Excessive conjunctival and scleral retraction during trabeculectomy: an unusual intraoperative complication.

Aim: Trabeculectomy is the gold standard surgery for achieving target intraocular pressure (IOP) in glaucoma. Besides the efficiency of trabeculectomy, intraoperative or postoperative complications such as, suprachoroidal hemorrhage, vitreous loss, malignant glaucoma, flat anterior chamber, hypotony, choroidal detachment, endophthalmitis, are also quite important. We present the management of excessive conjunctival and scleral retraction during trabeculectomy: an unusual intraoperative complication. Case report: A 66-year-old woman was referred to our glaucoma unit with progression of primary open angle glaucoma. No known systemic disease was observed in her history except hypertension. The best-corrected visual acuity was 20/ 63 in the right eye and 20/ 20 in the left eye. IOP was 27 mmHg and 19 mmHg (with bimatoprost timolol fixed combination and brimonidine tartrate) in the right and left eyes, respectively. We planned trabeculectomy with mitomycin C for the right eye of the patient. Excessive conjunctival and scleral retraction occurred during surgery. Autograft conjunctival tissue was prepared to cover for bare sclera area. No complications were observed in postoperative period. Seronegative spondyloarthropathy (HLA-B27-negative) was diagnosed postoperatively as a result of consultations. Discussion: Conjunctival retraction is observed as a postoperative complication after trabeculectomy. Postoperative conjunctival retraction can cause bleb leakage and hypotony, as well as predispose to infection. Nowadays, micro invasive glaucoma surgery (MIGS) is gaining popularity, especially because of its reduced complication rate compared to trabeculectomy. However, considering the IOP reduction rates, MIGS has been indicated in mild and moderate glaucoma. Conclusions: We presented the management of excessive conjunctival and scleral retraction during trabeculectomy, which has not been reported earlier. Conjunctival autograft transplantation is useful to manage this complication.

Efficacy of modified pterygium resection combined with conjunctival autograft transplantation in the treatment of pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To analyze the efficacy of modified pterygium resection combined with conjunctival autograft transplantation(CAT)in the treatment of pterygium.METHODS: A total of 140 patients(154 eyes)with pterygium treated in the ophthalmology department of our hospital from January 2018 to January 2021 were selected and grouped according to random number table method. In the observation group, 70 cases(76 eyes)were treated with modified pterygium excision combined with CAT, and improved iris restorer was used during the operation. In the control group, 70 patients(78 eyes)were treated with conventional pterygium excision combined with CAT, during which traditional iris restorer was used. Follow up for 1a, the postoperative vision, subjective symptoms, conjunctival signs(conjunctival congestion and chemosis), corneal epithelial healing, postoperative complications and recurrence rate were compared between the two groups.RESULTS: Compared with pre-operation, vision of the two groups decreased significantly on 1, 3 and 5d after operation(P<0.05), while there was no statistically significant difference between the groups(P>0.05). Compared with 1d after operation, the scores on subjective symptoms, conjunctival hyperemia and edema in the two groups decreased significantly on 3, 5 and 14d after operation(P<0.05), and those scores of the observation group on 3, 5 and 14d after operation were significantly lower than those of control group(P<0.05).The corneal fluorescein staining(FL)scores of the observation group on 3, 5 and 14d after operation were significantly lower than those of the control group(P<0.05). The proportion of repair time of corneal epithelial defect ≤5d in the observation group was significantly higher than that in the control group(P<0.05). The incidence rates of conjunctival granuloma, symblepharon, and the recurrence rate in the observation group were significantly lower than those in the control group(P<0.05).CONCLUSION: Modified pterygium resection combined with CAT is effective in the treatment of pterygium, which can alleviate postoperative irritative symptoms, conjunctival congestion and edema, and it is more conducive to postoperative corneal epithelial reconstruction, reduction of postoperative complications and recurrence rate.

Bilateral Double-headed Recurrent Pterygium: A Case Presentation and Literature Review.

Pterygium is a frequent corneal disease characterized by growing of fibrovascular tissue from the bulbar conjunctiva onto the cornea. Although the causes of pterygium are not obvious, sun exposure is closely correlated with its development. Pterygium, especially double-headed pterygium is mostly seen in warm climate and in individuals who work outdoors. A minority of pterygium is double-headed (both temporal and nasal origins). Bilateral recurrent double-headed pterygium is a very rare condition. Here, we reported a 35-year-old male patient with bilateral recurrent double-headed pterygium. A brief review about the recent literature concerning the etiology, associated risk factors, operation types and management of patients with recurrent pterygium was also discussed. The patient was a field worker, smoker and had a family history of pterygium. There was no ocular surgery history except pterygium surgery 15 years ago in both eyes. A successful pterygium excision was performed under local anesthesia with the vertical split conjunctival autograft transplantation (CAT) in both temporal and nasal parts of the right eye (randomly) for cosmetic disfigurement and avoidance of recurrence. The pathological report was consistent with pterygium. At postoperative first week, first and 1.5th month visits, conjunctival autografts were in place and stable. No complications such as infection, corneal thinning or graft dislocation were seen. The patient was satisfied with his right eye and demanded the same surgery for his left eye. We suggest vertical split simultaneous CAT as a safe and useful surgical method for the treatment of recurrent double-headed pterygium; however, longer follow-up is required to confirm the outcome.

Management of double-head pterygium with conjunctival autograft and primary closure.

PURPOSE: Double-headed pterygia are rare and present the surgeon with challenges. This case report illustrates the surgical management and the course of healing in a double-head pterygium patient. CASE REPORT: A 53-year-old man was referred to our eye hospital with a double-head pterygium of the right eye. During the follow-up examinations, 1 and 3 years later stable findings were found. Five years after initial referral we saw a progression of the double-head pterygium and the patient explained a worse visual acuity. The nasal and temporal pterygium was resected and conjunctival autograft transplantation, and a primary closure was performed, respectively, for the bulbar conjunctival reconstruction. After the surgery, a reduction in the inflammation and healing of the conjunctival lesion could be seen. At the 12-month follow-up, there was no sign of recurrence or any postoperative complication. CONCLUSION: A surgical excision combined with conjunctival autograft transplantation and primary closure in a one-time intervention seems to be effective and economical for the treatment of double-head pterygium.

Effects of excimer laser phototherapeutic keratectomy in limbal-conjunctival autograft transplantation for recurrent pterygium: a retrospective case control study.

BACKGROUND: Repeated surgery excisions could induce obvious irregular astigmatism in patients with recurrent pterygium. Our study is aimed to illustrate the effect of adjunct excimer laser phototherapeutic keratectomy (PTK) in limbal-conjunctival autograft transplantation on visual quality for patients with recurrent pterygium. METHODS: Retrospective case-control study. Eyes that underwent pterygium excision with (PTK group) or without (control group) PTK from 2006 to 2017 were retrospectively included. Recurrence rate, preoperative and postoperative surface regularity index (SRI), surface asymmetry index (SAI), cylinder and LogMAR vision were collected. Postoperative anterior segment optical coherence topography and in vivo confocal microscopy were performed to monitor the cornea epithelium healing and cellular recovery process respectively. RESULTS: A total of 99 eyes of 99 patients were collected, of which 39 were treated with PTK and 60 without PTK. The mean follow-up time was 50.4 ± 38.1 months. The recurrence rate was 10.3% (4 eyes) in the PTK group and 13.3% (8 eyes) in the control group (p = 0.759). The SRI decreased 0.53 (range: - 0.88, 2.81), SAI decreased 0.53 (range: - 0.64, 2.94), and the cylinder decreased 2.08 (range:-0.16, 9.40) D in the PTK group, and the corresponding values were 0.48 (range:-0.45, 2.27), 0.27 (range:-1.06, 2.21) and 0.71 (range:-1.75, 3.55) D in the control group, respectively (Z = 1.76, 2.15, and 3.97, p = 0.005, 0.016, and 0.000 respectively). LogMAR vision improved in both groups after surgery, with an improvement of 0.18 (range: 0.00, 0.70) in the PTK group and 0.06 (range: - 0.12, 0.50) in the control group (Z = 4.08, p = 0.000). Besides, the eyes treated with PTK showed faster re-epithelization and better cellular recovery. CONCLUSIONS: For recurrent pterygium, surgical excision with adjunct PTK might be a better option with improved corneal surface and vision outcomes.

Early postoperative outcomes of pterygium surgery: Sutures versus autogenous serum in-situ fixation of limbal conjunctival autograft.

Limbal Conjunctival Autograft Transplantation (LCAT) is considered to be the most effective treatment option for pterygium with the least recurrence rate and rapid restoration of normal epithelial morphology. Of the many available methods for securing Limbal Conjunctival Autograft (LCAG), sutures and autogenous serum in-situ are cost-effective and offers better outcomes. AIM: To compare the outcome of surgeries between the two groups: Group I - LCAG secured with autogenous serum in-situ versus Group II - LCAG secured with sutures. MAIN METHODS: A prospective randomized control trial conducted on 60 patients who were equally divided into two groups. Post-operative follow-up visits were scheduled at 1st week, 3rd week and 6th week. They were examined for pain, foreign body sensation, subconjunctival hemorrhage, tearing, hyperemia, graft edema, graft displacement, graft retraction, recurrence and/or any other complications and were graded depending on the severity. Mean surgical time was compared between the two groups. KEY FINDINGS: Average duration of surgery was significantly less in Group I than in Group II. Postoperatively, symptoms like pain, foreign body sensation, tearing and hyperemia were less common in Group I, furthermore subconjunctival hemorrhage and graft edema were more in Group II. SIGNIFICANCE: Though both the procedures are safe and effective, the use of autogenous serum in-situ significantly shortens the duration of surgery and is accompanied by lesser postoperative discomfort and inflammation. However, long-term studies are needed to assess the risk of recurrence. Graft displacement remains a severe, but infrequent complication.

Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery.

AIM: To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques: combined conjunctival autograft and overlay amniotic membrane transplantation (CAT with AMT), conjunctival autograft transplantation (CAT) alone and amniotic membrane transplantation (AMT) alone. METHODS: In this retrospective study, 142 eyes of 142 pterygium patients (104 primary, 38 recurrent) who underwent CAT (group A), AMT (group B) or CAT with AMT (group C) respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications. RESULTS: The number of recurrence post-surgery were 17 (9 from primary, 8 from recurrent; the same description below), 18 (10, 8) and 2 (1, 1) in groups A, B, and C respectively; dry eyes were 22 (16, 6), 27 (18, 9) and 7 (3, 4); conjunctival inflammations were 30 (17, 13), 27 (16, 11) and 11 (6, 5). Patients in group C (either primary or recurrent or both) mainly showed significantly better results than those in group A or B (P<0.05) regarding above-mentioned clinical effects. CONCLUSION: Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone.

Limbal-conjunctival autograft transplantation for the management of primary pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To investigate the efficiency of limbal conjunctival autografting technique in patients with primary pterygium.·METHODS: Fifteen eyes of 15 patients with primary pterygium underwent surgery for the removal of pterygium with limbal conjunctival autograft. After the pterygium excision, the limbal portion of the graft was oriented and sutured to the limbus at the recipient bed with the epithelial surface upside. Recurrence was defined as fibrovascular tissue of more than 1 mm over the cornea in the area of previous pterygium excision.·RESULTS: With mean follow-up period of 8 months, neither recurrences nor serious complications were recorded among our patients.·CONCLUSION; Simple excision followed by limbal-conjunctival autograft transplantation is a safe and very effective way of treating primary pterygium.

Preserved amniotic membrane combined with conjunctival autograft transplantation for recurrent symblepharon / 医学研究生学报

Objective:To evaluate the therapeutic effects and value of preserved amniotic membrane combined with conjunctival autograft transplantation for recurrent symblepharon. Methods:A group of 38 eyes in 38 patients with recurrent symblepharon due to recurrent pterygium,chemical burn and other causes were undertaken preserved amniotic membrane combined with conjunctival autograft transplantation.The patients were followed for 6 to 36 monthes.Results:No infections occurred.The amniotic membrane changed into transparent 10 days postoperatively.The conjunctival epithelium emigrated to the surface of amniotic membrane.Impression cytology showed a stable conjunctival epithelium on the surface of amniotic membrane.Efficient movement ability was recovered in 34 eyes(89.5%).Four eyes(10.5%) were still restricted in movement due to partly recurrent symblepharon.Conclusion:The preserved amniotic membrane combined with conjunctival autograft transplantation for is effective recurrent symblepharon

Limbal-Conjunctival Autograft Transplantation for the Treatment of Primary Pterygium

Pterygium is a common surgical ocular disease which recurs frequently. Various different techniques have been developed for the successful surgical treatment of pterygium and among them, autograft transplantation is known as the best successful surgical method. For the prevention of recurrence, the corneal epithelium must heal before the fibrovascular tissue grows and reaches to limbus. For this, we have believed that limbal transplanta- tion is more suitable than conjunctival transplantation. We had performed limbal-conjunctival autograft trasplata- tion for 52 patients with primary pterygia whose age was under 40 years old,or whose pterygia had involved above 5mm beyond limbus and had shown diffuse subconjunctival fibrovascular tissue. The recurrence rate was 1.9%and therewere no complications and no surgical problems. Therefore,we recommend this surgical technique as a safe and effective method of treating primary pterygia with the risk factors of recurrence.

The Clinical Results of Limbal Conjunctival Autograft Transplantation with Intraoperative Mitomycin C Application for Recurrent Pterygia

The recurrence is common problem to treat pterygium. Many surgical procedures were adopted to reduce the recurrence rate. We evaluated the surgical results of limbal conjunctival autograft transplantation (LCAT) accompanying application of 0.02% mitomycin C intraoperatively in 10 patients (10 eyes) who had a recurrent pterygium. There were 7 eyes with first recurrence and 3eyes with second recurrence. Mean age of the patients was 57.4 years, and mean follow-up period was 9.3 months. After a pterygium was excised, a sponge soaked in a solution of mitomycin C 0.02% was applied to the sclera at the site of the surgical bed for 2 minutes, then superior temporal limbal tissue was taken with conjunctival flap and transplanted to the excised area. None of all cases recurred for follow-up period and donor conjunctival site was well reepithelialized. In concluion, LCAT accompanying application of 0.02% mitomycin C intraoperatively was effective and safe method for recurrent pterygium.

The Treatment of Esodeviation with Abduction Deficiency Caused by Recurrent Pterygium

The recurrent pterygium can be caused by repeating excisions for simple pterygium. The severe conjunctival cicatrization on the area of the medial rectus muscle limits abduction and results in diplopia and it is one of the causes of acquired retraction syndrome. We experienced two patients who have marked abducticn limitation and diplopia in all directions of gaze by recurrent pterygium. In order to eliminate these troblesome symptoms and signs with only one surgery, we performed conjunctival autograft transplantation in one patient and on the other patient with bilateral recurrent pterygium, the procedure was performed with resection of the lateral rectus using adjustable suture at one time. The limitation of ocular movement and diplopia were completely gone postoperatively.