Scedosporium scleritis following pterygium excision with conjunctival autograft

2021 ◽  
Vol 3 (4) ◽  
pp. 230-235
Author(s):  
Ye Li ◽  
James McKelvie ◽  
Cliff Fairley ◽  
Cameron McLintock
Keyword(s):  
Optic Nerve ◽  
Donor Site ◽  
Oral Prednisolone ◽  
Light Perception ◽  
Conjunctival Autograft ◽  
Immune Mediated ◽  
Prior Surgery ◽  
Patch Graft ◽  
Pterygium Surgery ◽  
Pterygium Excision

A 67-year-old female presented 6 months following left pterygium surgery with autoconjunctival graft with presumed episcleritis. Following a trial of topical dexamethasone, she returned with pain, reduced vision, and a donor-site scleral nodule. MRI orbits demonstrated scleritis; oral prednisolone was commenced for presumed immune-mediated scleritis. Ten days later, vision reduced to light-perception with significant vitritis overlying a subretinal lesion associated with the donor site. Vitreous tap cultured Scedosporium aurantiacum. Treatment consisted of vitrectomy, scleral debridement with corneal patch graft, with both systemic and intravitreal voriconazole. Further scleral debridement was attempted but unable to be completed due to its posterior extent. As repeat MRI orbits showed persistent active scleritis in proximity to the optic nerve which posed a risk of meningitis, a decision was made for enucleation. This case highlights the difficulties in distinguishing between infectious and autoimmune scleritis, and the importance of excluding infection, particularly in eyes with prior surgery.

scholarly journals Outcome of Inferonasal Conjunctival Autograft in Pterygium Surgery

2021 ◽  
Vol 23 (4) ◽  
pp. 319-323
Author(s):  
Pragati Gautam Adhikari ◽  
Sagun Narayan Joshi
Keyword(s):  
Medical Records ◽  
Demographic Variables ◽  
Inclusion Criteria ◽  
Conjunctival Autograft ◽  
Donor Area ◽  
Mean Size ◽  
Pterygium Surgery ◽  
The Mean ◽  
Pterygium Excision

This study was done to evaluate the outcome of pterygium excision with inferonasal conjunctival autograft at a tertiary eye care centre. Retrospective analysis of medical records of primary pterygia patients operated by a single surgeon between 2017 to 2020 were analyzed. A total of 43 patients who met the inclusion criteria were included in the study. The demographic variables, along with size of pterygium and recurrence over a period of six month follow up was noted. The mean age of patients was 46.97 years (29-74 years). The mean size of pterygium was 3.17 mm. Recurrence was seen in 3 eyes over a period of 6 months. Graft edema was observed in 11 patients and graft hemorrhage along with congestion was seen in 8 cases which resolved over a 3 weeks follow up period. Mild conjunctival scarring was seen over donor area in 5 of the eyes. Pterygium excision with inferior conjunctival autograft is an effective alternative technique to superotemporal autograft technique.

scholarly journals Outcomes of Vertical Split Conjunctival Autograft Using Fibrin Glue in Treatment of Primary Double-Headed Pterygia

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Tarek Roshdy Elhamaky ◽  
Ahmed Mohammed Elbarky
Keyword(s):  
Fibrin Glue ◽  
Fibrous Tissue ◽  
Effective Technique ◽  
Normal Appearance ◽  
Conjunctival Autograft ◽  
Donor Area ◽  
Good Cosmetic ◽  
Pterygium Surgery ◽  
Pterygium Excision

Purpose. To evaluate the efficiency of pterygium excision with the vertical split conjunctival technique using fibrin glue in treatment of primary double-headed pterygia. Patients and Methods. 15 eyes of 15 patients with primary double-headed pterygia that underwent vertical split conjunctival autograft pterygium surgery were retrospectively reviewed. Recurrence was defined as fibrovascular proliferation over the limbus onto the cornea. Results. The patients’ mean age was 36.92 ± 10.8 years. At 12-month follow-up, recurrence was not seen in any cases. Regarding postoperative cosmetic grading, grade 1 (the appearance of the operated site is not different from the normal appearance) was found in 12 eyes (80%) and grade 2 (some fine episcleral vessels in the excised area extending up to but not beyond the limbus and without fibrous tissue) was found in 3 eyes (20%). None of the cases showed conjunctival scarring or fibrosis at the conjunctival donor area. Preoperative Sim K astigmatism at the central 3 mm and BCVA were 3.05 ± 1.5 diopters (D) and 0.64 ± 0.26 logMAR, which improved significantly to 1.15 ± 0.84 D and 0.26 ± 0.18 logMAR at 12-month follow-up postoperatively, respectively. Conclusion. Vertical split conjunctival autograft using fibrin glue is an effective technique with good cosmetic results and low to no recurrence for primary double-headed pterygia treatment. This trial is registered with NCT03507283.

Tailored Corneo-Conjunctival Autografting in Primary and Secondary Pterygium Surgery

2017 ◽  
Vol 27 (4) ◽  
pp. 407-410 ◽  
Author(s):  
Mahmoud M. Genidy ◽  
Ahmed A. Abdelghany ◽  
Jorge L. Alio
Keyword(s):  
Donor Site ◽  
Patients Âgés ◽  
Conjunctival Autograft ◽  
Nasal Side ◽  
Graft Donor ◽  
Cosmetic Outcomes ◽  
Recurrent Pterygium ◽  
Pterygium Surgery ◽  
Group 2

Purpose To describe the outcomes of a novel technique for pterygium removal: tailored corneo-conjunctival autograft, which offers the advantages of better postoperative cosmetic outcomes and recurrence prevention. Methods This retrospective interventional noncomparative study included 420 eyes in 370 patients (ages 25-60 years) (127 women, 243 men). We divided the patients into 2 groups. The first group included 348 primary pterygium; the second group included 72 recurrent pterygium. All underwent the same type of corneo-conjunctival autograft surgery from April 2009 to March 2014. The average follow-up period was 12 months. The main outcome measures were to assess pain after surgery, conjunctival healing, cosmetic appearance, and pterygium recurrence at the end of follow-up. Results In both groups, the graft donor site healed promptly without excessive scarring. No patient complained of pain during first week after surgery, except for mild discomfort. No major complications were observed such as infection or graft necrosis. In the first group, 2 patients had graft retraction towards the nasal side and were successfully managed conservatively. One patient had Tenon granuloma, which was removed surgically. Recurrence during the follow-up period was seen in one patient (0.2%). In the second group, no recurrent pterygium cases were observed. Conclusions The proposed type of corneo-conjunctival autograft offers the advantage of better postoperative cosmetic outcomes. This new technique is effective for surgical management of both primary and recurrent pterygium and preventing its recurrences.

scholarly journals A Study on Sutureless and Glue-free Conjunctival Autograft in Pterygium Surgery in A Tertiary Medical College Hospital

2019 ◽  
Vol 10 (1) ◽  
pp. 28-31
Author(s):  
Md Anwar Hossain Khan ◽  
AHM Zahirul Islam Biswas ◽  
Md Mosharrof Hossain
Keyword(s):  
Fibrin Glue ◽  
Medical College Hospital ◽  
College Hospital ◽  
Simple Method ◽  
Conjunctival Autograft ◽  
Medical College ◽  
Small Series ◽  
Pterygium Surgery ◽  
Pterygium Excision ◽  
Foreign Materials

Background: Foreign material used in ocular surface surgery may lead to local complications such as discomfort, scarring, or infection. Plasma-derived products such as fibrin glue may produce hypersensivity reactions whereas the risk of viral transmission remains. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures. Materials & Methods: This study was conducted at Jahurul Islam Medical college Hospital, Bajitpur, Kishoregonj from August 2016 to April 2018. Fifty cases with unilateral primary pterygium were selected for the study. The operation was done under local anaesthesia. After pterygium excision and fashioning of the autologus conjunctival graft, the recipient bed is allowed to achieve natural haemostasis and relative dessication before graft placement. Excessive haemorrhage in the graft bed is temponaded. Graft adherence and positioning is examined after surgery. Results: A total of 50 eyes of 50 patients mean age at the time of surgery was 40.5±10.3 years ranged from 17 to 70 years, with a female to male ratio was 1:1.94, underwent sutureless glue-free autologus conjuntival graft after pterygium excision. Mean graft area was 24(1.5) mm2. The patients were followed up for 4 months. Cosmesis was excellent in all cases and there were no intra- or post-operative complications requiring further treatment. Conclusion: This simple technique for pterygium surgery may prevent potential adverse reactions encountered with the use of foreign materials and this small series provided safe and comparable results to current methods. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 28-31

scholarly journals Comparison of conjunctival free autograft and Rotational flap technique in primary pterygium surgery: Visual changes and safety profiles

2021 ◽  
Vol 6 (3) ◽  
pp. 50-55
Author(s):  
Dr. Pawan Chaurasia ◽  
◽  
Dr. Vaishali Chaurasia ◽  
Keyword(s):  
Visual Acuity ◽  
Patient’S Satisfaction ◽  
Conjunctival Autograft ◽  
Flap Technique ◽  
Rotational Flap ◽  
Group A ◽  
Pterygium Surgery ◽  
Pterygium Excision ◽  
Group B ◽  
Visual Changes

Aims and objectives: To evaluate the postoperative symptomatic comfort, visual changes,complication and rate of recurrence in free conjunctival autograft and rotational flap technique inprimary pterygium surgery. Materials & Methods: This prospective study was conducted in 60 eyesof 60 patients, presented with primary progressive nasal pterygium larger than 1mm causingsymptomatic discomfort, astigmatism and cosmetic disfigurement. Patients were divided into twogroups randomly. In group A, patients with pterygium excision with free conjunctival autograft andgroup B, pterygium excision with rotation flap technique were included. Post-operative day 1symptomatic comfort (symptoms and signs), graft stability, corneal clarity and any complicationwere noted. Visual acuity (VA), auto-refracto keratometer measurements and detailedbiomicroscopic examinations, were performed preoperatively and postoperatively at 1month and 3months. Results: Most of the patients in our study were in the middle age group of 40-49 years(41.6%). Out of 60 patients, 35 were males (58.4%) and 25 were females (41.6%). Patients withoutdoor activities had a higher prevalence of pterygium (78.4%). The incidence of pterygium wasmore in the right eye (60%) than left eye (40%). Of the 60 patients, Grade I, II and III pterygiumwas 20%, 56.7% and 23.3% in group A and 16.7%, 63.3% and 20% in group B respectively. Themean symptomatic score was statistically significantly higher for group A for each factor (P<0.05).In the 3rd month, the overall patient’s satisfaction score was significantly higher in group B(P<0.05). Conclusion: Both surgical techniques were equally effective in terms of visual acuity,astigmatism and recurrence. The patient’s satisfaction score was significantly higher in the rotationflap technique group.

scholarly journals Twelve-Year Outcomes of Pterygium Excision with Conjunctival Autograft versus Intraoperative Mitomycin C in Double-Head Pterygium Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Tommy C. Y. Chan ◽  
Raymond L. M. Wong ◽  
Emmy Y. M. Li ◽  
Hunter K. L. Yuen ◽  
Emily F. Y. Yeung ◽  
...  
Keyword(s):  
Mitomycin C ◽  
Recurrence Rate ◽  
Clinical Assessment ◽  
Original Study ◽  
Conjunctival Autograft ◽  
Significant Difference ◽  
Pterygium Surgery ◽  
Pterygium Excision ◽  
Double Head

Purpose. The study aims to compare the long-term outcome of conjunctival autograft (CAU) and mitomycin C (MMC) in double-head pterygium surgery.Methods. This is a follow-up study of a comparative interventional trial. Thirty-nine eyes of the 36 patients with double-head pterygium excision in the original study 12 years ago were recruited for clinical assessment. Seven out of the 36 patients were lost. In the original study, each eye with double-head pterygium was randomized to have pterygium excision with CAU on one “head” (temporal or nasal) and MMC on the other “head.” All patients were invited for clinical assessment for conjunctival bed status and the presence of pterygium recurrence in the current study.Results. There was no significant difference between the size, morphology, and type of pterygium among the two treatment groups. The recurrence rate of CAU group and MMC group 12 years after excision was 6.3% and 28.1%, respectively (P=0.020). Among eyes without recurrence, the conjunctival bed was graded higher in the MMC group than the CAU group (P=0.024).Conclusion. The use of conjunctival autograft has a significantly lower long-term recurrence rate than mitomycin C in double-head pterygium surgery.

Pterygium surgery using a conjunctival autograft

2021 ◽  
pp. 174-178
Author(s):  
M.G. Kataev ◽  
◽  
M.A. Zakharova ◽  
I.U. Trofimova ◽  
A.V. Shakhmatova ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Effective Treatment ◽  
Recurrence Rate ◽  
Intraoperative Complication ◽  
Conjunctival Autograft ◽  
Common Technique ◽  
Pterygium Surgery ◽  
Pterygium Excision ◽  
Different Sources

Surgery is the only effective treatment for pterygium. The most common technique is the use of a conjunctival autograft after excision of the pterygium. However, the frequency of recurrences of this method, as well as possible complications in different sources, are different. Purpose. To evaluate the efficacy, safety and recurrence rate of conjunctival autograft after pterygium excision. Material and methods. 101 patients with pterygium. aged 57.31 ± 14.7 years. The follow-up period was 1 year in 56 patients and 2 years in 45 patients. All patients underwent excision of the pterygium with conjunctival autograft. Results. An intraoperative complication can be attributed to the insufficient area of the autoconjunctival graft during its transfer to the sclera, which occurred in three patients. Postoperative complications: graft edema in 14 cases (13.86%), granuloma in the suture area was observed in 1 case (0.99%). Recurrence of pterygium was noted in only three cases (2.97%). Conclusion. The use of a conjunctival autograft in pterygium surgery has shown its effectiveness and safety, as well as a low recurrence rate. The donor zone in the upper and lateral makes it possible to excise a sufficient area of autoconjunctival graft with preservation of the intact area of possible future surgery for glaucoma. Key words: conjunctival autograft, pterygium, recurrence of pterygium.

scholarly journals Pterygium excision with suture-less and glue-free conjunctival autograft

2020 ◽  
Vol 17 (2) ◽  
pp. 227-232
Author(s):  
Fariha S. Wali ◽  
Muhammad Jawed ◽  
Rafeen Talpur ◽  
Naeemullah Shaikh ◽  
Shehnilla Shujaat ◽  
...  
Keyword(s):  
Operating Time ◽  
Operation Time ◽  
Institutional Review Board ◽  
Simple Method ◽  
Conjunctival Autograft ◽  
Institutional Review ◽  
Pterygium Surgery ◽  
Pterygium Excision ◽  
Operative Recovery ◽  
Limbal Conjunctival Autograft

Introduction: Pterygium excision is a commonly encountered surgery with different methods being used. These procedures range from simple excision to use of grafts. Limbal conjunctival autograft is currently the most popular surgical procedure. The most common method of autograft fixation is suturing. But it has its own drawbacks like increased operating time, post-operative discomfort, inflammation, buttonholes, necrosis, giant papillary conjunctivitis, scarring, and granuloma formation. Glue is widely used due to many advantages like easy fixation of the graft, shorter operation time, and reduction in complications and post-operative discomfort but at the same time has some disadvantages also like high cost, the risk of transmission of infectionsand inactivation by iodine preparations. Purpose: In the following study, we describe a simple method of accomplishing conjunctival autograft adherence during pterygium surgery avoiding possible complications associated with the use of fibrin glue or sutures. Design: Prospective study. Method: We used conjunctival autograft, which was not sutured or glued to the scleral bed. The fibrin formed from the oozing blood was used to get the graft adhesion to the scleral bed. This study was approved by institutional review board, and written consent form was taken from each participant. Results: The suture-less and glue-free conjunctival autograft was found to have excellent results in terms of surgical outcome as well as post-operative recovery. In addition, risk of side effects related to sutures and glue was eliminated. Conclusion: Suture-less and glue-free conjunctival autograft is a new, easy, and cheaper technique for the management of pterygium.

scholarly journals Outcome of conjunctival autograft sutured with polyamide black sutures in pterygium surgery

2013 ◽  
Vol 5 (1) ◽  
pp. 94-99 ◽  
Author(s):  
CV Kavitha
Keyword(s):  
Inflammatory Reaction ◽  
Cost Effective ◽  
Patient Comfort ◽  
Conjunctival Autograft ◽  
Pterygium Surgery ◽  
Pterygium Excision ◽  
The Cost ◽  
Conjunctival Autografting ◽  
Primary Pterygium

Introduction: Pterygium excision with conjunctival autografting is the most effective way of treating pterygium with the least recurrence rate. The sutures which can be used to suture the conjunctival autograft are absorbable polyglactin 10-0 sutures or nonabsorbable polyamide 10-0 sutures. The polyamide sutures are inert, elicit minimal acute inflammatory reaction, do not support infection and allow easy removal without tissue adherence. They are very cost-effective compared to polyglactin sutures. Objective: This study was aimed to assess the efficacy of the cost-effective polyamide sutures in terms of patient comfort, graft stability, need for suture removal and recurrence. Materials and methods: In this prospective, non-comparative study, 56 eyes of 56 patients with primary pterygium underwent pterygium excision with conjunctival autograft transplantation sutured with 10-0 polyamide black sutures. The patients’ comfort, graft stability, need for suture removal and recurrence were assessed within a mean follow- up period of 28.75 months (range 47 - 14 months). Results: Mild discomfort was found in 14 (25 %) patients for up to 3 weeks, moderate discomfort in 8 (14.2 %) for up to 1 week, no patients had severe discomfort beyond the first day, and all patients were comfortable at the end of the sixth post-operative week. The graft was stable in all patients. Nine sutures in 5 patients out of 392 sutures in 56 patients, that is, 2.29 % of the sutures, needed to be removed at the end of the sixth post-operative week. Two patients, or 3.57 %, had a recurrence. Conclusion: In pterygium surgery, suturing the conjunctival autograft with cost-effective polyamide black sutures is efficient and safe. Nepal J Ophthalmol 2013; 5(9):94-99 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7833

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