Postoperative Foreign Body Sensation Research Articles

Outcome of Pterygium surgery with conjunctival autologous graft using suture and tissue glue at the tertiary eye center, Thimphu, Bhutan

Introduction: Pterygium is a degenerative condition of the conjunctiva characterized by fibro vascular growth of tissue onto the cornea, often necessitating surgical treatment. Currently the conjunctival autograft technique using either suture or fibrin glue is the preferred method of treatment. The aim of the study was to evaluate the outcome of Pterygium surgery using sutures and glue to fix the graft. Methods: This observational study was carried out at the tertiary eye hospital, involving fifty-one patients (51 eyes) with primary Pterygium who underwent Pterygium surgery using either suture (19 eyes) or fibrin glue(32 eyes). The outcome measures were operative time, post-operative symptoms (pain, photophobia, foreign body sensation), and graft complications (displaced, edema, hemorrhage). Patients were followed up on day1, day 7, and day 28 after the surgery as per the standard protocol. Results: The study consisted of 17 males and 34 females, with mean ages of 51.95 (SD 9.82) in the suture group and 51.75 (SD 5.77) in the fibrin glue group. In the suture group, mean operation time was 14.16 (SD 2.71) minutes, and in the fibrin glue group, it was 13.72 (SD 4.54) minutes. With regard to the post- operative symptoms, the intensity of foreign body sensation was found to be higher in the suture group on day 1 and day 7 (p<0.003 and p<0.001, respectively). However the foreign body sensation was not observed in both groups on day 28. There was no significant difference in symptoms like Pain and photophobia. Notably, no graft complications were observed in either group on day 28. All patients completed the required follow ups. Conclusions: The use of fibrin glue in Pterygium surgery with conjunctival autografts relatively reduces surgery time and decreases early post-operative foreign body sensation thus improving early post-operative patient comfort compared to sutures.

Manifestations of ocular irritation after pterygium surgery with sutured conjunctival autograft

Background: Ocular irritation remains the main disadvantage of the sutured conjunctival graft after pterygium excision. Evaluation of the severity of these manifestations can be helpful for better patient counselling about the expected postoperative course.Aim: To evaluate the manifestations of ocular irritation in patients treated by pterygium excision with sutured conjunctival autograft.Setting: A prospective interventional case series that evaluated the postoperative manifestations of ocular irritation in pterygium patients.Methods: Twenty-five pterygium patients were treated by pterygium excision with vicryl 8/0 sutured conjunctival autograft. The severity of postoperative foreign body sensation, pain, watering, and localised hyperemia involving the nasal conjunctival quadrant were evaluated, scored, and graded.Results: The main reported symptom was foreign body sensation, with a mean grade of 1.9 ± 0.54 recorded 3 to 4 days postoperatively, which declined one week postoperatively to a mean of 1 ± 0.45. Mild to moderate tolerable symptoms were reported in 92% at the first postoperative visit with an average score of 5 ± 1.05, which declined to an average of 1.4 ± 0.52 at one week, with all the patients reporting minimal symptoms. At the end of the follow-up, the mean index of localised nasal conjunctival hyperaemia was 2.5 ± 0.39. Recurrence was recorded in one patient (4%). No other complications were encountered.Conclusion: Sutured conjunctival autograft can be used safely with tolerable short-term minimal to moderate manifestations of ocular irritation with no significant complications.

A comparative study of conventional intermarginal split lamella with labial mucous membrane graft versus sutureless procedure using fibrin sealant to manage major trichiasis.

In the intermarginal split lamella with labial mucous membrane graft procedure to manage major trichiasis, the graft is usually sutured in the receptor bed using 6-0 polyglactin sutures. We aimed to compare the use of fibrin sealant to seal the graft to the receptor bed versus the conventional technique using sutures. This is a retrospective comparative study of patients who underwent conventional intermarginal split lamella with labial mucous membrane graft or sutureless procedure using fibrin sealant (Tisseel, Baxter Healthcare Corp) between 2016 and 2021. Etiology of the trichiasis, procedure duration, postoperative discomfort and edema, complications, and follow-up period were extracted from these patients' charts. Twenty-seven eyelids from 19 patients underwent the procedure: twelve patients underwent the sutureless procedure, while seven underwent the conventional procedure. Mean follow-up was 8.4 ± 2.9months and 13.7 ± 6.5months for the sutureless and conventional groups, respectively. Patients who underwent the sutureless procedure reported no postoperative foreign body sensation, while 71.4% of patients who underwent the conventional procedure reported some degree of ocular discomfort. In the sutureless group, operating time and postoperative edema were significantly reduced. Labial mucous membrane graft dehiscence was observed in one eyelid (8.3%) on the first postoperative day in the sutureless group. No dehiscence was observed in the conventional technique group. The use of fibrin sealant showed to be a good alternative to conventional absorbable sutures. Advantages include expedited operating time, decreased postoperative discomfort, and expedite postoperative recovery.

Tension-Free Mesh Repair for Incarcerated Groin Hernia: A Comparative Study.

Background. Management of emergent groin hernias remains challenging, due to limited consensus in surgical approach and repair options (eg, mesh vs nonmesh, biological mesh, and polypropylene [PP] mesh). Methods. A 5-year retrospective study was conducted on 118 patients who received emergency incarcerated groin hernia repair in Beijing Chaoyang Hospital. The incidence of surgical site infection (SSI), preoperative mortality, sepsis, and ileus was noted. In the follow-up, postoperative foreign body sensation, chronic pain, seroma/hematoma, and recurrence were recorded. The outcomes of different surgical procedures (with mesh/without mesh, biological mesh/PP mesh, transabdominal preperitoneal (TAPP)/Lichtenstein repair) were compared and analyzed. Results. Out of the 118 patients, 14 cases received suture repair (as group A); 104 cases had TAPP repair (n = 44) or Lichtenstein repair (n = 60) with meshes, including 23 cases of biological mesh (as group B); and 81 cases had repair with PP mesh (group C). There were no significant differences between the 3 groups regarding SSI, mortality, sepsis, and ileus. After 20.5 months of follow-up (range from 6 to 65 months), 21.4% of group A developed recurrence, a rate significantly higher than that of group B (4.3%) and group C (0). The incidence of seroma/hematoma in group B was higher than that in group A (7.1%) and group C (7.4%). The results between TAPP group and Lichtenstein group were comparable. Conclusion. Tension-free mesh repair in the treatment of emergency incarcerated groin hernia is safe and effective, which can reduce hernia recurrence without increasing infection risk. The results of biological mesh and PP mesh were comparable.

Application value of drainage technique in biological patch

Objective The reliability and necessity of the drainage technique were discussed by comparing the application of drainage technique in the clinical application of acellular matrix material biological mesh. Method Forty-three patients with inguinal hernia were divided into two groups, all of whom were treated with Biodesign Surgisis（SIS） biological mesh for inguinal hernia repair. Twenty-one patients in the experimental group were treated with drainage technology, while 22 patients in the control group were not treated with drainage technology. The postoperative indicators and complications such as seroma, postoperative infection and chronic pain in the two groups were statistically analyzed. Result After statistical observation and comparison, there was a significant difference in postoperative seroma between patients with and without drainage devices (P<0.05).There was no significant difference in postoperative indicators, postoperative infection, postoperative chronic pain, postoperative foreign body sensation, postoperative recurrence, etc. (P>0.05).Conclusion The application of drainage device can reduce the occurrence of adverse events of seroma after the repair of inguinal hernia with acellular matrix material biological mesh. Keywords: biological patch; Seroma; Tension-free herniorrhaphy; The drainage device

Hydrogel ocular sealant for clear corneal incisions in cataract surgery

To assess the relationship between use of a hydrogel ocular sealant (Resure) to secure clear corneal incisions (CCIs) in cataract surgery and surgeon efficiency, patient symptomatology, and postoperative results. Duke University Eye Center, Durham, North Carolina, USA. Retrospective case series. A 1:1 matched cohort of hydrogel sealant exposure-discordant eyes of cataract surgery patients was retrospectively generated. Consecutive patients who had bilateral cataract surgery during the study period and in whom the hydrogel sealant was used to secure the CCI in only 1 of the 2 eyes were included in the study. The relationship between use of the hydrogel sealant and surgical time, 1-day postoperative foreign-body sensation, clinically noted corneal edema, and intraocular pressure (IOP) was evaluated. Ninety eyes of 45 patients were included in the study. One day postoperatively, no wound leak was found in any eye; the sealant was noted to be out of place in 2 (4.4%) of 45 cases. No statistically significant difference was found between sealant and non-sealant eyes in total surgical time (P=.16) or in IOP (P=.55), corneal edema (P=1.00), or foreign-body sensation (P=.38) 1day postoperatively. The hydrogel sealant was not observed to affect duration of surgery or 1-day postoperative IOP, corneal edema, or foreign-body sensation.

EFFECTIVENESS OF PREPERITONEAL HERNIORRHAPHY WITH Ultrapro Plug MESH FOR UMBILICAL HERNIA REPAIR IN ADULTS

To explore the effectiveness of preperitoneal herniorrhaphy with Ultrapro Plug (UPP) mesh for umbilical hernia repair in adults. Between September 2011 and June 2015, 71 patients with umbilical hernia underwent preperitoneal herniorrhaphy with UPP mesh. There were 26 males and 45 females, aged 19-92 years (mean, 54.3 years). The disease duration was 45 days to 30 years (median, 18 months). Umbilical hernia was diagnosed through physical examination, ultrasound, and other relevant auxiliary examination. According to American Society of Anesthesiologists (ASA) classification, 12 cases were rated as grade Ⅰ, 34 cases as grade Ⅱ, 21 cases as grade Ⅲ, and 4?cases as grade Ⅳ. The operation time, postoperative hospitalization time, complication, and recurrence were recorded. The diameter of hernia ring ranged 0.5-3.0 cm (mean, 1.8 cm). There was no vessel or intestine injury. The operation time was 12-35 minutes (mean, 22.4 minutes); postoperative hospitalization time was 12-48 hours (mean, 16.3 hours). Fat liquefaction of incision occurred in 2 cases, and primary healing of incision was obtained in the other cases. Sixty-nine patients were followed up 8-51 months (median, 28 months). Hernia recurrence and patch infection occurred in 1 case respectively during follow-up. No postoperative foreign body sensation and chronic pain occurred. Repairing umbilical hernia in adults with UPP mesh should be safe and reliable, because it has the advantages of short operation time, short hospital stay, less complication, and lower incidence of recurrence.

Comparison of Inferior and Superior Conjunctival Autograft for Primary Pterygium

Purpose: To determine the postoperative symptom by using inferior conjunctival autografting (ICA) rather than superior conjunctival autografting (SCA) after excision of pterygium.Methods: This prospective randomized control study evaluated 80 eyes of 80 consecutive patients undergoing primary pterygium surgery. Patients in each subgroup were then randomized into the ICA (n = 40) or SCA (n = 40) group. All patients were asked to return for follow up on days 1, 2, 3, 5, 7, and 14 then at months 1, 3, 6, and 12 postoperatively. Outcome measures were postoperative patient discomfort, corneal epithelial healing time, complications and recurrence rate.Results: Fluorescein staining revealed complete corneal epithelial healing time was 3.1 ± 0.5 d (range 2–4) in the ICA group and 3.3 ± 0.6 d (range 2–4) in the SCA group (p = 0.11). Pain scores were significantly less in the ICA group than the SCA group on follow-up days 3 and 5 (p < 0.05). Postoperative foreign body sensation scores on follow-up days 5 and 7 were significantly lower in the ICA group than the SCA group (p < 0.05). Epiphora scores were significantly less in the ICA group than the SCA group on follow-up days 3, 5, and 7 (p < 0.05). No statistically significant differences between two groups were found for the overall (conjunctival and corneal) recurrence rates (5% versus 7.5%, p = 0.64). No serious complications were encountered.Conclusion: Pterygium excision with ICA led to less postoperative discomfort for patients with primary pterygium.

Past and present of corneal refractive surgery: a retrospective study of long-term results after photorefractive keratectomy, and a prospective study of refractive lenticule extraction.

Past and present of corneal refractive surgery: a retrospective study of long-term results after photorefractive keratectomy, and a prospective study of refractive lenticule extraction.

Past and present of corneal refractive surgery

Surgical correction of refractive errors is becoming increasingly popular. In the 1990s, the excimer laser revolutionized the field of corneal refractive surgery with PRK and LASIK, and lately refractive lenticule extraction (ReLEx) of intracorneal tissue, using only a femtosecond laser, has become possible. Two new procedures were developed, ReLEx flex (FLEX) and ReLEx smile (SMILE). Until this thesis, only a few long-term studies of PRK with a relatively limited number of patients had been published; therefore, this thesis intended to retrospectively evaluate long-term outcomes after PRK for all degrees of myopia for a large number of patients. Furthermore, a prospective contralateral eye study comparing FLEX and SMILE, when treating high to moderate degrees of myopia, had not been performed prior to this study. This was the second aim of this thesis. In the first study, results from 160 PRK patients (289 eyes) were presented. Preoperative spherical equivalent ranged from -1.25 to -20.25 D, with 78% having low myopia (<-6 D). Average follow-up time was 16 years (range 13-19 years), making this the longest published follow-up study on PRK patients. Outcomes from eyes with low myopia were generally superior to outcomes from eyes with high myopia, at final follow-up. Seventy-two percent were within ± 1.00 D of target refraction, as compared to 47% of eyes with high myopia. However, results from a subgroup of unilateral treated PRK patients indicated that refraction at final follow-up was affected by myopic progression. Fifty percent of eyes with low myopia had uncorrected 20/20 distance visual acuity or better, as compared to 22% of eyes with high myopia. Haze did not occur if attempted corrections were <-4 D, and only eyes with high myopia lost two lines or more of CDVA (corrected distance visual acuity). Eighty-one per cent were satisfied or very satisfied with their surgery. The results support the continued use of the excimer laser for corneal surface ablation as a treatment option for correction of low degrees of myopia, and as the treatment of choice for subgroups of refractive patients (thin corneas, etc.). The results also highlight that treatment of higher degrees of myopia with standard PRK should only be done today under special circumstances, due to low refractive predictability, and high risk of corneal haze. Technological advances since then should be taken into account when comparing these results with contemporary techniques. In the second study, 35 patients were randomized to receive FLEX in one eye and SMILE in the other. Preoperative spherical equivalent refraction ranged from -6 to -10 D with low degrees of astigmatism. A total of 34 patients completed the 6 month follow-up period. Refractive and visual outcomes were very similar for the two methods, as well as tear film measurements and changes in corneal biomechanics. Ninety-seven percent were within ± 1.00 D of target refraction, no eyes lost two lines or more of CDVA, and contrast sensitivity was unaffected after both procedures. The changes in higher-order aberrations were also very similar. There were also no differences in tear film parameters 6 months after surgery, although less postoperative foreign body sensation was reported within the first week after surgery in SMILE eyes. Corneal sublayer pachymetry measurements demonstrated equally increased epithelial thickness 6 months after surgery. Contrary to expectations, it was not possible to measure the theoretical biomechanical advantages of a small corneal incision in SMILE as compared to a corneal flap in FLEX. The main differences between FLEX and SMILE were found when the corneal nerves and intraoperative complications were evaluated. Thus, corneal sensitivity was better preserved and corneal nerve morphology was less affected after SMILE, but intraoperative complications occurred more frequently, although without visual sequela. Finally, 97% were satisfied or very satisfied with both their surgeries. The results support the continued use of both FLEX and SMILE for treatment of up to high degrees of myopia. Overall, refractive and visual results for both procedures were good and similar, but from a biological point of view, the less invasive SMILE technique is more attractive, as demonstrated in this study, despite being slightly more surgically demanding than FLEX.

Subbasal nerve morphology, corneal sensation, and tear film evaluation after refractive femtosecond laser lenticule extraction

The purpose of this study was to compare corneal subbasal nerve morphology, corneal sensation, and tear film parameters after femtosecond lenticule extraction (FLEX) and small-incision lenticule extraction (SMILE). A prospective, randomized, single-masked, paired-eye design clinical trial of 35 patients treated for moderate to high myopia with FLEX in one eye and SMILE in the other. In both techniques, an intrastromal lenticule was cut by a femtosecond laser and manually extracted. In FLEX, a LASIK-like flap allowed removal of the lenticule, whereas in SMILE, it was removed through a small incision. In-vivo confocal microscopy was used to acquire images of the central corneal subbasal nerve plexus, from which nerve density, total nerve number, and nerve tortuosity were analyzed. Corneal sensation was measured using Cochet-Bonnet esthesiometry. A visual analog scale, tear osmolarity, non-invasive tear film break-up time (keratograph) tear meniscus height (anterior segment OCT), Schirmer's test, and fluorescein tear film break-up time were used to evaluate tear film and ocular surface symptoms. Patients were examined before and 6 months after surgery. There were no statistically significant differences in baseline parameters between FLEX and SMILE (p > 0.050). With regard to changes from before to 6 months after surgery, mean reduction in subbasal nerve density was 14.22 ± 6.24 mm/mm(2) in FLEX eyes, and 9.21 ± 7.80 mm/mm(2) in SMILE eyes (p < 0.05). The total number of nerves decreased more in FLEX eyes than in SMILE eyes (p < 0.05). No change was found when comparing tortuosity (p > 0.05). Corneal sensation was reduced with 0.38 ± 0.49 cm in FLEX eyes, and 0.10 ± 0.34 cm in SMILE eyes (p < 0.01). No differences were found between FLEX and SMILE in tear film evaluation tests (p > 0.05). Significantly more patients felt postoperative foreign body sensation in the FLEX eye within the first days after surgery, as compared to the SMILE eye. Six months after surgery, the less invasive SMILE technique seemed better at sparing the central corneal nerves as compared to FLEX. Corneal sensation was only significantly reduced in FLEX eyes. There were no differences between FLEX and SMILE when comparing tear film evaluation tests 6 months after surgery.

A Novel Technique of Sutureless and Glueless Conjunctival Autografting in Pterygium Surgery by Electrocautery Pen

To compare the efficacy and safety of electrocautery pen (ECP) with nylon 10-0 sutures in conjunctival autografting for the treatment of primary pterygium. A prospective, randomized, clinical trial was carried out in 80 patients (80 eyes) with primary pterygium. Patients were randomized to undergo pterygium surgery using either ECP (40 eyes) or nylon 10-0 sutures (40 eyes) to attach the conjunctival autograft. All the patients were followed up postoperatively on postoperative days 1, 2, 3, 5, 7, and 14 and then at months 1, 3, 6, and 12. Outcome measures were surgery time, postoperative patient discomfort, complications, and recurrence rate. The mean surgical time for the glue group was significantly shorter at 20.4 minutes compared with the suture group at 27.1 minutes (P < 0.001). Postoperative pain, irritation, and epiphora were significantly less at postoperative days 5 and 7 (P < 0.05). Postoperative foreign body sensation was significantly less at postoperative days 2, 3, 5, and 7 (P < 0.05). Two patients in the ECP group had partial graft dehiscence; 2 patients in the suture group developed granulomas. During the follow-up period, conjunctival recurrence (grade 3) developed in 1 (2.5%) eye in the ECP group, and in 2 (5%) eyes in the suture group. Both groups had 1 (2.5%) corneal recurrence (grade 4). Using ECP for the attachment of conjunctival autograft in pterygium surgery is safe, fast, simple, and economical with less postoperative discomfort.

Improved subjective symptoms of conjunctivochalasis using bipolar diathermy method for conjunctival shrinkage

PurposeTo evaluate the improvement in subjective symptoms of conjunctivochalasis after bipolar coagulation.MethodsForty-three eyes of 26 patients (average age, 75.7 ± 8.4 years) were included in this study. The inferior conjunctivas were cauterized between April 2009 and June 2010. Surgery involved pinching the excess conjunctiva and performing bipolar cauterization after subconjunctival injection of a local anesthetic agent. Patients were asked to describe the postoperative foreign-body sensation and change in subjective symptoms 1 month postoperatively, with the preoperative symptom score defined as 10.ResultsTwenty-two patients (84.6%) reported symptom relief immediately after the procedure, though all patients had a mild gritty sensation for 1–2 weeks postoperatively. The mean postoperative symptom score obtained from the questionnaire was 3.27 ± 3.31, which was significantly lower than the preoperative score (P < 0.0001). No patients had experienced recurrent symptoms at the end of the follow-up period.ConclusionThermal cauterization can achieve conjunctival shrinkage and adherence to the subconjunctival tissues. Operation time is only a few minutes, postoperative pain is not severe, and the procedure can be performed in an outpatient clinic, all of which represent benefits to the patients.

Prospective, randomized, controlled trial comparing lightweight versus heavyweight mesh in chronic pain incidence after TEP repair of bilateral inguinal hernia

This prospective, clinical, randomized, controlled study was performed to define the incidence of chronic pain after total extraperitoneal (TEP) repair with a light-weighted mesh compared with heavyweight mesh in patients with bilateral inguinal hernias. Consecutive patients with bilateral inguinal hernias were recruited for TEP inguinal hernia repair under general anesthesia. Heavyweight mesh was randomly assigned to one side of the groin and lightweight mesh to the other. Patients were followed up regularly for up to 1 year by an independent surgeon who was unaware of the mesh assignment. The postoperative pain score by means of a visual analogue scale (VAS) and other data were recorded. Fifty bilateral TEP hernia repairs were performed between September 2007 and February 2009. Six patients (12%) complained of chronic pain 3 months after the operation. A higher average pain score was observed for the side of hernia repaired by heavyweight mesh compared with lightweight mesh, but the difference was not statistically significant. More patients complained about foreign body sensation on the side repaired with heavyweight mesh (24%) compared with the side with lightweight mesh (8%; P < 0.05). There was no recurrence or need for reintervention for either type of mesh. Lightweight polypropylene mesh may be preferable to heavyweight mesh for TEP inguinal hernia repair because it provides less postoperative foreign body sensation; however, there was no significant difference in the incidence of chronic pain.

The effects of one botulinum toxin type A (BTX-A) injection after UPPP

Botulinum toxin type A (BTX-A) can be used in various medical fields for more than simply cosmetic purposes, especially in pain control. Unlabelled uses of BTX-A for reducing pain include migraines, chronic anal fissures, chronic non-specific muscular pain syndrome, and temporomandibular joint arthritis. However, there are no reports of using BTX-A in postoperative situation. Therefore, we evaluated the effects of BTX-A after surgical procedures, especially in terms of pain reduction. We randomly selected 74 people who visited us not excluded by the criteria and were provided with uvulopharyngopalatoplasty for primary snoring from February 2005 to January 2007. Group A is the BTX-A-injected group and group B is the control group (normal saline injected group or N/S). Group A had 35 patients and group B had 39 patients. Among these patients, we chose 58 patients who can be under tracing observation. The mean age was 26 years (range 18-41). There were 49 males and 9 females. We compared the level of snoring, postoperative pain, use of drugs, and postoperative foreign body sensation with survey paper. Snoring scores were dramatically decreased in both the groups. Postoperative pain scores and foreign body sensation scores were much more decreased in group A than in group B (P < 0.001) and the total amount of NSAIDs used were lower in group A (P < 0.001). BTX-A could be used to reduce postoperative pain after snoring surgery by reducing a specific complication.

Palpebral dacryoadenectomy for epiphora.

The efficacy of palpebral dacryoadenectomy (PDA) to relieve epiphora was studied in 37 patients. Symptomatic relief and postoperative Schirmer testing was used in the evaluation. The technique is described. All patients had patent lacrimal excretory systems: 62% of patients undergoing lacrimal lobectomy had complete relief of epiphora; 19% had some improvement, but incomplete relief; 76% had postoperative decrease in their Schirmer testing; and 14% had postoperative foreign body sensation and some degree of dry eye.