Conjunctival Granuloma Research Articles

Clinicopathologic characteristics and surgical outcome of synthetic fiber conjunctival granuloma

BackgroundUntil recently, synthetic fiber conjunctival granuloma (SFCG) is rarely reported and has been poorly understood. Our study was to explore the clinical features, histopathologic characteristics, surgical outcomes, and prognosis of SFCG after surgical excision.MethodsRetrospective review of clinical findings, histopathological and immunohistochemical studies identified 18 cases of SFCG. Specimens were routinely processed and stained with H&E. Immunohistochemical stains for GMS, PAS, CD68 and CK-pan were also performed.ResultsEighteen patients with an average age of 9.3 ± 6.6 years had a tender white to red mass on the conjunctiva. All the lesions were completely removed, and none of the patients relapsed. Histologically, all of the specimens revealed inflammatory granulation tissues with a large number of inflammatory cells infiltration and the presence of synthetic fibers. Immunohistochemical stains were positive for CD68, CK, GMS and PAS.ConclusionsSynthetic fiber conjunctival granuloma is an uncommon lesion with foreign body sensation caused by inoculation of synthetic exogenous materials. These lesions are mostly unilateral and occur in the inferior conjunctival fornix. SFCGs are characterized by a large number of inflammatory cells infiltration and the presence of synthetic fibers. Surgical excision followed by topical corticosteroids has been clinically proven to be effective.

Recurrent Conjunctival Granuloma Treated with Subconjunctival Bevacizumab

ëª©ì  ì™¸ê³¼ì  ì ˆì œ 및 ìŠ¤í Œë¡œì´ë“œ 주사에도 í˜¸ì „ë˜ì§€ 않은 재발 ê²°ë§‰ìœ¡ì•„ì¢ í™˜ìžì—ì„œ ë² ë°”ì‹œì£¼ë§™ 주사 후 치료된 증례를 ë³´ê³ í•˜ê³ ìž 한다. 증례요약 45세 여성환자가 1개월 ì „ë¶€í„° 발생한 우안 상부 ëˆˆë¬¼ì  근처의 덩이를 주소로 내원하여 덩이에 대하여 ì™¸ê³¼ì  ì ˆì œ 및 조직검사를 시행하였다. 조직검사에서 ê²°ë§‰ìœ¡ì•„ì¢ ìœ¼ë¡œ ì§„ë‹¨ë˜ì—ˆê³ 5번 재발하여, 마지막 ìˆ˜ìˆ ì‹œì—ëŠ” ì™¸ê³¼ì  ì ˆì œì™€ 함께 ë² ë°”ì‹œì£¼ë§™ì„ 덩이와 주위 조직에 주사하였다. ìˆ˜ìˆ í›„ 7개월 동안 재발은 보이지 않았으며 부작용은 관찰되지 않았다. ê²°ë¡ ë² ë°”ì‹œì£¼ë§™ 주사 치료는 재발 ê²°ë§‰ìœ¡ì•„ì¢ í™˜ìžì—ê²Œì„œ ìœ ìš©í•œ 치료로 í™œìš©í• ìˆ˜ 있을 것으로 생각된다. Keywords: Bevacizumab, Granuloma

Autologous pericranium grafts for large orbital implants.

Insufficient orbital volume in an anophthalmic socket is a major problem for the placement of an ocular prosthesis. This study reports the outcomes of the use of autologous pericranium graft in association with a large primary or secondary orbital implant in patients with a contracted socket and large orbital volume deficit. This was a retrospective single-institution study. Participants were 13 patients with contracted socket, volume deficit, and insufficient conjunctiva to cover the new implant divided into two groups, A (n = 3) and B (n = 10), according to the baseline condition of the socket. Surgery was primary evisceration (group A only) and placement of a large orbital implant followed by an autologous pericranium graft over the implant (groups A and B). Mean follow-up duration for the patient series was 9.5 months (range 9-24). Complete epithelialization of the pericranium graft was recorded at 47.3 days of follow-up (range 33-67). No cases of implant exposure or shrinkage were noted during follow-up. Main postoperative complications were conjunctival granuloma (five patients, 38.5%), conjunctival seroma (one patient, 7.7%). All patients were satisfied with the aesthetic outcome. Autologous pericranial graft was effective in reconstructing the contracted socket so that the anophthalmic socket could accommodate a larger or secondary orbital implant. The efficacy of this procedure needs to be confirmed in a larger patient series.

SUTURELESS VERSUS SUTURED CONJUNCTIVAL AUTOGRAFT FOR SURGICAL TREATMENT OF PTERYGIUM

Background: Pterygium is a degenerative ocular surface disorder with wing-shaped fibrovascular growth of the subconjunctival tissue onto the cornea. Objectives: The purpose of this study was to compare the surgical outcomes of sutureless technique versus graft suturing technique for conjunctival autograft fixation following pterygium excision. Patients and Methods: This prospective interventional case study included 20 eyes with pterygium requiring surgical excision. Operated eyes were divided into 2 equal groups. group A, where the conjunctival auto graft was placed without using sutures and with placing a tight bandage for 24 hours after excision, and group B where the conjunctival auto graft was fixed by 8/0 nylon sutures. Results: The surgical time for group A was significantly less as compared to group B. Postoperative symptoms were seen in less number of patients and were of shorter duration in group A as compared to group B. Recurrence rate and conjunctival granuloma formation rate for group A and for group B were statistically insignificant. Visual acuity and astigmatism showed improvement in both group with no statistically significant difference between both divided groups. Conclusion: Suture-less and glue free limbal conjunctival autograft was safe, effective, economical, option for pterygium surgery.

Lower eyelid transconjunctival blepharoplasty with fat repositioning: outcomes and complications

The lower eyelid changes with aging include atrophy of the orbital septum with subsequent forward herniation of orbital fat, descent of the sub-orbicularis oculi muscle fat, ptosis of the orbicularis oculi muscle, weakening of the orbito-malar ligament and the development of laxity of the eyelid skin, the tarsus and the canthal tendons. In this article we aim at describing our experience of using a modified lower lid blepharoplasty with fat repositioning in patients with lower lid fat prolapse and tear trough deformity. A retrospective, non-randomised non-comparative interventional consecutive case series of patients seeking surgical treatment. Patients underwent surgery between April 2010 and October 2019 by a single surgeon (BL). Patient demographics, clinical examination, preoperative and postoperative clinical photography, outcomes and complications were recorded. Follow-up was initially at 2 weeks and finally at 16–20 weeks. Outcomes were recorded as subjective improvement and degree of patient satisfaction. A total of 150 patients were recruited in the study period. The mean age at the time of surgery was 49. One hundred forty-one (94%) patients were very satisfied with the final outcome of their surgery, 5 were satisfied and 4 were dissatisfied. One patient developed a bilateral lower lid infection requiring abscess drainage. Seventeen other patients experienced minor complications in the postoperative period, including 2 with a unilateral lower lid infection requiring oral antibiotics, 3 with a temporary inferior oblique palsy, 1 with temporary unilateral infraorbital nerve dysfunction, 3 with residual prolapses of the lateral fat pads, 1 with a medial lower lid lump, 2 with a conjunctival granuloma, 2 with a temporary medial ectropion, 1 with persistent unilateral lower lid oedema, 1 with persistent bilateral lower lid oedema and 1 with unilateral lower lid retraction. We report a high patient satisfaction with a low rate of significant complications following our modified lower lid transconjunctival blepharoplasty with fat repositioning. Level of evidence: Level III, therapeutic study

Clinical Profile in Genetically Proven Blau Syndrome: A Case Series from South India

ABSTRACT Purpose: To report the clinical profile of genetically proven Blau syndrome in seven cases from a single center in South India. Materials & Methods: Retrospective case series Results: There were four females and three males. All cases had a history of skin and joint involvement of varying severity. Flexion contractures of the proximal interphalangeal joints were seen in all cases except Case 2. Ocular involvement was bilateral and included keratoconjunctivitis sicca (six cases), granulomatous panuveitis (three cases), granulomatous anterior uveitis (three cases), conjunctival granulomas (three cases), subepithelial corneal opacities (one case), and subretinal granuloma (one case). Other ocular findings included band-shaped keratopathy (five cases) and cataract (three cases). All cases received oral steroids and methotrexate with an addition of mycophenolate mofetil in one case. Visual prognosis was good in all cases. Conclusions: Blau syndrome is underreported in India. This is the largest case series of genetically proven Blau syndrome from South India and highlights the clinical profile of Blau syndrome seen in India.

Topical timolol for the treatment of conjunctival pyogenic granulomas: Outcomes and effect on intraocular pressure

Purpose:To report the clinical outcomes of 0.5% timolol maleate eye drops for the treatment of conjunctival pyogenic granuloma (PG) and its effect on intraocular pressure (IOP).Methods:In this retrospective study, consecutive patients with conjunctival pyogenic granuloma between January 2019 and September 2019 were prescribed 0.5% timolol maleate eye drops twice a day and followed up for 8 weeks. IOPs were measured before treatment, while on treatment and 6 weeks after treatment.Results:A total of 12 patients with conjunctival PGs were treated with 0.5% timolol maleate eye drops. Patients ranged from 7 to 72 years with a mean age of 31.1 years. Eleven (11/12; 91.6%) patients had complete resolution of pyogenic granulomas after a mean duration of treatment of 4.4 weeks (range: 3–6 weeks). One patient had a persistent PG, which showed sub-optimal resolution at 6 weeks of treatment and was surgically excised. The mean IOP of the affected eye at presentation was 15.1 mm Hg (range: 10 to 20 mm Hg; SD: ±2.9 mm Hg). One week after initiating therapy, the mean IOP was 12.1 mm Hg (range: 8–16 mm Hg; SD: ±2.4 mm Hg). The mean reduction IOP compared to the baseline IOP was statistically significant (p = 0.02). No adverse events were noted in any of the patients.Conclusion:Topical timolol is effective in the treatment of conjunctival pyogenic granulomas with no major side effects. There is a significant reduction in IOP while on treatment which is reversible and returns to baseline following completion of therapy.

Anterior chamber angle granuloma: A rare ocular manifestation of histoid lepromatous leprosy

Leprosy is a chronic multisystem disease caused by Mycobacterium leprae with frequent ocular manifestations such as madarosis, lagophthalmos, lid abnormalities, impaired corneal sensations, chronic uveitis, and cataract. Granulomas are characteristic lesion of lepromatous leprosy commonly seen as conjunctival and iris granulomas. We report a case of leprosy with a rare ocular manifestation in the form of angle mass lesion or suspected granuloma which has not been reported before and its successful management following treatment with favorable outcome. The index case also highlights the anterior segment fluorescein angiography features of the lesion and study of its vascular pattern.

Allergic conjunctival granuloma with Splendore–Hoeppli phenomenon

Allergic conjunctival granuloma (ACG) or Splendore–Hoeppli phenomenon (SHP) (asteroid bodies) is characterized by microorganisms (fungi, bacteria, and parasites) or biologically inert substances surrounded by radiating intensely eosinophilic material thought to be due to the deposition of antigen–antibody complexes and debris from the host inflammatory cells. Noninfective pathologies (hypereosinophilic syndrome and ACGs) demonstrate this phenomenon occasionally. The purpose of this case report is to report a case of ACG with SHP in a 59-year-old female with a presumed noninfectious etiology which completely resolved with surgical excision.

Pyogenic granuloma associated with conjunctival epithelial neoplasia: report of nine cases

AimsTo systematically describe the clinical and histopathological features of a case series of conjunctival carcinomatous lesions underlying as—and also masquerading—pyogenic granuloma.MethodsNine cases of conjunctival carcinomatous lesions underlying a pyogenic granuloma...

Platelet-rich plasma to rescue an ulcerated orbital dermal fat graft.

Central graft ulceration is a rare complication of an orbital dermal fat graft caused by diminished blood supply to the implant. This study reports on the efficacy and safety of the use of a single subconjunctival injection of autologous platelet-rich plasma to rescue an ulcerated orbital dermal fat graft. Three patients, who had undergone autologous dermal fat graft to treat their anophthalmic socket, were given a 2-mL subconjunctival platelet-rich plasma injection in the exposed graft margins. Demographic and clinical features, treatment protocol, clinical course, complications and follow-up time are reported. In the preoperative examination, all the patients presented a primary epithelial defect of the dermal fat graft. There were no major complications such as necrosis or infection. One patient presented a small conjunctival granuloma at 1-month follow up. Mean postoperative follow-up duration was 13 (range: 10-16) months. By 1 month, the chronic epithelial defect had resolved with the graft integrated within the orbital tissues in all cases. All patients were referred for artificial prosthesis placement. Although further work is needed, our findings suggest that a single subconjunctival platelet-rich plasma injection could be an effective, safe and economic alternative to surgery to rescue an ulcerated orbital dermal fat graft.

Ologen Implantation versus Conjunctival Autograft Transplantation for Treatment of Pterygium.

Purpose To evaluate the effectiveness and safety of Ologen implantation versus conjunctival autograft transplantation for primary pterygium. Methods A retrospective case-series analysis. Thirty-one eyes of 29 patients were included in the Ologen group and 42 eyes of 35 patients in the autograft group. The patients were followed up for 1 year and evaluated for slit-lamp biomicroscopy, intraocular pressure, and adverse events. Recurrence rate, complications, and final appearance of the cases were evaluated prospectively. Result At 1 year after operation, 2 eyes recurred (6.5%) in the Ologen group and 4 eyes recurred (9.52%) in the autograft group. There was no statistically significant difference between both groups (P=0.157, χ2 = 3.781). There was no occurrence of serious complications. Two eyes among the 31 eyes of the Ologen group were conjunctivitis; the incidence of complications was 6.45% (2 eyes). There was conjunctivitis in 3 eyes of the autograft group, 1 eye complicated with symblepharon, and 1 eye with conjunctival granuloma; the incidence of complications was 11.90% (5 eyes), and there was no statistically significant difference between both groups (P=0.094). The conjuntiva was less vascular and inflamed at 1 month postoperatively in the Ologen group than in the autograft group. Conclusions Ologen transplantation was technically easier, provided short operative time compared with conjunctival autograft transplantation, and preserved healthy conjunctiva with less complication and less recurrence; it may be a new, safe, and effective alternative for improving the short-term success rate of primary surgery.

Reconstruction of medial orbital wall using a retrocaruncular approach

The purpose of the study was to analyze and describe the retrocaruncular approach to access medial orbital wall.A retrospective analysis was performed in patients referred for the treatment of orbital fractures between January 1st 2011 and July 31st 2017. The study included patients over 18 years old with isolated fractures of the medial orbital wall or combined with the orbital floor who underwent a transconjunctival approach with retrocaruncular extension and lateral canthotomy, and with a minimum follow-up of 6 months. Patients with fractures to the roof and/or lateral orbital wall were excluded.From a total of 319 orbits, 30 medial wall fractures were treated using a retrocaruncular approach, transconjunctival extension and lateral canthotomy. 7 of them were pure medial wall fractures and 23 were combined with orbital floor. Except for one case that required delayed reconstruction with customized orbital implant, all orbital reconstructions were successful in the first surgery. Only one patient developed a conjunctival granuloma in relation to the caruncle. No others patients had complications.This study concluded that this approach is a successful access for surgical treatment of medial orbital wall fractures because of their broad visibility without damaging structures, allowing adequate orbital reconstruction and excellent aesthetic results.

Infected conjunctival pyogenic granuloma at strabismus surgery site mimicking conjunctival abscess

We present a rare case of infected pyogenic conjunctival granuloma mimicking a conjunctival abscess as complication of strabismus surgery in a Saudi girl with exotropia. Despite administration of local antibiotics following strabismus surgery, a patient presented with localised redness and discharge after three weeks. The patient was afebrile with no signs of pre-septal or orbital cellulitis. After culture (Staphylococcus aureus) sensitivity testing the patient was prescribed oral Amoxicillin and Clavulanate and reviewed under general anaesthesia. A 55 mm2 conjunctival pyogenic granuloma was noted. A punch biopsy specimen indicated inflammatory and histiocytic cells. The addition of steroid to the medical therapy resulted in a quiet eye after three weeks.

The efficacy of fascial granuloma excision with conjunctival autografting after pterygium surgery

Pterygium has a high recurrence rate after simple excision, and fascial granuloma is one of the common complications of pterygium excision. This study aimed to investigate the treatment for the fascial granuloma. In this study, the 36 eyes of 36 cases with fascial granuloma after pterygium excision were collected and divided into two groups to receive granuloma excision and conjunctival autografting or simple granuloma excision. The patients in the treatment group containing 20 cases received granuloma excision and conjunctival autografting, while the patients in the control group containing 16 cases received simple granuloma excision. The pathology examination results showed that all the removed granulomas were inflammatory granulation tissues that without bacterial infection. After 12months' follow-up, there was no recurrence of fascia granuloma and pterygium in the treatment group, in which the cure rate was up to 100%. In the control group, 6 cases experienced a recurrence of the granuloma fascia 2~3weeks after operation; after further granuloma excision and conjunctival autografting, pterygium recurred in 8 cases. The fascial granuloma excision with conjunctival autografting is effective and safe in treating fascial granuloma after pterygium surgery, which contributes to reducing the recurrence of pterygium.

Clinicopathologic Characteristics and the Surgical Outcome of Conjunctival Granulomas After Pterygium Surgery.

To measure the incidence and evaluate the clinicopathologic characteristics, surgical outcome, and prognosis of conjunctival granulomas (CGs) after pterygium surgery. This was a retrospective review of 3851 pterygium eyes (3330 patients) that underwent pterygium surgery from March 2004 to May 2017. The outcomes were evaluated in 52 eyes (50 patients) that developed CGs after pterygium surgery. CGs developed in 52 of 3851 operated pterygium eyes (1.4%) over a 13-year period. Mean patient age was 54.4 ± 9.9 years (range, 28-72 years). The mean onset time of the CG after pterygium surgery was 42.8 ± 18.3 days (range, 12-90 days). The location of the granulation was around the free conjunctival flap. Histopathologic examination showed inflammatory granulation tissue with large amounts of inflammatory cell infiltration. All CGs were successfully cured by surgical excision combined with corticosteroid eye drops. No patient had recurrence at a mean follow-up time of 6 months. Kaplan-Meier analysis showed that the difference of the cumulative survival rate of pterygium surgery methods was statistically significant (P < 0.001). Using the multivariate Cox regression model, 2 factors were found to be not correlated with the survival rate of patients with CGs: sex (P = 0.17) and the category of pterygium (primary or recurrent) (P = 0.96). CGs are an uncommon potential complication of pterygium surgery. The histologic characteristics, including the proliferation of inflammatory granulation tissue with large amounts of inflammatory cell infiltration, could be helpful to diagnose this disease. Surgical excision combined with corticosteroid drops proved to be a simple and effective treatment of CGs.

Postoperative Complications of Dermis-Fat Autografts in the Anophthalmic Socket

ABSTRACTReconstruction of the anophthalmic socket allows the use of an ocular prosthesis and rehabilitation of facial appearance. Dermis-fat grafting is one option in volume augmentation of the anophthalmic socket and presents unique benefits, including increased surface area within the socket and the ability to grow with pediatric patients. Postoperative complications of this procedure are relatively common. Minor complications, such as graft hirsutism, keratinization, and conjunctival cysts or granulomas, are managed easily by observation or simple intervention. Major complications, such as graft atrophy, infection, or ulceration, may prevent good prosthesis fit and may require return to the operating room.

Rotatory Conjunctival Flap for Pterygium Removal: A Simple and Quick Technique

Pterygium is a frequent conjunctival abnormality in outdoor workers. Genetic background factors are involved. In this study, the authors report their experience in utilizing a rotatory conjunctival flap (RCF) under local anesthesia. A retrospective analysis was conducted of all patients undergoing the proposed technique by one surgeon from 2010 to 2016. Preoperative and postoperative photographs at the longest follow-up visit were used for analysis. A total of 76 patients underwent RCF in an office setting. The average follow-up time was 9 months (range, 6 months to 4 years). All patients were satisfied with the result. One patient required a conjunctival granuloma excision. Additional advantages include the ease of operation, cost, conjunctival preservation for glaucoma filtering surgery, and a short execution time.

Conjunctival granuloma with necrosis associated with exposed suture in upper double lid masquerading as ocular surface squamous neoplasia: a case report

BackgroundThis study reports two cases of conjunctival granuloma with necrosis caused by an exposed suture in the upper palpebral conjunctiva masquerading as ocular surface squamous neoplasia.Case presentationTwo patients presented with chronic conjunctival ulcerative and granulomatous lesions on the superior bulbar conjunctiva that repeatedly recurred after the mass was removed. The pathologic findings revealed the absence of malignant cells and presence of many lymphocytes, plasma cells, and histiocytes. There was no evidence of acid-fast bacilli or fungal organisms. When a past history of blepharoplasty was established, microscopic examination revealed occult exposed suture tips. After the sutures were removed, the granuloma with necrosis was resolved within a month.ConclusionFor all conjunctival lesions in the superior bulbar conjunctiva, a thorough examination of the ocular adnexae which includes eyelid eversion should be performed. There should be a suspicion of foreign body or exposed suture material especially when there is a non-healing ulcer.

Analysis of complications of frontalis suspension using expanded polytetrafluoroethylene for ptosis in children

Objective To analyze the complications of frontalis suspension using expanded polytetrafluoroethylene (e-PTFE) for ptosis in children . Methods The data of 2100 patients accepted frontalis suspension with e-PTFE was enrolled and analyzed retrospectively. The different treatment were adopted according to the clinical manifestations of different complications. Results Complications occurred in 38 cases after surgery, included 15 cases of rejection, early postoperative acute infection ocurred in 6 cases, avulsion after blunt trauma in 5 cases, conjunctival granuloma in 2 cases, 7 cases occurred early fallback and material exposure suspended in 3 cases. After follow-up 6-12 months, all patients achieved satisfactory results. Conclusion The e-PTFE has its advantages in children blepharoptosis surgery . The occurrence of materials-related complications was only 1.8%. The satisfactory curative effect can achieve after corresponding treatment. Therefore frontalis suspension using e-PTFE is a safe and effective surgical method for children with congenital ptosis. Key words: Expanded polytetrafluoroethylene; Frontalis suspension; Ptosis, children; Complications