1/15. Amniotic membrane transplantation after extensive removal of primary and recurrent pterygia.OBJECTIVE: To evaluate the postoperative outcome and the recurrence rate after extensive removal of primary and recurrent pterygia combined with amniotic membrane transplantation. DESIGN: A noncomparative interventional case series. PARTICIPANTS: Fifty-four eyes in 54 subjects with either primary (n = 33) or recurrent (n = 21) pterygia operated on by one surgeon (SCGT). INTERVENTION: All subjects were operated on for pterygia with an extensive excision of the lesion followed by amniotic membrane transplantation and intraoperative injection of a depot corticosteroid. MAIN OUTCOME MEASURES: Cumulative rates of conjunctival (grade 3) and corneal (grade 4) recurrence and incidence of complications. RESULTS: The mean follow-up was 12.8 /- 4.3 months for primary and 14.3 /- 4.9 months for recurrent pterygia. The true recurrence rate (grade 4) was 3.0%, 9.5%, and 5.6% for primary, recurrent, and all pterygia, respectively. The cumulative proportion of recurrence-free eyes at 12 months was 0.90 /- 0.06 for primary and 0.69 /- 0.11 for recurrent pterygia (P = 0.047, log-rank test). Removal of the semilunar fold was associated with longer survival times (P = 0.063) and decreased failure rate (P = 0.046). A similar success rate was achieved in double-head pterygia (1 recurrence in 11 eyes). CONCLUSIONS: Amniotic membrane transplantation is an effective and safe procedure for pterygium surgery, with a relatively low recurrence rate for both primary and recurrent pterygia. It can be a useful alternative to conjunctival autograft when a large conjunctival defect has to be covered, such as in primary double-head pterygia and in large recurrent pterygia.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/15. Multi-layer amniotic membrane graft for pterygium in a patient with xeroderma pigmentosum.BACKGROUND: xeroderma pigmentosum (XP) is a rare, autosomal recessive, premalignant condition of the skin, and is reported to be associated with ocular surface disorders such as conjunctival malignancy and pterygium. Herein, we report a case of successful management of pterygium with multi-layer amniotic membrane graft (AMG) in a young XP patient. CASE: An 11-year-old Japanese girl, who had been diagnosed as having XP, was referred to us for treatment of her bilateral pterygium. Surgical intervention was attempted for a temporal, presumably fast-growing pterygium in her left eye. Multi-layer amniotic membrane grafting was performed. OBSERVATIONS: The surgery-induced pain and irritation disappeared within a day. The limbal conjunctival autograft survived on the AMG and re-epithelialization over the AMG was completed in 2 weeks. Best corrected visual acuity improved from 20/32 to 20/16 one month postoperatively. During the 1-year follow-up period, no recurrence was noted. CONCLUSIONS: The present case exemplifies that AMG as an adjunct to primary pterygium resection is effective even in a young patient with XP. In addition, multi-layer AMG, which we first demonstrated in this report, seems to be useful for protecting bare sclera and extraocular muscles from mechanical injury.- - - - - - - - - - ranking = 0.85714285714286keywords = membrane (Clic here for more details about this article) |
3/15. Surgically induced necrotizing scleritis after pterygium excision and conjunctival autograft.PURPOSE: To report a case of surgically induced necrotizing scleritis (SINS) after pterygium excision and conjunctival autograft. methods: A 55-year-old man presented 2 weeks after excision of primary pterygium with conjunctival autograft in the right eye with severe pain in that eye. He had undergone cataract surgery in that eye 8 months before. The graft was pale and white. The underlying sclera was white and avascular. There was marked inflammation adjacent to the site of surgery and graft. A scraping from the graft surface revealed no organisms in smears, and culture revealed no growth. The conjunctival graft was removed. Amniotic membrane transplantation was performed. After surgery, the amniotic membrane was avascular and pale. Systemic steroid therapy was initiated. RESULTS: Three days after initiation of systemic steroid therapy, the graft became vascularized. Over the next 10 days, the eye quietened, conjunctival and scleral inflammation lessened, and the graft was well accepted. CONCLUSIONS: Surgically induced necrotizing scleritis is a rare complication of pterygium excision with conjunctival autograft. A pale graft with underlying avascular sclera and surrounding inflammation should arouse suspicion of this complication.- - - - - - - - - - ranking = 0.28571428571429keywords = membrane (Clic here for more details about this article) |
4/15. Surgical management of scleral perforation after pterygium excision.OBJECTIVE: Scleral perforation is a rare complication occurring after pterygium excision often leading to scleral ulceration and loss of vision. Our purpose is to evaluate the long-term effectiveness and safety of tenonplasty and amniotic membrane transplantation in the management of scleral perforation after pterygium excision. patients AND methods: We performed a retrospective study on patients with scleral perforation after pterygium excision that underwent tenonplasty and amniotic membrane transplantation at Chang Gung Memorial Hospital from 1997 to 1999 and followed up for at least 12 months postoperatively. RESULTS: There were 6 patients, 1 male and 5 females ranging in ages from 46 to 71 years (mean, 63.3). The interval between pterygium excisions to scleral perforation ranged from 3 to 20 years. There were no recurrences during the follow-up period of 12 to 24 months (average, 18.3 months). CONCLUSIONS: Tenonplasty and amniotic membrane transplantation appears to be a relatively simple, safe, and effective method for treating scleral perforation after pterygium excision.- - - - - - - - - - ranking = 0.42857142857143keywords = membrane (Clic here for more details about this article) |
5/15. Fordyce nodules in a buccal membrane graft to the ocular surface.PURPOSE: To present a case of epibulbar Fordyce nodules, with a referral diagnosis of primary tumor. methods: Case report. RESULTS: A 38-year-old woman was referred for ocular oncology consultation because of a conjunctival lesion in the right eye. She had had a buccal mucous graft to treat recurrent pterygium 18 years earlier. The lesion consisted of multiple small, yellow granules over a pink, thickened mucosa from the 12 to 3 o'clock meridians. Excisional biopsy revealed multiple subepithelial sebaceous glands consistent with Fordyce nodules. CONCLUSIONS: Fordyce nodules are a possible late benign complication of buccal mucous grafts.- - - - - - - - - - ranking = 0.57142857142857keywords = membrane (Clic here for more details about this article) |
6/15. Surgical treatment of chronically recurring pterygium.PURPOSE: To report the result of a combined surgical procedure of pterygium excision with simultaneous amniotic membrane transplant, conjunctival limbal autograft, and mitomycin C application in the management of two cases of chronically recurring pterygium. methods: Report of two cases. RESULTS: The two male patients, ages 24 and 42 years, had undergone six previous surgeries for pterygium, with and without adjunct procedures. In the follow-up period of 26 months for the first case and 25 months for the second case, no recurrence or complications were encountered. CONCLUSION: A combined procedure seems to be beneficial in cases of chronically recurring pterygia in younger patients. This approach may be considered when all other types of surgery have failed.- - - - - - - - - - ranking = 0.14285714285714keywords = membrane (Clic here for more details about this article) |
7/15. Reconstruction of the ocular surface by transplantation of a serum-free derived cultivated conjunctival epithelial equivalent.PURPOSE: The purpose of this study was to investigate the use of a serum-free derived cultivated conjunctival epithelial sheet for ocular surface transplantation and reconstruction. methods: Seven subjects with various ocular surface disorders were selected for the procedure: one patient had an extensive conjunctival nevus, three patients had pterygium, two patients had persistent leaking trabeculectomy blebs, and one patient had bilateral superior limbic keratoconjunctivitis. Conjunctival epithelial cells were harvested from the forniceal conjunctiva of patients 2 weeks before the definitive surgery. Cultivation of conjunctival epithelial cells on human amniotic membrane (HAM) was carried out under serum-free conditions. At the time of transplantation, the area of diseased conjunctiva was excised and the cultured conjunctival epithelium-HAM composite was transplanted onto the surgical defect. patients were followed up with serial slit-lamp examinations, fluorescein staining, and photographic documentation. RESULTS: A confluent stratified conjunctival epithelial sheet was formed on the HAM within 12 to 14 days. Transplanted grafts remained well-epithelialized after surgery. A successful outcome, defined as resolution of the disease, maintenance of conjunctival epithelialization, maintenance of graft integrity, and absence of significant complications, was obtained in all seven patients. A good functional and cosmetic result was achieved in all eyes. The mean follow-up period was 11.6 months (range, 6-18 months). CONCLUSIONS: transplantation of a serum-free derived autologous cultivated conjunctival epithelial sheet on HAM was successfully performed in seven patients with ocular surface disorders. This may provide a novel method for conjunctival replacement in conditions where the normal conjunctiva is damaged or deficient.- - - - - - - - - - ranking = 0.14285714285714keywords = membrane (Clic here for more details about this article) |
8/15. Autologous cultivated conjunctival transplantation for pterygium surgery.PURPOSE: To investigate the safety and efficacy of autologous cultivated conjunctival transplantation for the treatment of primary pterygium. DESIGN: Prospective nonrandomized clinical trial. methods: Forty patients with primary pterygium were recruited. Excision of the pterygium was followed by reconstruction using a serum-free derived autologous cultivated conjunctival equivalent in 22 patients (group A) and conventional denuded amniotic membrane transplantation in 18 patients (group B). In group A patients, conjunctival epithelial equivalents were constructed by the ex vivo expansion of conjunctival epithelial cells on human amniotic membranes (HAM). The main outcome measures were conjunctival epithelialization, recurrence, survival analysis, and incidence of complications. RESULTS: The mean follow-up was 14.1 /- 3.9 months (range, 12 to 25 months). Complete epithelialization was achieved within five days after surgery in group A patients compared with approximately three weeks for group B patients. The proportion of patients that had true recurrences was 22.7% in group A and 25.0% in group B. The mean time to recurrence was 4.8 /- 1.6 months in group A and 5.0 /- 2.9 months in group B. No ocular complications were noted in group A, while one eye (6.0%) in group B developed scleral necrosis associated with a persistent epithelial defect. CONCLUSIONS: transplantation of an autologous cultivated conjunctival epithelial sheet facilitated early postoperative epithelialization and recovery, and may aid in preventing serious complications associated with simple denuded HAM transplantation, such as scleral necrosis and secondary infection. This may provide a novel method for conjunctival epithelial replacement in the treatment of ocular surface disorders.- - - - - - - - - - ranking = 0.28571428571429keywords = membrane (Clic here for more details about this article) |
9/15. Gaze-induced Descemet's folds secondary to a primary pterygium.PURPOSE: To report a case of gaze-induced Descemet's folds secondary to a primary pterygium. methods: Interventional case report, chart review, and literature review. RESULTS: Slitlamp examination of a 49-year-old man showed Descemet's folds in the left eye on extreme right gaze secondary to the restrictive effect of a primary pterygium. The folds correlated with increasing astigmatism documented on corneal topography and restricted ocular motility and diplopia on attempted adduction. CONCLUSIONS: To the authors' knowledge, this is the first reported case of folds induced in Descemet's membrane secondary to the tethering effect of a primary pterygium.- - - - - - - - - - ranking = 0.14285714285714keywords = membrane (Clic here for more details about this article) |
10/15. A form of variable astigmatism induced by pseudopterygium.pterygium and pseudopterygium have long been known to induce astigmatism and may do so without entering the visual axis. We present a case report of a 34-year-old man with a traumatic pseudopterygium which produced a "dynamic" astigmatism, varying in different fields of gaze. Due to the pseudopterygium's attachment to the lateral canthus, it produced a tethering effect with markedly decreased vision and wrinkling of Descemet's membrane when the eye was directed away from the anchoring point. This model may apply to other ocular diseases where perilimbal attachments and adnexal adhesions to the corneal surface may occur; such connections should be looked for in cases with unexplained low levels of visual acuity.- - - - - - - - - - ranking = 0.14285714285714keywords = membrane (Clic here for more details about this article) |
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