Amniotic Membrane Graft Research Articles

A COMPARATIVE STUDY TO EVALUATE THE CLINICAL OUTCOME OF CONJUNCTIVAL LIMBAL AUTOGRAFT AND AMNIOTIC MEMBRANE TRANSPLANT FOR THE TREATMENT OF PRIMARY PTERYGIUM

Aim: The aim of the study was to assess the safety and effectiveness of the conjunctival limbal autograft (CLAG) and amniotic membrane transplantation (AMT). Methods: After a full pre-operative assessment 100 patients with primary pterygium attending the ophthalmology outpatient department of a teaching hospital in Eastern India, fulfilling the inclusion and exclusion criteria were selected for our study. The patients were explained the procedure of the study and possible outcomes. They were divided into two groups. Group A: Where 10-0 nylon was to be used for CLAG after pterygium excision. Group B: Where 10-0 nylon was to be used for AMT after pterygium excision. Results: There was marked improvement in vision postoperatively more in the AMT group than CLAG. In the AMT group: 34% had a visual acuity of LogMAR 0.00, 30% had LogMAR 0.12, 12% had LogMAR 0.18, and 24% had LogMAR 0.30 after the surgery. In the CLAG group: 52% had a visual acuity of LogMAR, 20% had LogMAR 0.12, 22% had LogMAR 0.18, and 6% had LogMAR 0.30 after the surgery. Graft and suture-related complications were more in the CLAG group than in the amniotic membrane (AM) graft group. Conclusion: In the present study, The CLAG group was found to be associated with more discomfort, and more post-operative complications than AMT. AM may provide a basement membrane rich in various growth factors and matrix proteins, which promotes epithelial cell migration, adhesion, and differentiation. It is also believed to have anti-inflammatory and antifibrotic effects and exerts anti-scarring effects through the transforming growth factor-β pathway. AMT may be a superior treatment in primary pterygium due to lower recurrence rate, shorter surgical times, and better visual and cosmetic outcomes.

Post trabeculectomy hypotonous maculopathy: Miraculous result with autologous blood injection in a young lad

A 28-year-old male patient was referred to us for the management of hypotonous maculopathy developed post trabeculectomy for angle recession glaucoma. After examination, the patient was advised cycloplegics, oral and topical steroids, but maculopathy had not settled even after treatment for 3 weeks and so scleral patch grafting was done. Post grafting also macular folds persisted and a part of the graft was exposed and so amniotic membrane grafting was done, still hypotony persisted with the development of neurosensory detachments. The over-filtration hypotonus maculopathy finally resolved with peri bleb injection of autologous whole blood.

Botryosphaeria dothidea Mycotic Keratitis: A Novel Phytopathogen Causing Human Infection.

The aim of this study was to report the first case of mycotic keratitis caused by Botryosphaeria dothidea . A 29-year-old man developed a fungal infection after being hit with chestnut thorns in the left eye. In vivo confocal microscopy, microbial culture, and next-generation sequencing (NGS) were used in the diagnosis of mycotic keratitis. The patient was provisionally diagnosed with mycotic keratitis based on IVCM and promptly received local and systemic antifungal treatment with voriconazole and amphotericin B. Although microbial culture failed to identify the pathogen, NGS revealed B. dothidea as the causative agent. Although the infection was quickly contained, corneal perforation still occurred. Owing to the lack of fresh donor corneas, the patient underwent multilayer amniotic membrane and conjunctival pedicle graft surgery. The infection was successfully controlled, and during the 6-month follow-up, the cornea remained clear in the inferotemporal optical zone. We report a novel phytopathogen- B. dothidea -causing mycotic keratitis . Our case indicates that B. dothidea responds well to voriconazole and amphotericin therapy. This case broadens the spectrum of fungal keratitis and highlights the application of NGS in identifying molds.

Freeze-dried amniotic membrane graft with a spongy layer in bilateral peripheral ulcerative keratitis: a case report

BackgroundPeripheral ulcerative keratitis (PUK) is a group of inflammatory corneal ulcers with stromal thinning and peripheral localization. Amniotic membranes (AM) are used for their anti-inflammatory and healing properties. A freeze-drying process now allows maintaining the AM viable for a long time at room temperature without altering its physical, biological, and morphologic characteristics. The effectiveness of spongy freeze-dried amniotic membrane (FD-AM) graft with multimodal imaging in the management of severe corneal thinning PUK has not been reported.Case presentationA 67-year-old Caribbean man histologically diagnosed with ulcerative colitis, was referred to our tertiary eye care center for a deep nasal juxtalimbal ulcer of the left eye. He was treated with topical steroids and antibiotics, methylprednisolone pulses, and oral prednisone. Due to continuous stromal thinning with 100 μm of residual corneal thickness, the decision was made to perform surgery. Conjunctival resection, inlay and overlay spongy FD-AM (Visio Amtrix® S, Tissue Bank of France, FR) were performed to preserve globe integrity. Despite tapering off oral steroids, PUK developed in the fellow eye on the 2 months follow-up. Treatment with human monoclonal antibody against tumor necrosis factor-alpha was initiated to control the active underlying inflammation. Six months following surgery, the ulcer was healed and corneal thickness in front of the former ulceration was measured at 525 μm on anterior segment-optical coherence tomography. Confocal microscopy confirmed the integration of the amniotic membrane between the corneal epithelium and the anterior stroma.ConclusionTransplantation of FD-AM with a spongy layer was associated with restoration of normal corneal thickness in the PUK area. It seems to be a safe, effective, and easily accessible solution for the surgical management of PUK with impending perforation.

Protonthérapie haute énergie des tumeurs extra-oculaires, kératite neurotrophique et conséquence fonctionnelle : une série de 3 cas

High energy proton therapy (HEP) is a form of radiation therapy using protons for extraocular tumors. Its ballistic properties are theoretically advantageous, but the real impact on the surrounding ocular tissues during cerebral and ENT irradiation is poorly documented. We describe three consecutive patients with corneal damage following such irradiation. Post-proton therapy neurotrophic keratitis (NK) is defined as corneal hypo/anesthesia responsible for an alteration of corneal trophicity and graded according to the Mackie classification, in terms of a prospective ophthalmological follow-up protocol for all patients with extraocular tumors treated with HEP. Among 193 patients treated with HEP between 2018 and 2021 for extraocular tumors, three patients developed severe neurotrophic keratitis, i.e. 1.6% of treated patients. According to the Mackie classification, the three patients showed grade 3 NK less than one year after the conclusion of their HEP. These three patients underwent amniotic membrane grafting. They were placed on autologous serum eye drops. Two of the three patients had to be eviscerated. The dose to the cornea was greater than 50 Gray (Gy)_Relative biological effectiveness (RBE) in the three cases. The diagnosis and etiological origin of neurotrophic keratitis are often difficult to establish. In these cases, the imputability of radiation therapy, proton therapy in our cases, in the development of neurotrophic keratitis was plausible based on the dosimetry of the patients, all of whom had anterior tumors with a poor prognosis requiring high tumoricidal doses. Further studies to establish the impact of proton therapy on corneal sensitivity are necessary. However, this feedback and the multidisciplinary management of tumors can help to limit the risk of some complications of radiation therapy. Early diagnosis allows for appropriate management and could possibly minimize the anatomical and functional ocular complications of neurotrophic keratitis.

Clinical outcomes, time span for healing of various ocular surface disorders with amniotic membrane: A prospective, an Indian study.

To study the clinical outcomes, time span of healing of various ocular surface disorders with amniotic membrane graft. A total of 41 patients, presenting to cornea clinic were included in the study and divided into five groups depending on the type of diagnosis: Group 1, with either >2 weeks of Persistent epithelial defect following cataract/retinal/glaucoma surgeries or Shield ulcers, Group 2 with >4 weeks of Non healing corneal ulcers, Group 3 with chemical injuries, Group 4 with Epithelial defects following keratoplasty, and Group 5 is the miscellaneous group. The mean age of the study subjects was 50.0 years. Overall mean duration between clinical presentation and AMT was 23.59 (30.7) days, a median 16 days (IQR; 2-26 days). Failure rate was high in Group 5 (n = 3: 30.0%) and Group 2 (n = 3: 27.3%). Time taken for epithelial closure was slower in groups 1 and 5 patients. The average time taken for reabsorption of AMG was 14.98 days. The complications included repeat AMG was in four eyes (9.75%), and graft displacement was noted in four eyes (9.75%) required resuturing, three eyes required TPK (7.31%), and one eye underwent evisceration (2.43%) following severe corneal melt secondary to neurotropic ulcer. The mean log MAR visual acuity improved from 1.52 to 1.26 at the 3 months. Understanding on timespan for healing of ocular surface disorders with AMG is needed to assess the prognosis of the disease, preoperative counselling for repeat procedures, and the compliance with regard to follow up.

The effect of different pterygium surgery techniques on the ocular surface parameters in different durations: a systematic review and meta-analysis.

To evaluate the effects of different pterygium surgery techniques on ocular surface (OS) in different follow-up periods. PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang, and China Biology Medicine disc were searched for studies reporting pre- and post-operative OS parameters in pterygium. A total of 33 articles were finally included. Three OS parameters showed relatively consistent changing trends after surgery including ocular surface disease index (OSDI), tear film break-up time (BUT), and score of corneal fluorescein staining (SCFS). They worsened significantly at 1w post-operation and then gradually improved: OSDI and BUT showed obvious improvement in 1m post-operation (SMD = - 0.58, 95%CI = [- 1.04, - 0.13]; SMD = 0.42, 95%CI = [0.06, 0.78]); SCFS was restored to preoperative levels in 3m after surgery (SMD = - 0.54, 95%CI = [- 1.16, 0.07]). Another parameter, Schirmer test without anesthesia (SIT), presented transient increase at 1w post-operation (SMD = 0.87, 95%CI = [0.27, 1.47]) and presented a relatively stable improvement after 1m post-operation (SMD = 0.52, 95%CI = [0.16, 0.89]). All parameters in amniotic membrane graft (AMT) showed better improvement in early stage and they showed non-inferior improvements in the long term compared with conjunctival autograft (CAG). Limbal-conjunctival autograft (LCAG) made excellent improvement to OS in the long term while pterygium excision (PE) showed the worst OS. The type of pterygium (primary and secondary), diabetes mellitus (DM) status, and fixation method had certain effects on the results. OS of pterygium is deteriorated at 1w post-operation then gradually improved to preoperative levels after 1m post-operation. Among various surgery techniques, LCAG had the best improvement to OS which especially displayed in the long-term outcomes.

Outcome of Application of Cryopreserved Amniotic Membrane Grafts in the Treatment of Chronic Nonhealing Wounds of Different Origins in Polymorbid Patients: A Prospective Multicenter Study.

To compare the therapeutic efficacy of cryopreserved amniotic membrane (AM) grafts and standard of care (SOC) in treating nonhealing wounds (NHW) through a prospective multicenter clinical trial, 42 patients (76% polymorbid) with 54 nonhealing wounds of various etiologies (mainly venous) and an average baseline size of 20 cm2 were included. All patients were treated for at least 6 weeks in the center before they were involved in the study. In the SOC group, 29 patients (36 wounds) were treated. If the wound healed less than 20% of the baseline size after 6 weeks, the patient was transferred to the AM group (35 patients, 43 wounds). Weekly visits included an assessment of the patient's condition, photo documentation, wound debridement, and dressing. Quality of life and the pain degree were subjectively reported by patients. After SOC, 7 wounds were healed completely, 1 defect partially, and 28 defects remained unhealed. AM application led to the complete closure of 24 wounds, partial healing occurred in 10, and 9 remained unhealed. The degree of pain and the quality of life improved significantly in all patients after AM application. This study demonstrates the effectiveness of cryopreserved AM grafts in the healing of NHW of polymorbid patients and associated pain reduction.

Demographic profile and clinical characteristics of patients presenting with acute ocular burns.

To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults. This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed. Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work-place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV-VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV-VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04). The findings clearly delineate the at-risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data-driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB.

Surgical Time and Postoperative Symptoms Study in Pterygium Excision and Amniotic Membrane Graft Using Celularity Triple Layer Dehydrated Amniotic Membrane.

To evaluate a novel sutureless glueless technique using a triple-layer dehydrated amniotic membrane (TLDAM) for pterygia excisions in surgical time, postoperative pain, epiphora, irritation, and FBS. Twenty eyes with pterygia underwent excision with mitomycin C. The conjunctival defect was closed with TLDAM placed on the dried scleral bed with the edges of the amniotic membrane tucked under the edges of the conjunctival defect. Surgical times were measured from injection of lidocaine to final placement of bandage contact lens. After a bandage contact lens was placed, the eye was patched until POD1. Patients graded self-administered questionnaires to rate pain, FBS, irritation, and epiphora on a scale of 1-5 (1-none; 5-severe) at POD1 and POW1. Surgical times ranged from 6:55 to 12:00, with mean of 8:29. Compared with a previous study of sutureless glueless methodology, the difference in mean surgical time was 11.9 (p < 0.0001). Mean questionnaire scores were as follows: POD1 pain 1.8, FBS 2.3, irritation 1.0, and epiphora 2.6; POW1 pain 1.5, FBS 1.6, irritation 1.6, and epiphora 1.6. Compared to previous studies, this technique showed significantly improved pain at POD1 (p=0.0086, p<0.0001, p<0.0001, p<0.0001) and POW1 (p=0.0002, p=0.0016, p<0.0001). Significant improvement in irritation and FBS was noted at POD1 and POW1. See Table 1 for full analysis. The sutureless glueless technique using TLDAM is a safe and effective technique compared to current standard methods. There appears to be a significant benefit regarding surgical time and postoperative pain, irritation, epiphora, and FBS compared to previous studies.

Management of 360° Peripheral Ulcerative Keratitis with Cataract in a One-Eyed: A Challenging Scenario

Abstract The purpose of this study is to discuss the management of 360° peripheral ulcerative keratitis with cataract in a patient with only one functioning eye. Peripheral ulcerative keratitis (PUK) is a type of crescent-shaped inflammatory damage that occurs in the limbal region of the cornea. PUK is always combined with an epithelial defect and the destruction of the peripheral corneal stroma. This is a case of a 78-year-old male who presented to us with complaints of redness in his right eye for the last year, with similar recurrent episodes on and off for the last 3 weeks. Examination revealed his right eye anterior segment having 360° peripheral ulcerative keratitis with dense brown hard cataract, and the uncorrected visual acuity was finger counting at 3 metres. At this point of the first examination, the eye was inflamed, so we decided to treat this patient in a phased manner. Phase-1 included a planned 360° amniotic membrane grafting when the eye is rendered quiet, followed by cataract extraction for the patient’s rehabilitation. This case demonstrates the approach we should consider in such cases, with a good result of accomplishing both phases and achieving a best-corrected visual acuity of 6/12 with a pinhole of 6/9.

Modified ulcer debridement versus argon laser photocoagulation as an adjunctive therapy for treatment of fungal keratitis

Abstract Background Mycotic keratitis is a disorder due to fungal invasion into the corneal stroma. Early diagnosis and immediate management are critical to avoiding long-term consequences with fungal keratitis as it grows quickly and can cause corneal ulcers and vision loss. Aim To compare the effect of argon laser photocoagulation with tissue debridement as a supportive therapy for treatment of fungal keratitis. Patients and methods In this prospective study, 40 patients with resistant fungal keratitis were evaluated and treated with argon laser and debridement as a supportive therapy in resistant cases.The duration of the study was 12 months with follow-up period of 3 months. Results Of 20 eyes, 18 responded to argon laser with complete epithelial healing occurring in the range of 2–4 weeks, with mean of 47.50 ± 7.96 weeks. On the contrary, 16 of 20 eyes responded to debridement, with complete healing occurring in the range of 3–7 weeks, with a mean of 46.15 ± 7.57 weeks. Two cases needed amniotic membrane graft in the laser group, whereas four cases in the debridement group. Conclusion Argon laser therapy is the most effective supplementary step in the treatment of resistant fungal keratitis. Argon laser therapy is preferred to debridement in the management of resistant fungal corneal ulcer and has a significant effect on reducing corneal scarring and improvement of visual acuity.

Auro-Keratoprosthesis for Visual Rehabilitation in Ocular Graft Versus Host Disease

Abstract A 36-year-old male presented with right eye graft melt post-penetrating keratoplasty (PK) for Aspergillus infection. The patient had a history of acute lymphocytic leukemia and had undergone a bone marrow transplant. He developed ocular graft versus host disease (GVHD) in both eyes and tissue adhesive application had to be performed for bilateral corneal melt. The right eye developed fungal keratitis, necessitating therapeutic keratoplasty. At presentation, the visual acuity was perception of light with an accurate projection of rays in the right eye and finger counting at 1 m in the left eye. An anterior chamber tap showed no organism on culture. Considering the non-ambulatory state of the patient and the need for early visual rehabilitation due to deteriorating mental well-being, a keratoprosthesis (KPro) surgery with amniotic membrane grafting was performed in the right eye. By post-operative day 20, the patient achieved a best-corrected visual acuity of 20/20. A PK was later performed in the other eye. It is conventionally believed that KPro is the last resort for bilateral corneal blindness and is commonly performed after multiple PK grafts have failed. However, this case highlights another indication of KPro in ocular GVHD; the rehabilitation of vision when PK will not work. In addition, this case illustrates the difference in the long-term outcomes between the two eyes, one that underwent early KPro surgery and the other that underwent early PK in ocular GVHD.

MACRO- AND MICROSCOPIC MORPHOLOGICAL RESULTS OF THE APPLICATION OF AUTOTRANSPLANT DEEP BACK MUSCLE FASSIS IN TYMPANOPLASTY IN RABBITS WITH CHRONIC OTITIS MEDIA

In the practical work of an otolaryngologist, clinical cases are often observed when there is an acute need for plastic materials to restore the integrity of the tympanal and neotympanal membranes. For this purpose, surgeons often began to use the following materials: fascia of the temporal muscle, inguinal and inguinal membrane, periosteum, nasal septum and lung mucosa, vein wall, amniotic membrane, polymer implants, two- and three-layer grafts. One of the urgent problems of otiatrics of great social importance is to restore the integrity of the sound transmission system in patients with chronic inflammatory diseases of the middle ear. Chronic otitis media and some of its possible complications: paresis of the facial nerve, hearing loss, severe autogenic intracerebral complications, and obvious social disadaptation of patients occupy a leading position in the diseases of the ENT organs, while the surgical treatment methods used in the treatment of this pathology are always does not give a chance to achieve satisfactory results.

Amniotic Membrane Transplant: About A Case in Mali

The amniotic membrane graft consists of suturing a fragment of membrane on the de-epithelialized area with a few separate stitches. We report a case of amniotic membrane transplant on keratitis following the local use of a traditional treatment in Mali. It was of a case of amniotic membrane transplant performed in Mali in the management of bilateral keratitis occurring following eyewash with a decoction made from cooked tamarind leaf in a 36-year-old man. We used a 3cm/3cm square AMTRIX® Amniotic Membrane from the Banque de Tissus de France. The membrane was grafted in Patch on the two eyes of our patient, this allowed us to have good healing and improved visual acuity. The use of the amniotic membrane in the management of keratitis gives good functional and anatomical results. She is now possible, However, its availability and cost remains a challenge for our developing countries.

Inter-placental variability is not a major factor affecting the healing efficiency of amniotic membrane when used for treating chronic non-healing wounds

This study aimed to evaluate the efficacy of cryopreserved amniotic membrane (AM) grafts in chronic wound healing, including the mean percentage of wound closure per one AM application, and to determine whether the healing efficiency differs between AM grafts obtained from different placentas. A retrospective study analyzing inter-placental differences in healing capacity and mean wound closure after the application of 96 AM grafts prepared from nine placentas. Only the placentas from which the AM grafts were applied to patients suffering from long-lasting non-healing wounds successfully healed by AM treatment were included. The data from the rapidly progressing wound-closure phase (p-phase) were analyzed. The mean efficiency for each placenta, expressed as an average of wound area reduction (%) seven days after the AM application (baseline, 100%), was calculated from at least 10 applications. No statistical difference between the nine placentas’ efficiency was found in the progressive phase of wound healing. The 7-day average wound reduction in particular placentas varied from 5.70 to 20.99% (median from 1.07 to 17.75) of the baseline. The mean percentage of wound surface reduction of all analyzed defects one week after the application of cryopreserved AM graft was 12.17 ± 20.12% (average ± SD). No significant difference in healing capacity was observed between the nine placentas. The data suggest that if there are intra- and inter-placental differences in AM sheets’ healing efficacy, they are overridden by the actual health status of the subject or even the status of its individual wounds.

THE LONG-TERM FOLLOW-UP OF AUTOLOGOUS BLOOD CLOT-ASSISTED LYOPHILIZED HUMAN AMNIOTIC MEMBRANE COVERING TREATMENT UNCLOSED MACULAR HOLE.

The objectives were to assess the long-term morphologic and functional outcome of eyes with unclosed macular hole (MH) in which the internal limiting membrane has been peeled in previous vitrectomy with autologous blood clot-assisted lyophilized human amniotic membrane (LhAM) graft covering. Twelve eyes with MH unclosed in previous surgery were selected and studied. Autologous blood clot-assisted LhAM graft was used to cover the MH in vitrectomy. The main clinical outcomes including best-corrected visual acuity, closure of MH, and the outcome of LhAM graft were recorded. The mean minimum diameter of the MH was 641.7 ± 245.9 µ m and the mean axial length was 27.3 ± 3.50 mm. The LhAM graft was maintained in the former position and all the MH closed in 10 eyes, whereas the graft slipped and the MH unclosed in two eyes. The MH closure rate was 83.3% and the mean best-corrected visual acuity improved significantly from 1.47 ± 0.58 logMAR (Snellen 20/590) preoperatively to 1.17 ± 0.60 logMAR (Snellen 20/296) postoperatively. During 18 to 36 months follow-up, LhAM grafts were attached to the retinal surface in nine eyes, detached from the retinal surface in one eye, dislocated from the fovea in one eye, and inserted into the retina in one eye; and macular atrophy occurred in one eye. Autologous blood clot-assisted LhAM graft covering provided a simple and effective treatment option for unclosed MH and reduce surgical trauma. Although the graft remained on the macular surface for a long time, it did not affect the recovery of MH and postoperative vision.

Long-term outcomes of fornix reconstruction and cicatricial entropion repair in ocular mucous membrane pemphigoid and drug-related secondary pemphigoid

ObjectifExaminer les résultats à long terme de la reconstruction du fornix oculaire et de la réparation de l'entropion cicatriciel en présence d'une pemphigoïde de la muqueuse oculaire (MMP, pour mucous membrane pemphigoid) et d'une MMP secondaire. MéthodesOn a procédé à un examen rétrospectif des dossiers médicaux de patients qui présentaient une MMP et qui devaient subir une reconstruction du fornix oculaire (greffe de membrane amniotique ou greffe de muqueuse buccale) ou une réparation de l'entropion cicatriciel (intervention de Wies) entre le 1er janvier 2000 et le 1er septembre 2020. La biopsie de la muqueuse des patients était positive et/ou ces derniers présentaient des caractéristiques cliniques typiques d'une MMP ou d'une MMP secondaire. Le paramètre primaire consistait en une réussite globale de la reconstruction du fornix oculaire mesurée par le maintien de sa profondeur lors de la dernière visite de suivi. La disparition du trichiasis, l'acuité visuelle et le soulagement des symptômes subjectifs comptaient au nombre des paramètres secondaires. RésultatsAinsi, 8 patients (10 yeux) présentant un diagnostic de MMP (3 hommes et 5 femmes; âge médian : 71 ans) et 4 patients (4 yeux) présentant un diagnostic de MMP secondaire (2 femmes et 2 hommes; âge médian : 87 ans) ont été admis à l’étude. La durée moyenne du suivi était de 22,7 mois (fourchette : 0,3–87,5 mois) dans le cas des patients présentant une MMP et de 15,4 mois (fourchette : 3,0–43,9 mois) dans celui des patients présentant une MMP secondaire. Dans le groupe MMP, 30,0 % des yeux ont fait l'objet d'une reconstruction du fornix oculaire, 60,0 % des yeux ont fait l'objet d'une réparation de l'entropion et 10,0 % des yeux ont subi les 2 formes d'intervention. La récurrence d'un symblépharon et la perte de la profondeur du fornix oculaire sont apparues dans tous les yeux qui présentaient une MMP en moyenne 6,4 ± 7,0 mois après l'intervention; le trichiasis avait réapparu chez tous les patients lors de la dernière visite de suivi. Chez les patients qui présentaient une MMP secondaire, 75,0 % des yeux ont présenté une récurrence du symblépharon, et 66,7 %, une récurrence du trichiasis. On a noté un soulagement à court terme des symptômes tant dans la MMP que dans la MMP secondaire. ConclusionsLa reconstruction du fornix oculaire et la réparation de l'entropion cicatriciel au sein de notre cohorte de patients présentant une MMP ou une MMP secondaire ont donné lieu à un soulagement à court terme des symptômes, mais une récurrence s'est produite en moyenne 6 mois après l'intervention.

Bilateral pseudopterygia following pediatric cataract surgery

Pseudopterygia are the advancement of the conjunctiva onto the corneal surface in the setting of active or old ocular surface inflammation. Pterygia and pseudopterygia are exceptional conditions in children.[1] We report a case of a 3-year-old child with a visually significant bilateral double-headed pseudopterygium, which developed following pediatric cataract surgery. The child was managed with pseudopterygium excision with conjunctival autograft and amniotic membrane grafting followed by visual rehabilitation.

Conjunctival and Limbal Conjunctival Autograft vs. Amniotic Membrane Graft in Primary Pterygium Surgery: A 30-Year Comprehensive Review.

The purpose of this study is to compare the "real-life" effectiveness of amniotic membrane graft (AMG) and conjunctival (CAT) or limbal conjunctival (LCA) autograft in the management of primary pterygium. Human-based studies on primary pterygium surgery that were published between 1993 and 2022 with at least 3months of follow-up were identified, and only those that were retrospective were included. The global recurrence rate of pterygium was assessed for each surgical technique separately. Specific recurrence rates taking into consideration the fixation technique (glue versus sutures) were also measured. 35 real-life retrospective subgroups comprising a total of 3747 eyes were included in the final review. The mean global recurrence rates for CAT, LCA and AMG were 7.61%, 5.50% and 9.0%, respectively. Recurrences were less common for patients who received fibrin glue (5.92%, 2.56% and 3.60%) than for those who received sutures (8.99%, 6.03% and 23.0%) for the three groups, respectively. Surgical techniques combining CAT or LCA with AMG yielded an even lower global recurrence rate (1.83%). AMG seems like a reasonable option that could be considered in primary pterygium surgery, especially when glued to the underlying sclera. Combining AMG with other treatment modalities such as CAT or LCA seems to offer an interesting alternative in terms of recurrence.