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.

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.

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.

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.

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.

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.

Esclerótica azul: asociaciones sistémicas de un signo oftalmológico

La presencia de una coloración azul en la esclerótica representa, con frecuencia una reducción en el espesor escleral. La uvea pigmentada subyacente se hace visible a través de la esclerótica adelgazada originando dicha coloración. Aunque puede encontrarse normalmente en algunos niños menores de tres meses, la esclerótica azul se puede asociar con frecuencia a multiples síndromes sistémicos y a anomalías oculares aisladas. En el presente artículo se revisa la fisiopatología de este hallazgo oftalmológico así como las asociaciones sistémicas más frecuentes.

Clinical ocular study in leprosy patients at a sanitary dermatological hospital in Brazil.

This study is based upon the observation f 363 leprosy patients having different types of the disease. At the time of the examination, we did not have any previous knowledge about the type of leprosy the patients were having. Thus, the eye examination was done without the knowledge of clinical diagnosis. The ocular examination protocol covered the following: visual activity, facial muscle function, eyebrows, eyelashes, lacrimal system, pupil, eye motility, corneal sensitivity, Schirmir's test and study of the anterior segment of the ocular bulb with a slit-lamp. The study patients included 275 cases of lepromatous leprosy, 57 tuberculoid, 29 indeterminate and two dimorphous cases. The age of the patients ranged between 18 and 82 years, and 229 of them were males. Among those patients, 183 were whites, 23 were black and 157 were mulatto.

Escleromalácia perfurante: relato de um caso / Scleromalacia perforans: case report

O autor apresenta um caso de escleromalácia perfurante em paciente com artrite reumatóide

Periósteo autógeno no tratamento da necrose de esclera após exérese de pterígio e betaterapia / Autogenous periosteum in scleral necrosis treatment after pterygium graft and betatherapy

Os autores apresentam um estudo no qual se utiliza o periósteo autógeno como alternativa de enxerto para o tratamento cirúrgico de necrose de esclera e exposiçäo uveal em olhos submetidos a betaterapia após exérese de pterígio. A revisäo da literatura demonstrou que o periósteo autógeno ainda näo havia sido utilizada neste tipo de patologia. A técnica foi empregada em cinco pacientes. Houve boa integraçäo em todos os casos. Como complicaçäo relatam um caso de dellen corneano e um caso de reabsorçäo parcial tardia do enxerto. Ressaltam a necessidade de tratar a necrose escleral para evitar a ocorrência de infecçäo que, frequentemente leva esses olhos a dano funcional irreversível.