Corneal endothelial alteration is present in patients with chronic renal failure, more marked in patients undergoing hemodialysis and with raised blood urea level.
Our aim primarily was to compare the recurrence rate with three techniques of conjunctival fixation (suture versus fibrin glue versus autologous in situ blood coagulum) over bare sclera following pterygium excision. Ninety eyes of 90 patients with primary pterygium were randomly divided into three groups: group I (30 eyes) underwent autografting and fixation with 8-0 vicryl sutures, group II (30 eyes) with fibrin glue and group III (30 eyes) with autologous in situ blood coagulum. The patients were reviewed on 2nd day, weeks 1 and 4, and at every 3 months till 12 months after surgery. Rate of recurrence was similar (p = 0.585) across the three groups. Time taken for surgery for Group 1 was more as compared to group 2 (p < 0.001) and group 3 (p < 0.001). Also, group 2 cases took significantly more time as compared to group 3 (p < 0.001). Postoperative patient discomfort (foreign body sensation, epiphora, pain and irritation) was more in suture-assisted autografting as compared to the other two groups. However, at some points along the time line, patient discomfort was significantly more in group III as compared to group II. Complications like graft retraction, graft displacement and cyst formation were seen in a few patients but were not statistically significant across the three groups. All three techniques were found to be useful methods and were associated with similar rate of recurrence.
Purpose:
To compare the outcomes between mini-simple limbal epithelial transplantation (mini-SLET) and conjunctival autograft (CAG) fixation with fibrin glue after excision of pterygium.
Methods:
Ninety-two eyes with primary nasal pterygium were prospectively randomized into a CAG control arm and a mini-SLET study arm. Follow-up examinations were set at the first and third day, at weeks 1, 2, and 4, and at the third and sixth month after surgery. The primary outcome measure was the recurrence rate at 1, 3, and 6 months after surgery, whereas the secondary outcome measures were the intraoperative time, postoperative symptoms, and other complications.
Results:
Eighty-two eyes completed the 6-month follow-up interval. Of the 42 eyes that underwent CAG, 4 (9.5%) exhibited recurrences, whereas only 1 of the 40 eyes (2.5%) treated with mini-SLET had recurrence (P = 0.358). The time taken for surgery in the study group (21.4 minutes) was greater as compared to the control group (15.1 minutes) (P < 0.001). The postoperative median symptom (foreign body sensation, lacrimation, pain, and irritation) score in the CAG group was significantly more for all symptoms on day 1 and day 3; however, on day 7, it was significantly more for pain and irritation only. Except dellen formation (1 in each group), both groups exhibited different other complications, although less in the study group.
Conclusions:
The study group exhibited a positive trend of less recurrence with reduced postoperative symptoms and other complications. More similar studies are required in future to validate the results.
A positive correlation was seen between conjunctival vessel width and tortuosity with severity of retinopathy. Widths over 80 μ and tortuous segment length over 900 μ are suggestive of severe grades of retinopathy.
The existing acute shortage of good quality donor corneas in a developing country like India, prompted us to attempt customised component corneal transplantation. Using this surgical strategy, one corneoscleral button was used for three recipients. Anterior and posterior lamellar discs were used for anterior lamellar keratoplasty and Descemet's stripping endothelial keratoplasty in patients with superficial corneal scar and pseudophakic bullous keratopathy, respectively. From the remnant peripheral corneoscleral rim, a patch graft was taken and used for a case of perforated corneal ulcer. Postoperatively, the two earlier mentioned cases achieved visual acuities of 20/30 and 20/60, respectively, whereas the latter mentioned patient with the patch graft achieved good tectonic stability. This case report highlights the optimal utilisation of a corneoscleral button by customising it for three recipients. Moreover, a patch graft has been introduced in the armamentarium of customised component corneal transplantation for the first time.
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