RESUMO
A 63-year-old man presented with a 10-day history of severe pain, redness of the right eye, and reduced vision in both eyes. In addition, he had been diagnosed incidentally with liver cirrhosis and splenomegaly 1 week before he was admitted to our center. The patient was found to have severe intraocular inflammation that initially involved the right eye and then progressed to bilateral panuveitis. The presenting visual acuity was 20/60 for the left eye and lumbar puncture (LP) for the right eye. Vitreous tap revealed a nonturbid, yellow fluid that was negative for organism culture, polymerase chain reaction (PCR), and tumor markers. Oral prednisolone significantly improved the clinical status of both ocular and hepatic inflammation. During the admission period, the patient developed several medical comorbid complications that temporarily altered the management of our case. After a full evaluation of uveitis causes, the patient was diagnosed with biopsy-proven autoimmune hepatitis. In addition to a high-dose oral steroid, azathioprine was given for 3 months before the patient developed decompensated liver failure, which was successfully managed with a liver transplant. The patient was stable for 1 year following the transplant but eventually developed blindness of the right eye and visual acuity of 20/30 in the left eye.
RESUMO
BACKGROUND: This study described the clinical features of patients with pterygium and analyzed the recurrence rate of conjunctival autografting alone, conjunctival autografting combined with intraoperative mitomycin C, and amniotic membrane grafting. METHODS: A retrospective cohort study of primary pterygium was conducted between January 2017 and February 2020. Factors associated with pterygium severity and recurrence were analyzed by univariate analysis and logistic regression models. RESULTS: The study included 292 patients with an average age of 53.3 ± 14.1 years, while the number of operated cases was 94. Pterygia involving the cornea were observed in 55 % of the cases. The overall rate of recurrence for the three procedures was 17 %. The average time of recurrence was 14.2 ± 11.9 months, with 37 % of the recurrences occurring after the first year. The only factor associated with a significant risk of recurrence was dry eye disease in both univariate (p = 0.021) and multivariate analysis (p = 0.026). The recurrence rates following conjunctival autografting with and without mitomycin C were 15.6 and 15.8 %, respectively. The recurrence rate following the amniotic membrane graft was twofold (OR= 2.02) (27 %) that following the conjunctival autograft (15.8 %). CONCLUSIONS: The only factor associated with the recurrence of pterygium was dry eye disease. More than one-third of recurrences developed after the first year, which stresses the importance of a long follow-up. The recurrence rate in our study following conjunctival graft was slightly higher compared to the literature mainly due to differences in study areas, populations, and follow-up periods.
