scholarly journals The Effect of Limbal Autograft Location at Primary Pterygium Excision on Anterior and Posterior Corneal Astigmatism: A Comparative Prospective Study

2021 ◽  
Author(s):  
BURCU KAZANCI ◽  
Fatma Çorak Eroğlu ◽  
Emine Şen
Keyword(s):  
Corneal Astigmatism ◽  
Front Face ◽  
Radius Of Curvature ◽  
Bulbar Conjunctiva ◽  
Significant Difference ◽  
Pterygium Surgery ◽  
To Receive ◽  
Epidemiologic Features ◽  
Posterior Corneal Astigmatism ◽  
Primary Pterygium

Abstract Purpose: The aim of the study is to evaluate the effect of limbal autograft location on corneal astigmatism in inferior and superior conjunctival autografted pterygium surgery.Methods: Patients were divided into 2 groups as diagnosed with primary pterygium and planned to receive surgical treatment. Pterygium surgery was performed 25 patients with superior and 25 patients with inferior limbal autograft who have similar epidemiologic features. Cornea anterior and posterior surface keratometry (K) 1, K2, Kmax, peripheric radius (Rper) (the mean radius of curvature of the 7.0-9.0 mm ring area), refractive astigmatism and axis values, were examined. Corneal irregularity indices were the index of surface variance (ISV), index of vertical asymmetry (IVA, mm), index of height asymmetry (IHA, μm), index of height decentration (IHD, μm). The data were compared pre and postoperative and the effect of graft location on results was evaluated.Results: K1 which is from the values of the cornea front face has risen after surgery both of superior and inferior groups (p=0.011). However, no postoperative significant difference was detected in terms of the change. Otherwise, both of groups (p<0.001) have changed regarding astigmatism and Rper, but no postoperative significant difference was found in terms of the change. There were not any differences between groups regarding the changes of postoperative back face values. A significant decrease was detected on ISV, IVA, IHD values of the SLAG group (p<0.001) and ILAG group (p<0.001) in terms of all corneal anterior surface indices. However, there was no significant difference between the groups regarding the results of postoperative (p>0.05).Conclusion: The effects of pterygium surgery with limbal autograft were not significant on corneal astigmatism. However, we suggest that for the cases which need the protection of bulbar conjunctiva or when it can not be used, inferior bulbar conjunctiva preference can achieve successful results.

scholarly journals Superior versus Inferior Conjunctival Limbal Autograft with Sutures in the Management of Primary Pterygium in a Tertiary Care Hospital in Dakshina Kannada - A Cross Sectional Study

2021 ◽  
Vol 8 (11) ◽  
pp. 603-607
Author(s):  
Madhuri Upadhyaya ◽  
Sheetal Savur
Keyword(s):  
Cross Sectional Study ◽  
Bulbar Conjunctiva ◽  
Care Hospital ◽  
Sectional Study ◽  
Surgical Time ◽  
Cross Sectional ◽  
Significant Difference ◽  
The Mean ◽  
Pterygium Excision ◽  
Primary Pterygium

BACKGROUND Pterygium excision with conjunctival limbal autograft (CAU) is one of the most frequently used modalities in the treatment of pterygium. The graft has traditionally been harvested from the superior bulbar conjunctiva, but this may not be possible in all patients. The purpose of this study was to compare the intraoperative difficulties and early postoperative outcomes between superior and inferior CAU in the management of primary pterygium. METHODS This hospital based cross sectional study evaluated 58 eyes of 50 patients with primary pterygium who underwent pterygium excision with conjunctival limbal autograft secured with the help of sutures over a period of 2 years from March 2018 to March 2020. In 28 eyes, the superior bulbar conjunctiva was used for grafting whereas in 30 eyes, the inferior conjunctiva was used for the same. The outcome measured was in terms of the mean surgical time, clinical symptoms and signs in the early postoperative period and recurrence rate. RESULTS The mean age of the patients was 44.14 ± 12.71 years in the superior CAU group and 45.76 ± 14.51 years in the inferior CAU group. There was no statistically significant difference between the two groups in terms of the mean surgical time (68.39 ± 31.51 in superior group, 2.60 ± 0.79 in inferior group; P value 0.712). The duration of follow-up after surgery was significantly more (P = 0.048) in the inferior CAU group (42.60 ± 11.71 days) as compared to the superior CAU group (37.39 ± 7.52 days). Postoperative symptoms were comparable, and no recurrence was observed in either of the two groups. CONCLUSIONS Pterygium excision with inferior conjunctival limbal autograft is safe and effective in the management of primary pterygia and may be considered as an alternative to superior graft in cases where harvesting the superior conjunctiva is not possible or not advisable. KEYWORDS Primary Pterygium, Conjunctival Limbal Autograft, Inferior Graft

scholarly journals Effect of 1.8-mm steep-axis clear corneal incision on the posterior corneal astigmatism in candidates for toric IOL implantation

2020 ◽  
Author(s):  
Xi Li ◽  
Xiang Chen ◽  
Suhong He ◽  
Wen Xu
Keyword(s):  
T Test ◽  
Corneal Astigmatism ◽  
Corneal Incision ◽  
Toric Iol ◽  
Iol Implantation ◽  
Clear Corneal Incision ◽  
Significant Difference ◽  
Paired T Test ◽  
Anterior Corneal Astigmatism ◽  
Posterior Corneal Astigmatism

Abstract PURPOSE In the present study, we aimed to analyze the effects of cataract surgery using a 1.8-mm steep-axis clear corneal incision (CCI) on the posterior corneal surfaces based on the keratometry from the rotating Scheimpflug imaging device (Pentacam HR) in candidates for toric intraocular lens (IOL) implantation. METHODS Preoperative and at least 1-month postoperative data measured by Pentacam HR were collected in patients for toric IOL implantation. Surgically induced astigmatism on the posterior cornea (P-SIA) was calculated based on the preoperative and postoperative keratometric data, and the related factors of P-SIA were analyzed. RESULTS A total of 60 eyes from 56 patients were enrolled. The preoperative anterior and posterior corneal astigmatism was 1.58±0.61 D and 0.28±0.22 D, respectively. The postoperative anterior and posterior corneal astigmatism was 1.26±0.68 D and 0.41±0.26 D, respectively. The astigmatism was significantly decreased on anterior surface (P<0.001, paired t-test) and increased on posterior surface (P<0.001, paired t-test). The mean of P-SIA calculated by Holladay–Cravy–Koch method was 0.34±0.20 D, with 0.5 D or greater accounting for 26.7%. P-SIA showed no significant difference among with-the-rule (WTR) astigmatism, against-the-rule (ATR) astigmatism and oblique astigmatism (F=1.85, P=0.167). A statistically significant correlation was observed between the P-SIA and preoperative anterior corneal astigmatism (r = 0.29, P=0.024), as well as preoperative posterior corneal astigmatism (r=0.27, P=0.038). CONCLUSIONS In candidates for toric IOL implantation with a 1.8-mm steep-axis CCI, the incision caused a significant reduction of the anterior corneal astigmatism but an increase of the corneal posterior astigmatism. P-SIA could not be ignored, and it played a significant role in SIA, especially in cases with higher preoperative anterior or posterior corneal astigmatism.

scholarly journals Refractive outcome and tomographic changes after Descemet membrane endothelial keratoplasty in pseudophakic eyes with Fuchs’ endothelial dystrophy

2021 ◽  
Author(s):  
Bishr Agha ◽  
Nura Ahmad ◽  
Daniel G. Dawson ◽  
Thomas Kohnen ◽  
Ingo Schmack
Keyword(s):  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Corneal Astigmatism ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Corneal Densitometry ◽  
Scheimpflug Imaging ◽  
Fuchs Endothelial Dystrophy ◽  
Posterior Corneal Astigmatism

Abstract Purpose To analyze refractive and topographic changes secondary to Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes with Fuchs’ endothelial dystrophy (FED). Methods Eighty-seven pseudophakic eyes of 74 patients who underwent subsequent DMEK surgery for corneal endothelial decompensation and associated visual impairment were included. Median post-operative follow-up time was 12 months (range: 3–26 months). Main outcome measures were pre- and post-operative manifest refraction, anterior and posterior corneal astigmatism, simulated keratometry (CASimK) and Q value obtained by Scheimpflug imaging. Secondary outcome measures included corrected distance visual acuity (CDVA), central corneal densitometry, central corneal thickness, corneal volume (CV), anterior chamber volume (ACV) and anterior chamber depth (ACD). Results After DMEK surgery, mean pre-operative spherical equivalent (± SD) changed from + 0.04 ± 1.73 D to + 0.37 ± 1.30 D post-operatively (p = 0.06). CDVA, proportion of emmetropic eyes, ACV and ACD increased significantly during follow-up. There was also a significant decrease in posterior corneal astigmatism, central corneal densitometry, central corneal thickness and corneal volume over time (p = 0.001). Only anterior corneal astigmatism and simulated keratometry (CASimK) remained fairly stable after DMEK. Conclusion Despite tendencies toward a hyperopic shift, changes in SE were not significant and refraction remained overall stable in pseudophakic patients undergoing DMEK for FED. Analysis of corneal parameters by Scheimpflug imaging mainly revealed changes in posterior corneal astigmatism pointing out the relevance of posterior corneal profile changes during edema resolution after DMEK.

scholarly journals Does pterygium morphology affect corneal astigmatism?

2021 ◽  
Vol 13 ◽  
pp. 251584142110304
Author(s):  
Emine Doğan ◽  
Burçin Çakır ◽  
Nilgün Aksoy ◽  
Elif Köse ◽  
Gürsoy Alagöz
Keyword(s):  
Anterior Segment ◽  
Clinical Information ◽  
Corneal Astigmatism ◽  
Continuous Group ◽  
Optic Coherence Tomography ◽  
Morphological Pattern ◽  
Horizontal Length ◽  
The Mean ◽  
Anterior Corneal Astigmatism ◽  
Posterior Corneal Astigmatism

Purpose: The purpose of this study was to evaluate the correlation between corneal astigmatism and the morphology of pterygium with anterior segment optic coherence tomography (AS-OCT). Material and Methods: The size of pterygium (horizontal length, vertical width) was measured manually; pterygium area and percentage extension of the pterygium onto the cornea were calculated. Anterior and posterior corneal astigmatism, Sim K, K1, K2 were measured using a dual Scheimpflug analyzer. Morphological patterns of the pterygium analyzed with AS-OCT were determined according to the extension of the pterygium apex below the corneal epithelium. Two tomographic patterns were identified: continuous and nodular. Correlation between anterior corneal astigmatism and pterygium size, percentage extension of the pterygium, and morphological pattern of the pterygium was analyzed. Results: The mean ages of the 47 patients were 49.4 ± 16.6 (22–80) years. Mean horizontal pterygium length, vertical width, pterygium area, and percentage extension of the pterygium were 2.8 ± 1.2 mm, 4.8 ± 1.6 mm, 7.42 ± 5.6 mm2 and 24.5 ± 10.4%, respectively. Mean anterior corneal astigmatism was 2.3 ± 2.3 D and simulated keratometry was 43.4 ± 2.02 D. In terms of the morphological pattern of the pterygium, 24 eyes had continuous, 23 eyes had a nodular pattern and the median (interquartile range) anterior corneal astigmatism was 1.87 (1.01–3.80) and 1.22 D (0.58–2.35), respectively ( p = 0.102). Other topographic and pterygium size parameters were similar between groups. Analyzing the correlations in groups separately, a positive moderate statistically significant correlation was present between vertical width, percentage extension, pterygium area, and anterior corneal astigmatism in both continuous and nodular groups. Conclusions: Although not statistically significant, anterior corneal astigmatism was higher in continuous group. Using AS-OCT to standardize the morphology of pterygium could provide additional clinical information.

Comparison of 4 Techniques for Limbal-Conjunctival Autograft Fixation in Primary Pterygium Surgery

2017 ◽  
Vol 27 (4) ◽  
pp. 466-469 ◽  
Author(s):  
Luis F. Mejía ◽  
Juan P. Santamaría ◽  
Miguel Cuevas ◽  
Andrea Córdoba ◽  
Sergio A. Carvajal
Keyword(s):  
Recurrence Rate ◽  
Fibrin Glue ◽  
Ocular Inflammation ◽  
Postoperative Patient ◽  
Patient Discomfort ◽  
Conjunctival Autograft ◽  
Significant Difference ◽  
Fixation Techniques ◽  
Pterygium Surgery ◽  
Limbal Conjunctival Autograft

Purpose To compare 4 limbal-conjunctival autograft fixation techniques—conventional suture, commercial fibrin glue, autologous fibrin glue, and cautery—in primary nasal pterygium surgery. Methods This is a retrospective and descriptive study. The postoperative patient discomfort, graft edema, ocular inflammation, and other complications of 4 limbal-conjunctival autograft fixation techniques in primary nasal pterygium surgery were evaluated. Results Postoperative patient discomfort was significantly lower with the sutureless techniques (p<0.001), with fixation with cautery having the lowest rate of discomfort. Graft edema and ocular inflammation during the early postoperative period were significantly higher when fibrin glue techniques were used (p<0.001). The recurrence rate did not show a statistically significant difference (p = 0.682) among the 4 groups. Conclusion In primary nasal pterygium surgery, limbal-conjunctival autograft fixation using cautery is the technique with the lowest postoperative discomfort rate and without a statistically significant increase in recurrence rate when compared to conventional suture and fibrin glue techniques.

A Difference in Mortality Rate and Incidence of Kernicterus Among Premature Infants Allotted to Two Prophylactic Antibacterial Regimens, by William A. Silverman, et al, Pediatrics, 1956;18:614–624

PEDIATRICS ◽  
1998 ◽  
Vol 102 (Supplement_1) ◽  
pp. 225-227
Author(s):  
John C. Sinclair
Keyword(s):  
Birth Weight ◽  
Death Rate ◽  
Prophylactic Treatment ◽  
Absolute Risk ◽  
Risk Increase ◽  
Serious Infections ◽  
Significant Difference ◽  
Postmortem Blood ◽  
High Incidence ◽  
To Receive

Background. Low birth-weight (LBW) infants have a high incidence of serious infections. These are difficult to diagnose early. Thus, prophylactic treatment with antibiotics appears to be rational, but the best choice of antibiotics is uncertain. Objective. In newborn LBW infants, to compare the effects on death rate and principal findings at necropsy of two prophylactic antibacterial regimens, oxytetracycline (OT) versus penicillin/sulfisoxazole (P/S). Methods. Consecutively admitted LBW infants (N = 193) were randomly assigned, within three birth-weight strata, to receive either subcutaneous 0T or a combination of P/S. The primary outcomes were death before 120 hours, death before 28 days, and principal diagnoses at necropsy. Results. Infants allocated to P/S had a large and statistically significant increase in death rate, determined up to 120 hours (OT, 20.6%; P/S, 48.4%; absolute risk increase, 27.8%) and up to 28 days (0T, 27.8%; P/S, 63.2%; absolute risk increase, 35.3%). This increase in deaths was not attributable to death from infection; the incidence of positive postmortem blood culture results was lower in the P/S group, and there was no significant difference between groups in the incidence of pneumonia or other infections at necropsy. However, in the P/S group, there was a large, unexpected, and statistically significant increase in the finding of kernicterus at necropsy among necropsied deaths occurring up to 120 hours (0T, 6.3%; P/S 36.4%; absolute risk increase 30.1%) and up to 28 days (0T, 4.5%; P/S, 43.2%; absolute risk increase, 38.7%). Conclusions. Infants who received P/S died at a significantly higher rate and had a higher rate of kernicterus at necropsy than those who received OT. The mechanism of the differences observed in rates of mortality and death with kernicterus is unknown.

A Comparative Study Between Preoperative Subconjunctival Bevacizumab Injection And Postoperative Topical Application In Prevention Of Recurrence After Excision Of Primary Pterygium In Egyptian Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Basma Helal Mohamed ◽  
Othman Ali Othman Ziko ◽  
Hisham M Khairy Abd El Dayem ◽  
Nancy Ezzelregal Khamis Ahmed
Keyword(s):  
Corneal Thickness ◽  
Anterior Segment ◽  
P Value ◽  
Eye Drops ◽  
Subconjunctival Injection ◽  
Fibrovascular Tissue ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1 ◽  
Primary Pterygium

Abstract Purpose to compare between recurrence incidence after primary pterygium excision when using preoperative subconjunctival injection of Bevacizumab (Avastin) and using it as a postoperative eye drops. Methods thirty two eyes of thirty patients (two patients had bilateral pterygium) with primary pterygia were clinically examined, classified into 3 groups and operated by simple excision with bare sclera technique. Group 1 included 10 patients received Bevacizumab (Avastin) in the form of eye drops (10 mg/ml) 3 times daily for 6 days postoperative. Group 2 included 10 patients received preoperative Bevacizumab in the form of subconjunctival injection (1.25 mg/0.05ml) single dose 1 week preoperative. Group 3 included 10 patients (12 eyes) 2 patients with bilateral Pterygium didn’t receive any form of Bevacizumab. Postoperative follow up was done clinically and by serial photography at 1 week, 1 month, 3 months and 6 months searching for signs of recurrence and/or complications. Results The results showed different grades of recurrence in 18 eyes of 32.True recurrence was seen in 7 patients of 18 (1 patient in group 1, 2 in group 2 and 4 in group3).Recurrence grades in group 1and 2 who used the Bevacizumab (20%grade II, 50% grade III, and 30% grade IV). Recurrence could be predicted by 100% depending on fibrovascular tissue appearing in the surgical bed at 3 months postoperative (P value 0.038).Preoperative fleshy pterygium has high statistical significance in realation to recurrence(P value = 0.006).Patient’s sex, residence and occupation had no statistically significant value in the process of recurrence (P value &gt; 0.05). Patients with recurrent Pterygia (in group 1&2) had statistically significant changes in the corneal K- readings at 3 months and 6 months.No significant difference in the limbal or central corneal thickness in the operated eye and the other eye (Pvalue &gt; 0.05). Conclusion Bevacizumab (Avastin) is a well tolerated drug with multiple drug delivery methods.The eye drops give better results than the subconjunctival injection.Appearance of fibrovascular tissue in the surgical bed at 3 months predict the recurrence by 100%. Preoperative fleshy pterygia will mostly recur again whatever Bevacizumab form was used .The corneal thickness by anterior segment OCT has no role in prediction or detection of early pterygium recurrence.

Solumedrol Treatment for Severe Sepsis in Humans with a Blunted Adrenocorticotropic Hormone-Cortisol Response: A Prospective Randomized Double-Blind Placebo-Controlled Pilot Clinical Trial

2021 ◽  
pp. 088506662110388
Author(s):  
Divya Birudaraju ◽  
Sajad Hamal ◽  
John A. Tayek
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Adrenocorticotropic Hormone ◽  
Serum Cortisol ◽  
High Dose ◽  
Cortisol Response ◽  
Acth Stimulation ◽  
Double Blind ◽  
Significant Difference ◽  
To Receive

Purpose To test the benefits of Solumedrol treatment in sepsis patients with a blunted adrenocorticotropic hormone (ACTH)-cortisol response (delta <13 µg/dL) with regard to the number of days on ventilator, days on intravenous blood pressure support, length of time in an intensive care unit (ICU), 14-day mortality, and 28-day mortality. The trial was prospective, randomized, and double-blind. As part of a larger sepsis trial, 54 patients with sepsis had an intravenous ACTH stimulation test using 250 µg of ACTH, and serum cortisol was measured at times 0, 30, and 60 min. Eleven patients failed to increase their cortisol concentration above 19.9 µg/dL and were excluded from the clinical trial as they were considered to have adrenal insufficiency. The remaining 43 patients had a baseline cortisol of 32 ± 1 µg/dL increased to 38 ± 3 µg/dL at 30 min and 40 ± 3 at 60 min. All cortisol responses were <12.9 µg/dL between time 0 and time 60, which is defined as a blunted cortisol response to intravenous ACTH administration. Twenty-one were randomized to receive 20 mg of intravenous Solumedrol and 22 were randomized to receive a matching placebo every 8 h for 7-days. There was no significant difference between the two randomized groups. Data analysis was carried out bya two-tailed test and P < .05 as significant. Results Results: The mean age was 51 ± 2 (mean ± SEM) with 61% female. Groups were well matched with regard to APACHE III score in Solumedrol versus placebo (59 ± 6 vs 59 ± 6), white blood cell count (18.8 ± 2.2 vs 18.6 ± 2.6), and incidence of bacteremia (29 vs 39%). The 28-day mortality rate was reduced in the Solumedrol treated arm (43 ± 11 vs 73 ± 10%; P < .05). There was no change in days in ICU, days on blood pressure agents, or days on ventilator. Seven days of high-dose intravenous Solumedrol treatment (20 mg every 8 h) in patients with a blunted cortisol response to ACTH was associated with an improved 28-day survival. This small study suggests that an inability to increase endogenous cortisol production in patients with sepsis who are then provided steroid treatment could improve survival.

Sign in / Sign up

Export Citation Format

Share Document