Comparison of fibrin glue and sutures for conjunctival wound closure in strabismus surgery

Purpose

To evaluate and compare the efficacy and tolerance of fibrin glue and sutures for closing conjunctival wounds in strabismus surgery.

Methods

In a prospective trial, we performed strabismus surgery using limbal incisions. Conjunctival wounds were closed with fibrin glue in 20 eyes of 20 patients (fibrin group) and 8-0 polyglactin suture in 20 eyes of 20 patients (suture group). Postoperative pain, tearing, and inflammation were compared at 1 day, 1 week, 3 weeks, and 6 weeks after surgery. Conjunctival incision healing was also investigated.

Results

One day and one week post-operatively, pain and tearing scores were lower in the fibrin group (p = 0.000, respectively). Mean surgery time was significantly shorter in the fibrin (48 ± 5 minutes) than the suture group (63 ± 7 minutes) (p = 0.000). Inflammation was significantly more severe in the suture group until 3 weeks postoperative (p = 0.000, respectively), but conjunctival healing did not differ between the groups. Hyperemia appeared more prominent in the fibrin group 3 and 6 weeks after surgery (p = 0.087 and 0.000, respectively). Two eyes in the fibrin group showed conjunctival gaps of more than 2 mm, which closed spontaneously by three weeks after surgery. No allergic reactions or infections developed.

Conclusions

Fibrin glue proved to be as effective as sutures in closing conjunctival wounds. It provides more comfortable early postoperative courses and might be considered as an alternative to sutures in strabismus surgery.     

Amniotic membrane transplantation for the repair of severe conjunctival dehiscence after strabismus surgery with adjustable sutures

PURPOSE: To evaluate the outcome of amniotic membrane transplantation (AMT) for the repair of severe conjunctival dehiscence that occurred during or after fornix-incision strabismus surgery with adjustable sutures. DESIGN: Retrospective, interventional case series. METHODS: Four patients in whom severe conjunctival dehiscence developed during or after strabismus surgery were treated with amniotic membrane grafts. The extent of conjunctival reepithelization over sclera, range of ocular motility, and patient comfort were evaluated immediately after the surgery and at 1, 2, and 4 weeks. RESULTS: The mean follow-up period was 16 weeks (range 4 to 28 weeks). Conjunctival dehiscence was detected 0 to 14 days after surgery. AMT was performed 0 to 14 days later. The conjunctival defect was reepithelized in all patients by the fourth postoperative week without evidence of scarring or restriction of motility. CONCLUSIONS: In the treatment of large conjunctival defects that may follow strabismus surgery, AMT may be an alternative to conservative management or primary conjunctival closure.     

Granuloma piogénico tras blanqueamiento ocular cosmético

Clinical caseA 46-year-old caucasian male with a history of chronic conjunctival hyperemia, presented at our clinic 5 years after he underwent the surgical procedure of cosmetic eye whitening. On examination we observed pyogenic granuloma in the right eye; besides acute nongranulomatous anterior uveitis and necrotizing scleritis in both eyes.ResultComplete clinical evaluation and full work-up exclusion of systemic diseases was done. The pyogenic granuloma was treated with surgical resection, as well as anterior uveitis and necrotizing scleritis were successfully treated with systemic corticoesteroids and methotrexate.ConclusionThe surgical cosmetic eye whitening could have as complication the pyogenic granuloma in addition to necrotizing scleritis and nongranulomatous anterior uveitis; and be present 5 years after the procedure. The surgical resection is a successful treatment for this presentation of pyogenic granuloma.     

Use of a fibrin adhesive for conjunctival closure in trabeculectomy

Purpose: To assess the safety and efficacy of a fibrin tissue adhesive (Tissucol Duo^®) used to close the conjunctiva in trabeculectomy. Methods: A nonrandomized prospective study including 57 patients with chronic simple glaucoma who underwent trabeculectomy surgery. All the trabeculectomies were conducted by the same surgeon using the same surgical technique with the exception that conjunctival closure was achieved by either running Nylon 10/0 suture (n = 29) or using the fibrin glue (n = 28). Preoperative and postoperative data were obtained on intraocular pressure (IOP), number of hypotensive medications used, self‐reported discomfort and complications arising during and after surgery. Results: No differences were detected between the two patient groups regarding the intraocular pressure reduction achieved during follow‐up. In the first 2 weeks of follow‐up, reported discomfort assessed using a visual analogue scale was significantly lower in the Tissucol Duo^® group. Two patients in the Tissucol Duo^® group suffered conjunctival dehiscence and suturing was required at 24 hours postsurgery. Remaining complications were similar in the two groups. Conclusion: The use of Tissucol Duo^® seems to be a safe and efficient option for conjunctival closure in trabeculectomy that simplifies the surgical procedure and reduces patient discomfort in the immediate postoperative period.     

Role of conjunctival inflammation in surgical outcome after amniotic membrane transplantation with or without fibrin glue for pterygium

PURPOSE: To determine the clinical significance of postoperative conjunctival inflammation noted at the third or fourth week after intraoperative application of mitomycin C and amniotic membrane transplantation for pterygium. METHODS: This retrospective study included 27 eyes of 23 patients with primary (n = 12) or recurrent (n = 15) pterygia. All cases were operated by extensive removal of subconjunctival fibrovascular tissue and intraoperative application of 0.04% mitomycin C in the fornix, followed by amniotic membrane transplantation by using either fibrin glue (14 eyes) or sutures (13 eyes). Main outcome measures included development of conjunctival inflammation, pyogenic granuloma, and pterygium recurrence after surgery. RESULTS: For a follow-up of 29.6 +/- 17.2 months (range, 6-56 months), 16 (59.3%) eyes without postoperative conjunctival inflammation resulted in favorable outcomes. Conjunctival inflammation around the surgical site was noted in the remaining 11 (40.7%) eyes and was significantly more common in eyes with sutures than those with fibrin glue (61.5% vs. 21.4%, respectively; P = 0.05). Among those with this inflammation, 7 eyes receiving subconjunctival injection of triamcinolone resulted in complete resolution and a good aesthetic outcome. Four eyes without this injection gradually developed conjunctival (n = 1) or corneal (n = 1) recurrence and/or pyogenic granuloma (n = 3). CONCLUSIONS: Host conjunctival inflammation is still common after intraoperative application of mitomycin C and amniotic membrane transplantation, especially when sutures are used in pterygium surgery. If left untreated, persistent inflammation may lead to a poor surgical outcome.     

Localized conjunctival argyrosis: a late sequela of strabismus surgery

We describe a case of focal argyrosis of the conjunctiva clinically simulating a melanoma. An 82-year-old woman was referred for an asymptomatic pigmented conjunctival lesion. Her only significant past ocular history was strabismus surgery 76 years earlier. Biopsy of the conjunctiva and lateral rectus muscle revealed the discoloration was pigment granules. Energy-dispersive x-ray microanalysis revealed the pigmentation to be silver deposits. The patient had strabismus surgery probably using a silver clip. Argyrosis should be considered in the differential diagnosis of focal pigmented conjunctival lesions.     

Merits of conjunctival frill incision in reducing trabeculectomy-induced astigmatism and patient discomfort

Purpose:To compare results of a novel “conjunctival frill/smile incision” on surgically induced astigmatism (SIA) and patient discomfort vs conventional trabeculectomy in the initial postoperative period.Methods:Sixty trabeculectomy cases were subjected to either conjunctival frill incision, performed 1.5–2.0 mm from the limbus (study group) or conventional fornix-based conjunctival flap (control group). Corneal astigmatism and suture-induced discomfort were assessed by keratometry and a self-devised patient questionnaire, respectively.Results:Both groups generated a “with the rule” SIA, which was 1.77 vs 2.42 at 1 week and reduced to 1.27 vs 1.8 in the study vs control group, after removal of sutures – both scleral flap releasable and conjunctival at 1 month. Patient discomfort score revealed enhanced comfort in 37% of patients (study group) vs 17% (control group) during the early postoperative period. After 1 month of surgery, good comfort was regained in all cases.Conclusion:This novel suturing technique results in reduced SIA, patient discomfort during the 1^st month after trabeculectomy.     

Comparison of conjunctival autograft and conjunctival transposition flap techniques in primary pterygium surgery

Purpose

To investigate and compare the efficacy of conjunctival autograft and conjunctival transpositional flap for the treatment of primary pterygium surgery.

Topical mitomycin C chemotherapy for conjunctival melanoma and PAM with atypia

AIM—To evaluate topical mitomycin C (MMC) chemotherapy in the treatment of conjunctival melanoma and primary acquired melanosis with atypia.
METHODS—In a phase I clinical trial, 10 patients with conjunctival melanoma and/or primary acquired melanosis with atypia were treated with topical MMC 0.04% four times daily. Four patients were given MMC for 28 days as a primary treatment. Six patients were treated with MMC for 7 days after excision and cryotherapy in an effort to improve local control. In this series, 10 patients have been followed for an average of 29 months.
RESULTS—All patients were noted to develop transient keratoconjunctivitis during treatment. One patient also developed a transient corneal epithelial defect. Decreased conjunctival pigmentation was noted in the four patients where topical chemotherapy was used as a primary treatment. Nodular tumours were resistant to topical MMC chemotherapy. Of the six patients treated within 2 weeks after primary excision and cryotherapy, there has been no tumour recurrence or symblepharon formation. Nine of the 10 study patients have maintained within one line of their pretreatment visual acuity. No retinal or optic nerve toxicity was noted.
CONCLUSION—Since no complications which might preclude further investigation of topical MMC chemotherapy occurred, it was concluded that topical MMC chemotherapy was tolerated as a treatment for conjunctival melanoma and primary acquired melanosis with atypia.

Keywords: conjunctival melanoma; primary acquired melanosis; mitomycin C     

The contribution of inflammatory cell infiltration to conjunctival inclusion cyst formation

PURPOSE: The incidence of inclusion cysts was examined histopathologically in conjunctival disorders where inflammatory cell infiltration was seen in the subepithelial connective tissue. METHOD: The incidence of inclusion cysts was examined histopathologically in pterygium, vernal conjunctivitis, pyogenic granuloma and pingueculitis. The specimens of pinguecula were used as control. RESULTS: Inclusion cysts were recognized in 5/55 cases of pterygium, 2/12 cases of vernal conjunctivitis, 1/4 cases of pyogenic granuloma, and 1/2 cases of pingueculitis. On the other hand no inclusion cyst was recognized in 20 cases of pinguecula in which no inflammatory cell infiltration was seen. CONCLUSIONS: Inflammatory cell infiltration may contribute to the formation of conjunctival inclusion cysts in pterygium, pingueculitis, vernal conjunctivitis and pyogenic granuloma.     

角膜缘梯形结膜瓣切口与改良Parks切口对斜视患者泪膜功能及术后并发症的影响

目的:探讨角膜缘梯形结膜瓣切口与改良Parks切口对斜视患者泪膜功能及术后并发症的影响。方法:前瞻性研究,选择2017-01/2019-10于南阳医专一附院手术治疗的斜视患者作为研究对象,分为结膜瓣切口组(60例82眼,行角膜缘梯形结膜瓣切口斜视手术)及改良Parks组(62例83眼,行改良Parks切口斜视手术),评价斜视治疗效果,于手术前后进行干眼症状评分,泪液分泌试验(SⅠt)、泪膜破裂时间(BUT)及角膜荧光素染色(FL)评分,采用眼表综合分析仪测定泪河高度(TMH)、非侵入性泪膜破裂时间(NIKBUT),手术满意度及不良反应。结果:两组患者均完成手术,角膜缘梯形结膜瓣切口组、改良Parks组分别有80、79眼达到眼位基本正位(±10PD以内),两组治愈率比较无差异(P>0.05)。改良Parks组术后7d SⅠt、BUT、FL评分、NIKBUT与角膜缘梯形结膜瓣切口组比较有差异(P<0.05)。术后14d改良Parks组SⅠt、BUT、TMH、NIKBUT较角膜缘梯形结膜瓣切口组有差异(P<0.05)。角膜缘梯形结膜瓣切口组及改良Parks组手术总体并发症发生率无差异(7.3%vs 2.4%,P>0.05),总体满意度有差异(83.3%vs 95.2%,P<0.05)。结论:角膜缘梯形结膜瓣切口与改良Parks切口手术术式对斜视均有较好的矫正效果,但改良Parks切口手术对泪膜稳定性影响较小,手术满意度较高。     

Thermal cautery as a treatment for conjunctival inclusion cyst after strabismus surgery.

Conjunctival cysts may be congenital or acquired. A common cause of acquired conjunctival inclusion cysts is the implantation of conjunctival epithelium after surgery or trauma. These cysts often form at the site of muscle reattachment after strabismus surgery. They may disappear spontaneously, but persistent cases often require surgical excision. We report a new technique using cauterization under slit-lamp visualization to treat conjunctival inclusion cysts that can form after strabismus surgery. This procedure is fast, effective, and well tolerated by patients.     

斜視手術后肥大性結膜瘢痕的治療

目的觀察應用5-氟脲嘧啶(5-FU)聯合康寧克通-A局部注射治療斜視手術后肥大性結膜瘢膜的臨床療效.方法用5-FU 2.5mg、康寧克通-A4mg對41例斜視手術后肥大性結膜瘢痕作局部注射,每周1次,共1～2次.結果隨訪6月～3年,顯效率78.05%(32例),有效率21.95%(9例).副作用有局部結膜水腫、結膜下出血及角膜上皮損傷.結論 5-FU聯合康寧克通-A局部注射是治療斜視手術后肥大性生結膜瘢痕的一種安全有效的方法.     

Timing of fornix reconstruction for postoperative conjunctival prolapse

Background and objective: To describe fornix reconstruction for conjunctival prolapse occurring after ocular surgery. Materials and methods: Two patients with persistent conjunctival prolapse of variable duration following ocular surgery underwent fornix reconstruction using the method described by Barrett. The two patients underwent different surgical methods. In the second patient, no attempt was made to include the malar periosteum.Results: Case 1 with longer duration of prolapse needed further surgery to excise residual prolapsing conjunctiva that had hyperplastic squamous epithelium. Case 2 in which fornix reconstruction was done 2 months after prolapse showed a good result after only one surgical operation.Conclusion: Forniceal reconstruction is recommended for persistent postoperative conjunctival prolapse. Early surgery appears to have better results.     

Primary localized conjunctival amyloidosis following strabismus surgery.

A 13-year-old white boy developed bilateral polypoid conjunctival masses overlying the lateral rectus muscles six months after surgery for divergent strabismus. Histologic examination confirmed the presence of amyloid in these lesions.     

AS-OCT在翼状胬肉切除联合自体结膜移植加戴绷带镜术后的结膜植片厚度测量中的应用

目的应用前段光学相干断层成像(anterior segment optical coherence tomography,AS-OCT)对翼状胬肉切除联合自体结膜移植加戴绷带镜术后患者球结膜植片厚度进行研究,同时研究绷带镜对翼状胬肉患者术后角膜上皮愈合率、疼痛评分的影响。方法回顾性分析2016年1月至2018年1月在我院眼科就诊的52例单眼初发翼状胬肉患者资料。行翼状胬肉切除联合自体球结膜移植加戴绷带镜26例为试验组,行相同手术方式但不加戴绷带镜26例为对照组,应用AS-OCT测量两组患者术后1 d、1周、2周及2个月鼻侧结膜植片距离巩膜突1 mm、2 mm及3 mm的厚度并进行比较,同时比较两组患者角膜上皮愈合率、疼痛评分。结果术后1 d,两组患者各部位结膜植片厚度比较,差异均无统计学意义(均为P>0.05);术后1周、2周、2个月,试验组各部位结膜植片厚度均较对照组薄,差异均有统计学意义(均为P<0.05)。术后1 d、1周,两组患者三处部位平均结膜植片厚度比较,差异均无统计学意义(均为P>0.05);术后2周、2个月,试验组患者三处部位平均结膜植片厚度均较对照组...     

Intumescent cataract after topical mitomycin-C for conjunctival malignant melanoma

PURPOSE: To present the clinical and histologic findings of a patient in whom intumescent cataract developed after successful topical mitomycin-C (MMC) chemotherapy for conjunctival melanoma originating from primary acquired conjunctival melanosis (PAM) with atypia. DESIGN: Observational case report; follow-up at 30 months. METHODS: In a patient with PAM and subsequent conjunctival melanoma that was successfully treated with topical MMC chemotherapy an intumescent cataract developed after two cycles of 0.04% MMC, each for 1 month. RESULTS: After MMC chemotherapy pigmentation of the acquired melanosis vanished almost completely. Histopathology of the check-up specimen revealed local tumor control. Six weeks after the completion of the second cycle, an intumescent cataract developed. Cataract surgery was performed uneventfully. The patient was followed up for 30 months. CONCLUSIONS: In selected cases, topical MMC chemotherapy is effective for treating conjunctival melanoma. Although severe complications are rare and usually transient, development of cataract may be observed. A prospective study should be initiated.     

Pyogenic granuloma following eye muscle surgery]

BACKGROUND: A pyogenic granuloma developing after eye muscle surgery is a rare complication. It can impair aestethical results and ocular motility. PATIENT AND METHODS: A 7-year-old girl presented in our department with recurrence of a conjunctival granuloma following a bimedial retroequatorial myopexia an excision of conjunctival suture granuloma in the left eye. Clinically, a nodular painless and reddish mass was found at the nasal limbus in the interpalpebral zone. Other results of ocular examinations were limitation of adduction and elevation, mild amblyopia (visual acuity 0.8) due to microstrabismus of 1 degree. After surgical excision following the initial biopsy, the histopathologic study established the diagnosis of pyogenic granuloma. After recessing residual conjunctiva and Tenon's fascia in 10 mm distance from the limbus the conjunctiva was fixed to the sclera. The sclera between the limbus and the conjunctiva was left uncovered. Reepithelialisation of the bare sclera occurred after few days. RESULTS: No further symptoms were observed during a follow-up time of 1 year. CONCLUSIONS: The rapid growth and appearance as well as the clinical examination may imitate another tumor necessitating surgical excision and histopathological study. Bare sclera-technique is a suitable method for plastic reconstruction.     

绷带式角膜接触镜在翼状胬肉切除合并结膜移植术的应用

目的:探讨绷带式角膜接触镜应用于翼状胬肉切除合并结膜移植术的临床效果。方法:回顾性分析2012-06/2013-06行翼状胬肉切除合并结膜移植术101例114眼的临床资料,按术后处理方式分为A、B、C三组,A组30例38眼,配戴绷带式角膜接触镜,B组33例38眼,绷带加压包扎,C组38例38眼,遮盖普通眼垫,术后第1,3,5d观察。结果:选取114眼术后随诊均未发生角膜溃疡、肉芽肿、复发等并发症。三组间比较在各种眼部刺激症状程度方面A组比其他两组轻;术后角膜上皮修复时间上比较A、B组短于C组。结论:绷带式角膜接触镜能明显减轻翼状胬肉切除合并结膜移植术后患者各种眼部刺激症状,促进缺损区角膜上皮修复,与传统处理方式比较能明显提高患者术后的舒适度,易于推广,风险小,具有广泛的临床实用价值。     

Pterygium excision with conjunctival autografting: an effective and safe technique.

The optimum mode of treatment for symptomatic pterygia would combine efficacy (a low recurrence rate) with safety (freedom from sight threatening complications), and would not affect visual acuity adversely. The efficacy of pterygium excision with conjunctival autografting in a sun exposed population in which pterygia are prevalent has previously been questioned. A cross sectional review of 93 eyes of 85 patients was carried out by slit-lamp examination a minimum of 6 months (range 6-76 months) after pterygium excision and free conjunctival autografting. Case notes were reviewed to obtain details of complications and visual acuity changes related to surgery. Of six recurrences (6.5%) four of these were asymptomatic with minor recurrences. Two patterns of recurrence were identified: cross graft recurrence (three cases) and outflanking (three cases). Complications (wound dehiscence, three cases; Tenon's granuloma one case; conjunctival cyst, one case) were all corrected by minor surgical revision without sequelae. Unaided acuities were unchanged or improved 3 months after surgery in 86 cases, with a minor diminution (1 Snellen line) in seven cases. This study demonstrates a low recurrence rate for a safe technique in an area in which ongoing ultraviolet light exposure levels are high and pterygia are prevalent.