Scleral Bed Research Articles

Third surgery of Ahmed valve tube exposure: A case report

Aims/Purpose: Exposure of the glaucoma drainage devices tube is one of the main postsurgical complications, and it is important not to delay treatment in order to avoid serious situations such as endophthalmitis. Our aim is to report a case of a patient with an Ahmed valve tube exposure who had undergone two previous surgeries unsuccessfully.Methods: We present the case of a 71‐year‐old male patient with diabetic retinopathy with an Ahmed valve in his left eye for 4 years due to neovascular glaucoma. In the first surgery the tube was positioned in the posterior chamber. After two months, displacement of the tube was observed so it was repositioned in anterior chamber with apposition of Ologen® on temporal, superior sclera. Three years later, exposure of the valve tube was seen and it was covered with Tutopatch® and conjunctiva. Recently, on examination, exposure of the valve tube was observed once again. We removed the epithelial cells from the scleral bed with absolute alcohol, after that we revitalized the conjunctival borders of the wound and covered the tube with fascia lata. Finally, we sutured the conjunctiva without tension.Results: At the moment, the tube remains covered and the superior temporal conjunctiva has a good appearance.Conclusions: Different repair techniques are described in the bibliography, such as conjunctiva covering, grafting of different materials, repositioning of the tube with grafting, valve removal and implantation in a different quadrant and even definitive removal of the valve. In our case we used a fascia lata graft, which is associated with a lower risk of subsequent exposure. The previous preparation of the scleral bed and the edges of the conjunctiva, as well as a conjunctival suture free of tension and traction are key to obtaining a good result.

A meta‐analysis of surgical treatments for childhood glaucoma

Aims/Purpose: To assess the comparative efficacies of surgical interventions for childhood glaucoma (CG).Methods: Through electronic database searches up to August 7, 2022, randomized controlled trials (RCTs) involving surgical interventions for CG were identified. A meta‐analysis was conducted to compare the surgical interventions: Conventional partial trabeculotomy ([CPT] control), 240‐degree trabeculotomy, Illuminated microcatheter‐assisted circumferential trabeculotomy (IMCT), Viscocanalostomy, Visco‐circumferential‐suture‐trabeculotomy, Goniotomy, Laser goniotomy, Kahook dual blade ab‐interno trabeculectomy, Trabeculectomy with mitomycin C, Trabeculectomy with modified scleral bed, Deep sclerectomy, Combined trabeculectomy‐trabeculotomy with mitomycin C, and Baerveldt implant. The main outcome measures were postoperative 6‐month mean intraocular pressure (IOP) reduction and surgical success rate. The mean differences (MDs) or odds ratios (ORs) were obtained using a random‐effects model, and the efficacies were ranked by P‐score.Results: Sixteen (16) RCTs were eligible for inclusion in the analysis, involving 710 eyes of 485 participants and 13 surgical interventions, which formed a 14‐node network. IMCT was superior to CPT in both IOP reduction (MD [95% CI], −3.10 [−5.50 to −0.69]) and surgical success rate (OR [95% CI], 4.38 [1.61 to 11.96]), while the MD and OR comparing the other surgical interventions with CPT were not statistically significant. Moreover, the IMCT was ranked as the most efficacious surgical intervention for success rate (P‐score = 0.777).Conclusions: This meta‐analysis revealed that IMCT is more effective than CPT and might be the most efficacious surgical intervention for CG.

Evaluating surgical outcome of pterygium excision with conjunctival autograft using autologous blood: Can it be a new norm?

To evaluate the surgical outcome of use of autologous blood as an adhesive agent in pterygium excision with conjunctival auto-grafting. To observe the effectiveness of autologous blood adherence on the scleral bed and to know whether autologous blood technique can be made as a standard procedure in pterygium surgery or not.The present study is a retrospective observational study. The records of 94 cases of primary pterygium surgery done during August 2022- January 2023 were taken. All patients underwent comprehensive ocular examination pertinent to the disease. Pterygium was dissected and remaining subconjunctival pterygium tissue was separated and excised. The conjunctival limbal auto-graft was taken secured in place by autologous blood and dressing done. Follow-up was done on second post operative day,1st week and 1 month. The study displayed excellent surgical outcome with minimal post operative complications, which too resolved in a week. The most common complication was subconjunctival hemorrhage in 38 cases followed by graft edema in 32 cases. Though graft displacement was observed in 4 cases, they were later rearranged successfully. We did not observe even a single graft loss in our study.Pterygium excision with conjunctival auto-grafting with autologous blood is very safe, less time consuming, easy to perform with less learning curve, economical with excellent postoperative outcome and most importantly more patient satisfaction, thus, making it equivalent to or rather superior to other comparable procedures.

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.

Comparative efficacies of 13 surgical interventions for primary congenital glaucoma in children: a network meta-analysis of randomized clinical trials.

Timely and proper intraocular pressure (IOP) management is vital to the prevention of visual impairment in children with primary congenital glaucoma (PCG). Although various surgical interventions have been proposed, no well-founded evidence exists on their comparative efficacies. We aimed to compare the efficacies of surgical interventions for PCG. We searched relevant sources up to 4 April 2022. Randomized controlled trials (RCTs) entailing surgical interventions for PCG in children were identified. A network meta-analysis (NMA) was performed, comparing 13 surgical interventions: Conventional partial trabeculotomy ([CPT] control), 240-degree trabeculotomy, Illuminated microcatheter-assisted circumferential trabeculotomy (IMCT), Viscocanalostomy, Visco-circumferential-suture-trabeculotomy, Goniotomy, Laser goniotomy, Kahook dual blade ab-interno trabeculectomy, Trabeculectomy with mitomycin C, Trabeculectomy with modified scleral bed, Deep sclerectomy, Combined trabeculectomy-trabeculotomy with mitomycin C, and Baerveldt implant. The main outcomes were mean IOP reduction and surgical success rate at postoperative 6 months. The mean differences (MDs) or odds ratios (ORs) were analyzed by a random-effects model, and the efficacies were ranked by P -score. We appraised the RCTs using the Cochrane risk-of-bias (ROB) tool (PROSPERO: CRD42022313954). Sixteen RCTs were eligible for NMA, including 710 eyes of 485 participants and 13 surgical interventions, which formed a network of 14 nodes comprising both single interventions and intervention combinations. IMCT was superior to CPT in both IOP reduction [MD (95% CI): -3.10 (-5.50 to -0.69)] and surgical success rate [OR (95% CI): 4.38 (1.61-11.96)]. The MD and OR comparing the other surgical interventions and intervention combinations with CPT were not statistically significant. The P -scores ranked IMCT as the most efficacious surgical intervention in terms of success rate ( P -score =0.777). Overall, the trials had a low-to-moderate ROB. This NMA indicated that IMCT is more effective than CPT and might be the most efficacious of the 13 surgical interventions for management of PCG.

Клинические результаты модифицированной имплантации клапанного дренажа Ahmed

Purpose. To evaluate safety and efficacy of modified Ahmed drainage implantation in neovascular and open-angle glaucoma. Material and methods. The study included patients with refractory glaucoma who underwent standard Ahmed drainage implantation (FP7 model with a surface area of 184 mm² ; New World Medical, USA) or drainage implantation using a modified technique. All patients had a follow up period up to one year after surgery. Control group included 22 eyes of 20 patients who underwent standard Ahmed drainage implantation and 38 eyes of 34 patients who underwent modified Ahmed drainage implantation. Fixation to the scleral bed was not used during modified implantation technique. Silicone tube near the episcleral plate was covered with a half silicone sponge 2 mm thick, which was fixed to the sclera with mattress stiches. Results. Modified Ahmed drainage implantation is faster and easier than conventional implantation, which requires fixation to the scleral bed. Using this technique, it was possible to achieve no drainage displacements in the postoperative period in all patients. There were no significant differences between the groups in intraocular pressure or hypotensive therapy in postoperative period. Conclusion. New Ahmed drainage implantation technique is safe and effective and is promising for clinical practice. Key words: Ahmed drainage, glaucoma, IOP, modified technique

Repeated use of fibrin sealants kept at room temperature in conjunctival autografting: An animal study.

Purpose:In this study, our aim was to investigate if fibrin adhesives used in conjunctival wound surgery with autologous conjunctival grafts could be used repeatedly at different times after surgical opening.Methods:40 New Zealand rabbits were used in the study. These animals were divided into four groups, each consisting of 10 rabbits, and hence 20 eyes. In the first group (control group), Tisseel fibrin sealant was used on the day the eye was first opened surgically; in the second group, it was used on the seventh day; on the third group, it was used on the 14th day; and in the fourth group, it was used 28 days after surgical opening. The graft from the inferior bulbar conjunctiva was attached using Tisseel fibrin glue to the superior scleral bed at the location where the superior bulbar conjunctiva was excised in the same eye.Results:No microbial growth was detected in the cultures of the samples tested. There were two partial graft loss in group 2 and there was one partial graft loss in each group of the other groups, and further total graft loss was present in one rabbit in group 3. None of the rabbits had any complications like granuloma, Corneal dellen or infection.Conclusion:Based on these results, fibrin sealants can be used repeatedly by storing them at room temperature. Repeated use of fibrin adhesives will reduce the cost of ophthalmologic surgeries and non-ophthalmologic surgeries.

Clinical outcomes of penetrating canaloplasty in patients with traumatic angle recession glaucoma: a prospective interventional case series

Background/aimTo evaluate the clinical outcomes of penetrating canaloplasty in traumatic angle recession glaucoma at 1 year.MethodsPatients with angle recession glaucoma underwent penetrating canaloplasty, a new Schlemm’s canal-based internal drainage procedure,...

Surgical outcomes of partial ciliary body direct suturing under the scleral flap for traumatic cyclodialysis cleft: A five-case series.

Cyclodialysis cleft is an uncommon finding due to blunt ocular trauma. A larger and more chronic cyclodialysis requires surgical repair. The aim of this study was to introduce a minimally invasive suturing technique for the lens-sparing repair of traumatic cyclodialysis cleft and evaluate outcomes. This study was a retrospective case series. The medical and surgical records of five patients with traumatic cyclodialysis cleft who underwent this surgery were reviewed. The surgeon (Y.S.) dissected a fornix-based conjunctival flap and created a 90° circumferential and limbal-based scleral flap. Several small incisions parallel to the limbus were made within the scleral bed 1.5 and 3 mm posterior to the limbus. After suprachoroidal fluid drainage, tiny bumps in the ciliary body were exposed from the incisions and sewn directly onto the scleral bed with 10-0 nylon sutures. The mean age of the patients was 37.8 ± 1.3 years. The mean duration from injury to surgery was 14.8 ± 16.7 months. Mean best-corrected visual acuity (BCVA) was 0.56 ± 0.70 and intraocular pressure (IOP) was 5.2 ± 1.9 mmHg. In all patients, IOP normalized and BCVA then returned to baseline following this procedure. Mean postoperative BCVA was 1.17 ± 0.86 and IOP was 17.8 ± 1.3 mmHg. Mean IOP and BCVA recovery times were 82.0 ± 139.6 and 294.3 ± 284.3 days, respectively. Partial ciliary body direct suturing under the scleral flap is a less invasive surgical option without lensectomy and considered safe and effective as a primary surgical repair for traumatic cyclodialysis cleft.

Comparative Analysis of Tear Film Parameters in Patients Undergoing Pterygium Excision by Conjunctival Autograft or Bare Sclera Technique Augmented by Intraoperative Mitomycin C Application

Introduction: Excision of the pterygium has been shown to enhance tear film stability. The study was designed to assess the effects of pterygium removal utilising two different surgical procedures on tear film parameters: bare sclera with Mitomycin C (MMC) and conjunctival autograft. The bare sclera with MMC application and conjunctival autograft techniques are the two most common treatments for pterygium. Conjunctival autograft is a procedure in which the superior conjunctiva of the patient's eye is removed in one piece and the excised tissue is used to cover the area where the pterygium was removed.The bare sclera with MMC application procedure involves removing the pterygium and intraoperatively applying 0.02% MMC to the scleral bed, leaving it to re-epithelialise. Aim: Comparative analysis of improvement in tear film parameters of patients undergoing pterygium excision by conjunctival autograft or bare sclera technique augmented by intraoperative MMC application. Materials and Methods: The prospective interventional study was conducted in Department of Ophthalmology, SGT University affiliated hospital, Gurugram, Haryana, India, from January 2019 to January 2020. A total of 54 Patients were divided into two groups. Group 1 has 26 patients undergoing pterygium excision with bare sclera technique (with MMC 0.02%), and Group 2 has 28 patients undergoing pterygium excision with conjunctival autograft technique (with MMC). Tear Break-up Time (TBUT) and Schirmer's I were measured in 54 eyes with pterygium before and after surgery. Data analysis was done using Two tail (inequality) test on Statistical Package for the Social Sciences (SPSS) software version 28.0. Patients were randomly divided into two groups by using RAND between software. Results: The mean preoperative Schirmer's I was 9.333 mm which improved to 12.203 mm after pterygium excision, which was a statistically significant change irrespective of the technique used. The mean preoperative Tear Break-up Time (TBUT) was 7.212 seconds which improved to 13.059 seconds after pterygium excision, which was a statistically significant change irrespective of the technique used. In the autograft group, TBUT improved from preoperative mean value of 7.253 seconds to 14.0 seconds and Schirmer's I mean values improved from 9.178mm to 12.678 mm, respectively.In the bare sclera group TBUT improved from preoperative mean value of 7.169 second to 12.046 second and Schirmer's I mean values improved from 9.500 mm to 11.692 mm, respectively. The mean postoperative Schirmer’s1 in autograft technique was 12.678 mm and postoperative Schirmer’s1 in bare sclera technique was 11.692 mm.The postoperative improvement in both groups was statistically similar. The mean postoperative TBUT in autograft technique was 14 seconds and postoperative TBUT in bare sclera technique was 12.046 seconds. Postoperative results in the autograft group were statistically better than the bare sclera group. Conclusion: The tear film stability parameters in pterygium patients improved after surgery in both the groups. Statistical analysis of postoperative Schirmer's I data was similar in both the techniques. Although postoperative TBUT values were statistically better in the autograft group, the mean value in both the techniques were more than ten seconds. The analysis of data indicates that bare sclera technique with MMC can be used as an alternative surgical procedure in patients with scarred conjunctiva or in situations where superior conjunctiva has to be preserved for future use.

Comparison between Autologous Blood and Fibrin Glue for Adhering Conjunctival Autografts after Pterygium Excision- A Randomised Clinical Trial

Introduction: Fibrin glue is a biological tissue adhesive and acts on the principle of final stages of the coagulation cascade. The cost of commercially available products is very high and not affordable for the patients of low socio-economic strata. As an alternative, pterygium surgery was done using patient’s own blood to adhere the conjunctival autograft to scleral bed by the process of coagulation of fibrin from the oozing blood from the blood vessels under the flap. Aim: To compare autologous blood and fibrin glue for adhering conjunctival autografts after pterygium excision. Materials and Methods: It was a randomised clinical trial. Total 97 subjects with primary pterygium who visited the Ophthalmology Department were randomised into two groups. In group A (n=31), patients had undergone pterygium excision wherein conjunctival autograft was attached by fibrin glue. In group B (n=66) the graft was attached by autologous blood present on the scleral bed. Mean operative time for the procedures were compared. Follow- up was done for 12 months and all subjects were examined for postoperative pain, foreign body sensation, inflammation, graft stability and recurrence. Results: The mean age of patients in group A was 48.32±14.3 years (21-65 years), and in group B was 54.48±15.67 (23-74 years). Mean operating time in group A was 23.21±9.4 minutes and 13.7±4.3 minutes in group B, (p-value=0.001). Postoperative pain of mild degree was present in all the 31 (100%) subjects of group A. In group B, pain was absent in 32 (48.5%) and mild degree in 34 (51.5%) subjects. No recurrence was found in both the groups. Mean follow-up period was 11.4 months. Conclusion: This study concludes that autologous blood is a useful alternative method for graft attachment in pterygium surgery without the untoward complications related to fibrin glue.

The autologous blood become gold standard procedure in pterygium surgery: An observational study

Introduction: Degenerative pterygium causes visual impairment due to astigmatism and blockade of visual axis. As pterygium cannot be treated medically, surgical excision of pterygium is the only way. Simple excision can be done but it is associated highest recurrence rate. Hence the standard method of preventing the recurrence after pterygium excision is Limbal conjunctival Auto Graft (LCAG). Adherence of the Auto graft to the excisional site is done by overlaying the auto graft upon the sclera either with sutures or glue routinely. However to address suture and fibrin related complications the concept of Autologous Blood came up. The current study taken up to find out whether autologous blood has become standard technique in treatment of degenerative pterygium. Aim: To assess the efficacy of Autologous blood in the adherence of the LCAG. Purpose: To know whether leaving the Autologous blood on the scleral bed can be made as a standard procedure in Pterygium surgery. Materials and Methods: 30 patients with the degenerative pterygium grown beyond the limbus were taken for the study. Patients with bleeding disorders, recurrent pterygium, ocular surface disorders, minimal pterygia and pregnancy were excluded. Pterygium was excised leaving the patient’s own blood on the excised area with minimal cautery and LCAG is placed on the bare sclera, and then pad bandage applied. Post operatively eyes were examined whether LCAG is well adhered or not. All the patients were followed for minimum of 6 weeks. Results: All eyes (100%) showed excellent adherence throughout the post operative period. None of the eyes lost the graft. Conclusion: The autologous blood excellent replacement for sutures and donor fibrin. Autologous blood is simple adjuvant of choice and has become gold standard in Pterygium surgery. Keywords: Autologous blood, Adherence, Fibrim, Graft, Pterygium.

A Mitomycin C-Sparing Novel Technique for Subscleral Trabeculectomy in Primary Congenital Glaucoma.

Purpose To evaluate the safety and efficacy of a novel modified subscleral trabeculectomy technique in management of primary congenital glaucoma. Methods This study included 25 infants diagnosed of having bilateral primary congenital glaucoma. For each patient, one eye was assigned to undergo subscleral trabeculectomy with trimming of the edges of the scleral bed (group I), while the contralateral eye underwent subscleral trabeculectomy with application of mitomycin C (0.4 mg/ml for 3 min) (group II). All the patients were followed up for a period of 14 ± 3 months (range 13–22 months). Results 25 eyes were included in each group. Patients' mean age was 2.5 ± 0.5 months (range 1.8–6.5 months). The mean preoperative intraocular pressure was 31 ± 4.9 mmHg and 32.1 ± 4.0 mmHg in group I and II, respectively. The mean postoperative intraocular pressure was 9.0 ± 1.0, 11.0 ± 3.2, 12.5 ± 0.9, 13.0 ± 2.9, and 15.5 ± 1.5 mm Hg in group I and was 10.3 ± 1.2, 12.0 ± 2.5, 13.5 ± 1.7, 15.0 ± 1.5, and 17.1 ± 2.8 mm Hg in group II at the first week and 1, 3, 6, and 12 months, respectively. There was no statistically significant difference between the mean intraocular pressure values recorded at both groups preoperatively and at each follow-up visit. Failure necessitating further surgical interventions was recorded in 4 eyes (16%) in group I as compared to 3 eyes (12%) in group II (P > 0.05). Postoperative complications included mild hyphema, which occurred in one eye (4%) in group I and 2 eyes (8%) in group II, and shallow anterior chamber in 3 eyes (12%) in group I and in 2 eyes (8%) in group II. One eye (4%) in group I developed drawn-up pupil. Choroidal effusion developed in one eye (4%) at each group. Conclusion Trimming the edges of the scleral bed adjacent to the sclera flap is a safe and effective surgical step which can be added to the subscleral trabeculectomy procedure to effectively control the intraocular pressure in patients with primary congenital glaucoma, sparing them the hazards associated with mitomycin C application.

Pterygium excision with suture-less and glue-free conjunctival autograft

Introduction: Pterygium excision is a commonly encountered surgery with different methods being used. These procedures range from simple excision to use of grafts. Limbal conjunctival autograft is currently the most popular surgical procedure. The most common method of autograft fixation is suturing. But it has its own drawbacks like increased operating time, post-operative discomfort, inflammation, buttonholes, necrosis, giant papillary conjunctivitis, scarring, and granuloma formation. Glue is widely used due to many advantages like easy fixation of the graft, shorter operation time, and reduction in complications and post-operative discomfort but at the same time has some disadvantages also like high cost, the risk of transmission of infectionsand inactivation by iodine preparations.&#x0D; Purpose: In the following study, we describe a simple method of accomplishing conjunctival autograft adherence during pterygium surgery avoiding possible complications associated with the use of fibrin glue or sutures.&#x0D; Design: Prospective study.&#x0D; Method: We used conjunctival autograft, which was not sutured or glued to the scleral bed. The fibrin formed from the oozing blood was used to get the graft adhesion to the scleral bed. This study was approved by institutional review board, and written consent form was taken from each participant.&#x0D; Results: The suture-less and glue-free conjunctival autograft was found to have excellent results in terms of surgical outcome as well as post-operative recovery. In addition, risk of side effects related to sutures and glue was eliminated.&#x0D; Conclusion: Suture-less and glue-free conjunctival autograft is a new, easy, and cheaper technique for the management of pterygium.

Fibrin Glue Versus Autologous Serum for Conjunctival Autograft Fixation in Pterygium Surgery

Purpose: To compare the outcomes of conjunctival autograft fixation using autologous serum vs fibrin glue to cover the bare sclera in pterygium excision surgery.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: The study was conducted in Ophthalmology Department of CMH Kharian from April 2018 to November 2018.&#x0D; Material and Methods: Forty patients with primary pterygium were selected by convenient sampling technique. Patients with recurrent Pterygia and moderate to severe dry eyes, keratitis or secondary to trauma were excluded. The patients were divided into two groups, group A treated with fibrin glue and group B treated with autologous serum technique. All patients underwent pterygium excision under topical anaesthesia. The conjunctival autograft was removed from superior temporal bulbar conjunctiva to cover the scleral bed produced by pterygium excision. Post operatively the patients were followed-up for three months to assess the fixation or otherwise. Data was noted and analysed by using SPSS version 23.&#x0D; Results: The graft was taken-up nicely in most of the cases. The patients were followed up for three months after surgery. The frequency of graft lost in Group A and Group B was noted as n = 8 (40%) and n = 1 (5%), respectively (p = 0.008). The only other complication was recurrence of pterygium which was n = 5 (25%) and n = 3 (15%), in Group A and Group B, respectively (p = 0.429). No case of infection was noted.&#x0D; Conclusion: Fixation of conjunctival autograft with autologous serum is a safe and effective method and potential alternative of fibrin glue technique.

Releasable Suture versus Autologous Blood for Pterygium Surgery using Conjunctival Autografts.

PurposeTo evaluate the efficacy of releasable single suture (RS) for conjunctival autograft (CAG) and to compare it with sutureless gluefree (SG) technique in pterygium surgery.MethodsWe conducted a retrospective comparative study on patients with primary pterygium who underwent CAG. In 150 patients, CAG was additionally secured by a single 10-0 nylon releasable suture (RS) which was released on the first postoperative day. In 47 patients, no suture was applied, and CAG was allowed to stick to the scleral bed by autologous fibrin only (SG group). The duration of surgery and size of CAG (in mm) was noted in both groups. All patients completed one year of follow-up. Factors that were studied included graft stability, patient comfort, complications, and recurrence.ResultsThe mean age of patients in RS and SG groups was 39.6 11.8 and 47.3 13.8 years, respectively. The mean duration of surgery was 4.84 1.34 min in RS group and 4.90 1.42 min in SG group (P = 0.001). The size of CAG used in both groups was comparable with more stability in RS group postoperatively. Graft retraction rate in RS group was 5.3% (1 mm retraction in CAG more than 36 mm) with no event of graft loss. The graft loss occurred in 6.3% of eyes in SG group. The recurrence rate in RS group was 4%, while in SG group it was 6.3% (P = 0.4).ConclusionRS, by augmenting the autologous blood mechanism, may offer an easy to learn option for pterygium surgery with good stability even in large sized CAGs.

Prevention and treatment of the toxic tumour syndrome following primary proton beam therapy of choroidal melanomas

IntroductionThe aim of this study was to evaluate the efficacy and safety of endoresection for choroidal melanoma to prevent and treat the toxic tumour syndrome (TTS).Material and methodsThirteen patients who underwent primary proton beam therapy (PBRT) for choroidal melanoma followed by endoresection were evaluated. Main outcome measures were functional and anatomical results, surgical complications, rate of local recurrence, presence or absence of metastatic spread.ResultsThe median time of the follow-up period was 61.6 months. Six patients with clinical signs of TTS and seven with large tumours to prevent TTS underwent endoresection. Tumour thickness was 5.8 to 9.3 mm (mean: 7.6), the basal diameters were 10.6 to 15.0 mm (mean: 13.4). Preoperative best corrected visual acuity (BCVA) was 6/7.5 to counting fingers and the final BCVA was 6/15 to no light perception, and was better in those treated to prevent TTS (p = 0.01). The most universal early postoperative complication was bleeding from the scleral bed. The most common late postoperative complications were epiretinal membrane formation (30.8%), cystoid macular oedema (23.1%) and silicone oil-induced glaucoma (15.4%). Two (15.4%) patients developed phthisis bulbi, neither developed local recurrence. One patient developed liver metastases.ConclusionsEndoresection for choroidal melanoma is a safe and effective procedure with a high rate of local tumour control. The procedure appears to be useful in the prophylaxis and treatment of TTS after PBRT of choroidal melanoma.

Giant squamous cell carcinoma of the conjunctiva: a clinical case report

AbstractPurposeConjunctival Squamous cell carcinoma (SCC) represents a malignant disease that, if untreated, can cause irreversible loss of vision or even death. It is a rare disease, which is why the diagnostic and therapeutic approaches are not always linear. To report a case of a giant conjunctival SCC, including its diagnostic and therapeutic approach.MethodsA 82 years old man, with history of basal cell carcinoma in situ of the upper eyelid, was referred to the emergency department by a conjunctival lesion of the right eye with 3 months of evolution and rapid growth. Examination revealed a whitish, conical‐shaped temporal conjunctival lesion (16 x 18 x 6.5mm) in the right eye with no mobility relative to the scleral plane and staining with 1% toluidine blue. Orbital magnetic resonance imaging identified the temporal conjunctival lesion in the right eye, without unequivocal signs of scleral and other intraocular structures invasion.ResultsThis lesion was excised with a 4 mm margin, using 1% toluidine blue dye, through a no‐touch technique. As adjuvant therapy, we performed cryotherapy of the conjunctival margins and scleral bed, which was covered with amniotic membrane. Histological examination confirmed the presence of a well differentiated conjunctival SCC. One month after surgery, he started treatment with mitomycin‐c 0.04 mg/mL. Three months later, there were no signs of relapse.ConclusionClinical observation allows, in some cases, a high clinical suspicion. The vital staining with topical toluidine blue is an excellent aid in diagnosis, staining most lesions with high sensitivity, and in treatment, allowing to delineate surgical margins. Surgical treatment alone is associated with recurrence rates of up to about 70%, which is why adjuvant therapy, in particular cryotherapy and topical mitomycin‐c, is advocated. Although less common in the daily practice of an ophthalmologist, conjunctival SCC is potentially fatal and, therefore, deserves particular attention.

Clinical features of uveal effusion syndrome and the efficacy of sclerectomy in the treatment of uveal effusion syndrome

Objective To observe the clinical features of uveal effusion syndrome (UES) and the efficacy of sclerectomy in the treatment of UES. Methods A retrospective case series. Twenty patients (36 eyes) of UES with sclerectomy were enrolled in this study from June 2012 to December 2016 in Beijing Tongren Hospital. Among them, there were 12 males (22 eyes) and 8 females (14 eyes), with an average age of 37.8 years. All patients suffered from bilateral diseases, including 4 patients in single eye group and 16 patients in double eye group. Visual acuity, intraocular pressure, indirect ophthalmoscope, UBM, FFA combined with ICGA, A/B ultrasonography, axial length (AL) and scleral thickness were measured. All patients underwent lamellar sclerectomy, and those with exudative retinal detachment underwent four quadrant lamellar sclerectomy, followed by four quadrant full-thickness sclerectomy with the size of 1 mm × 2 mm in the center of the scleral bed. The follow-up time after operation was more than 6 months. Visual acuity, intraocular pressure and fundus examination were performed 1, 3 and 6 months after operation with the same equipment and methods before operation. Results There was no obvious inflammation in the anterior chamber of all eyes, and intraocular pressure was 24-28 mmHg (1 mmHg = 0.133 kPa) in 4 eyes (11.1%). Axial length of 8 eyes (22.2%) were 16-18 mm (true microphthalmia). 12 eyes (33.3%) had scleral thickness>1.0-1.8 mm. Visual acuity ranged from hand movement to 0.05 in 20 eyes, 0.1 to 0.3 in 10 eyes and>0.3 in 6 eyes. Fundus examination showed peripheral choroidal and ciliary detachment; UBM examination showed annular peripheral ciliary and choroidal detachment. 32 eyes (88.9%) were complicated with exudative retinal detachment. FFA examination showed that 14 eyes (38.9%) had leopard spot changes. Compared with preoperative vision, the visual acuity improved in 28 eyes (77.8%) and remained unchanged in 8 eyes (22.2%) after surgery. Thirty-two eyes with different degrees of retinal detachment were found before surgery. After surgery, ciliary body detachment, choroidal detachment and retinal detachment were restored. Six eyes (16.7%) recurred and underwent sclerectomy again. Conclusions The mild symptoms and recurrent attack are the characteristics of UES. Sclerectomy is an effective method to treat UES. Key words: Uveal diseases/diagnosis; Uveal diseases/therapy; Sclerectomy

Scleral Patch Graft With Fibrin Adhesive For Post Pterygium Scleral Thinning

Scleral patch graft is commonly done for scleral thinning post pterygium surgeries. This procedure is done with sutures. Review of literature revealed few such cases. Scleral patch graft with fibrin glue has not been done so far. The novelty of our procedure is that we have applied fibrin glue to the scleral bed and pasted the graft over it. Then this graft was secured with minimal sutures. This not only saves the operative time but also increases patient comfort post op. Herein, we present a case of post pterygium surgery scleral melt successfully treated with scleral patch graft with fibrin adhesive.