged 35 to 48 days) from operation. The complications were visual disturbance, endophthalmitis, complicated cataract, exudative retinal detachment, exotropia, and posterior synechia of iris. In 1 case, a corticosteroid which was used in the early of treatment induced exacerbation of disease.Because the complications of disease were so severe,early prophylactic operation will be necessary in noninfected scleral necrosis, and when infection is suspected, it should be necessary to do culture and sensitivity test with an intensive anti-pseudomonal therapy.

Surgical Treatment of Scleral Ulceration as a Complication of Pterygium Excision

Mitomycin C is now being used not only as an adjunct in the surgical treatment of pterygia but also in glaucoma surgery. However, several serious complications that are possibly related to mitomycin C treatment have been reported. We report on a series of 8 patients(10 eyes) who experienced scleral ulcer after pterygium excision. The period from operation to onset of scleral ulcer was between 5 months and 20 years. Complications included corneoscleral perf oration(1 eye), scleral ulceration(9 eyes), corneal ulceration(2 eyes), complicated cataract(5 eyes) and uveitis(4 eyes). We used autogenous temporalis fascia to reinforce the weakened lesion of 10 eyes with scleral or corneoscleral ulceration. Three eyes underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation after stable grafting. Grafts remained stable in 9 eyes over a mean follow-up of 10.8 +/- 10.4 months(3 to 37 months). One graft melted but regrafting salvaged the eye. Six of 10 eyes improved vision. All patients resolved their subjective symptoms after temporalis fascia grafting. We found autogenous temporalis fascia grafting is efficacious in both treating and preventing ocular perforation due to progressively destructive scleral ulceration.

A Scleral Homograft on Pseudomonal Scleral Abscess after Pterygium Excision

Pseudomonas scleral abscess is characterized by acute onset and rapid progression to scleral perforation, and has a subsequent risk of endophthalmitis. After control of infection with appropriate antibiotics, graft surgery should be performed for reinforcing the defected sclera. We performed a scleral homograft on the eye with large necrotic sclera caused by Pseudomonas aeruginosa infection after pterygium excisIon. And the results were remarkably good.

Temporalis Fascia Grafting in Scleral Necrosis after Pterygium Excision

We performed scleral grafting with autogenous temporalis fascia and autogenous conjunctiva in 32 patients (32 eyes) in scleral necrosis after pterygium excision. The average age of patients was 54.3 years (range, 38 to 74 years). Nine of them were male and twenty-three were female. The intervals between pterygium excision and scleral necrosis were from 2 months to 23 years (mean, 6.2 years). After the mean follow-up 6.6 months, in 29 eyes graft was stably adhered but in three eyes graft was melted. Conjunctival wound dehiscence and conjunctival necrosis were noticed in three eyes and one eye respectively. There were no cases showing significant difference between the preoperative and the postoperative visual acuity and intraocular pressure. Autogenous temporalis fascia appears to be a good alternative to homologous sclera for scleral reinforcement.