Ocular surface changes in recurrent pterygium cases post-operatively treated with 5-fluorouracil subconjunctival injections.

INTRODUCTION:: To investigate the ocular surface changes occurring in eyes with recurrent pterygium post-operatively treated with 5-fluorouracil intralesional injections. METHODS:: Retrospective observational study of recurrent pterygium cases treated with weekly intralesional injections of 0.1 mL (5 mg) of 5-fluorouracil (10 injections). Impression cytology samples taken from the lesion, the healthy conjunctivae (inferior, superior, and contralateral to injury), and the cornea before and after treatment were analyzed. Clinical ocular characteristics (including Schirmer's test and break-up time) were evaluated during treatment. RESULTS:: A total of 15 eyes were treated, with the mean follow-up of 27 ± 8.7 months (mean ± standard deviation). Prior to treatment initiation, the ocular surface citology over the pterygium was found to be abnormal. No epithelial cells (27%) and a lower goblet cell density (73%) compared to the healthy conjunctivae (p < 0.01) were found. Squamous metaplasia was observed to some degree in the cornea (100%), pterygium (81%) and healthy conjunctivae (73%). Following treatment, pterygium composition had changed: epithelial cell number (100%) and goblet cell density (47%) had increased (p < 0.05). Goblet cell density was also increased in healthy conjunctivae (67%; p < 0.05). The degree of squamous metaplasia decreased in the cornea (67%), pterygium (45%), and healthy conjunctivae (60%; p < 0.05). No adverse effects were reported, recurrence progression was arrested, and conjunctival redness and dry-eye severity level were decreased in all cases (p < 0.01). DISCUSSION:: The cytology of ocular surface in recurrent pterygium is abnormal. After weekly intralesional 5-fluorouracil injections, it tends to normalize. The 5-fluorouracil compound is a safe and effective treatment to prevent pterygium recurrence.

Ocular features and histopathologic changes during follow-up of toxic epidermal necrolysis.

OBJECTIVE: To evaluate ocular surface histopathologic changes and ocular sequelae in the follow-up of patients with toxic epidermal necrolysis (TEN). DESIGN: Prospective, consecutive, comparative, interventional case series. PARTICIPANTS: Eleven patients (22 eyes) with TEN that developed after drug treatment and 33 normal subjects as the control group. METHODS: Toxic epidermal necrolysis diagnosis was based on data obtained from medical records. Only patients with ocular involvement in the acute stage were included. Patients and controls underwent a complete ophthalmic assessment, including tear film evaluation and corneal and conjunctival impression cytology. These were performed at the beginning of the study (∼1 month after TEN) and 6 and 12 months later. Tear film production and stability were evaluated by break-up time, Schirmer's test with anesthesia, rose bengal, and fluorescein staining pattern. Conjunctival retraction was determined by studying the vanishing point in eye abduction of the lacunar folds. MAIN OUTCOME MEASURES: Break-up time, Schirmer's test, fluorescein and rose bengal stain, corneal and conjunctival epithelial squamous metaplasia, conjunctival retraction, and ocular sequelae. RESULTS: Mild or moderate ocular involvement was present in 73% of patients in the acute stage. Ocular involvement was not related to TEN severity, area of skin involvement, or drug etiology. One-year follow-up, ocular manifestations, slit-lamp findings, and epithelial cell squamous metaplasia were related to ocular involvement severity in the acute phase. We found pathologic conjunctival retraction in 86.4% of patients. Decreased levels of break-up time and Schirmer's test were found in patients with TEN. Conjunctival cytology showed a marked decrease in goblet cell density. No patients died, and there were no recurrences of TEN during the study. CONCLUSIONS: Ocular involvement in the acute stage was not related to TEN severity or etiology. Ocular sequelae were related to ocular involvement severity in the acute phase. Early ophthalmic assessment and frequent follow-up are helpful because ocular involvement represents the first long-term complication in patients with TEN. Impression cytology and measurement of conjunctival retraction can be useful tools in the assessment of dynamic ocular changes in patients with TEN.

Histopathologic limbus evolution after alkaline burns.

PURPOSE: To study the histopathologic evolution of the corneal limbus after alkaline burns according to the clinical severity and therapy used. METHODS: A prospective study of 15 eyes from 12 patients (9 men and 3 women) with moderate and severe alkaline burns was performed. All patients were divided into 2 groups in accordance with the clinical ocular severity and the therapy that was used: medical therapy, amniotic membrane transplantation (AMT), autologous limbal transplantation (ALT), and ALT combined with AMT (ALT + AMT). Biopsies were obtained from affected limbal areas immediately after the ocular burn and 9 months later. RESULTS: Limbal regeneration was limited to small areas in patients with moderate burns treated with medical therapy; in contrast, the limbal structure showed significant stromal and epithelial regeneration in patients with moderate burns treated with AMT. There was an important stromal regeneration with an incomplete reepithelialization in patients with severe burns treated with AMT. Patients treated with ALT showed a good reepithelialization with a defective stromal regeneration. Epithelial and stromal regeneration was notable in patients with severe burns treated with ALT + AMT. CONCLUSIONS: In patients with moderate alkaline burns, AMT improved both limbal stromal and epithelial regeneration more effectively than medical therapy. In patients with severe burns, the best reepithelialization and stromal regeneration were obtained with ALT + AMT.