Severe scleral dellen as an early complication of pterygium excision with simple conjunctival closure and review of the literature

García-Medina, Manuel; del-Río-Vellosillo, Mónica; Zanón‐Moreno, Vicente; Ortiz-Gomariz, Amanda; Morcillo-Guardiola, Manuela; Pinazo-Durán, María Dolores

doi:10.5935/0004-2749.20140046

Cited by 8 publications

(15 citation statements)

References 7 publications

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“…Current management strategies for pterygium imply surgical excision [ 11 ] that is a complex and invasive procedure that often results in the recurrence of a lesion more clinically aggressive than the original one [ 9 ]. In addition, surgery can lead to further clinical manifestations such as symblepharon, corneal clouding, corneal or scleral dellen [ 9 , 12 ], keloid formation [ 13 ], and scleral necrosis [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Curcuma longa Is Able to Induce Apoptotic Cell Death of Pterygium-Derived Human Keratinocytes

Sancilio

Staso

Sebastiani³

et al. 2017

BioMed Research International

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Pterygium is a relatively common eye disease that can display an aggressive clinical behaviour. To evaluate the in vitro effects of Curcuma longa on human pterygium-derived keratinocytes, specimens of pterygium from 20 patients undergoing pterygium surgical excision were collected. Pterygium explants were put into culture and derived keratinocytes were treated with an alcoholic extract of 1.3% Curcuma longa in 0.001% Benzalkonium Chloride for 3, 6, and 24 h. Cultured cells were examined for CAM5.2 (anti-cytokeratin antibody) and CD140 (anti-fibroblast transmembrane glycoprotein antibody) expression between 3th and 16th passage to assess cell homogeneity. TUNEL technique and Annexin-V/PI staining in flow cytometry were used to detect keratinocyte apoptosis. We showed that Curcuma longa exerts a proapoptotic effect on pterygium-derived keratinocytes already after 3 h treatment. Moreover, after 24 h treatment, Curcuma longa induces a significant increase in TUNEL as well as Annexin-V/PI positive cells in comparison to untreated samples. Our study confirms previous observations highlighting the expression, in pterygium keratinocytes, of nuclear VEGF and gives evidence for the first time to the expression of nuclear and cytoplasmic VEGF-R1. All in all, these findings suggest that Curcuma longa could have some therapeutic potential in the treatment and prevention of human pterygium.

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Section: Introductionmentioning

confidence: 99%

Curcuma longa Is Able to Induce Apoptotic Cell Death of Pterygium-Derived Human Keratinocytes

Sancilio

Staso

Sebastiani³

et al. 2017

BioMed Research International

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“…In bare scleral technique, the sclera is exposed and denudated for some time and this theoretically might favor the onset of dellen [5]. The exposed sclera is prone to dryness and concomitant significant conjunctival edema inhibiting a normal tear distribution over the defect causing dryness more often in the presence of decreased tear production [5,9,10]. Also, vigorous cauterization of episcleral vessels during surgery has been theoretically postulated to contribute to the onset of sclera dellen or perforation as it may cause local ischemia of the scleral [9].…”

Section: Discussionmentioning

confidence: 99%

“…The exposed sclera is prone to dryness and concomitant significant conjunctival edema inhibiting a normal tear distribution over the defect causing dryness more often in the presence of decreased tear production [5,9,10]. Also, vigorous cauterization of episcleral vessels during surgery has been theoretically postulated to contribute to the onset of sclera dellen or perforation as it may cause local ischemia of the scleral [9]. Use of subconjunctival intraoperative anaesthesia containing vasoconstrictive agent (adrenaline) and post-operative topical corticosteroid may also be implicated in the onset of dellen as the former may cause local ischemia of the sclera while the latter would enhance collagenases, inhibit collagen synthesis and delay would healing [9].…”

Section: Discussionmentioning

confidence: 99%

“…Also, vigorous cauterization of episcleral vessels during surgery has been theoretically postulated to contribute to the onset of sclera dellen or perforation as it may cause local ischemia of the scleral [9]. Use of subconjunctival intraoperative anaesthesia containing vasoconstrictive agent (adrenaline) and post-operative topical corticosteroid may also be implicated in the onset of dellen as the former may cause local ischemia of the sclera while the latter would enhance collagenases, inhibit collagen synthesis and delay would healing [9]. In addition, exposure to a dusty and dry weather condition as well as presence of certain ocular and systemic diseases such as Sjögren syndrome, keratoconjunctivitis sicca, acne rosacea, atopic keratoconjunctivitis, diabetes (poor wound healing), herpes keratitis, autoimmune disease or vasculitis have also been proposed to be contributory factors to the onset of corneoscleral dellen [5].…”

Section: Discussionmentioning

confidence: 99%

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Severe Corneoscleral Dellen Following Uneventful Bilateral Pterygia Excision in a Nigerian Adult: A Case Report

Ihemedu¹

2018

IJOVS

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We describe a patient who had uneventful excision of bilateral nasal pterygia using bare sclera technique with adjunctive topical antimetabolite therapy and subsequently developed bilateral corneoscleral dellen. A 44-year old Nigerian male presented with signs of bilateral nasal pterygia and had surgery done on both eyes. The pterygia excisions were performed under local anaesthesia using bare sclera technique with intraoperative adjunctive antimetabolite application. There was no post-operative complication until after 23 days with the appearance of bilateral corneal and sclera dellen, first on the left eye then the right with 5 days interval between both eyes. Treatment modality involved topical lubricant therapy, alternating eye patching and bandage contact lens. Corneal and sclera epithelization occurred in both eyes after six weeks of medical therapy with a slightly inflamed recurrent pterygium in the right eye. Corneal and sclera dellen is a rare late complication of uneventful pterygium excision with adjunctive therapy and it can however be managed effectively by medical therapy albeit increased risk of early recurrence of the pterygium.

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“…However, cautery generates a direct current to heat a wire loop at the end of the device up to 350°C to 400°C, leading to acute tissue damage 5 and wound ischemia 6 and even delayed wound healing and inflammatory reactions. 7 Possibly because of the excessive burn damage and related inflammation, these adjunctive devices may be associated with complications such as conjunctival granulomas, scleral dissolution, anterior segment ischemia, and even higher recurrence rates. 5 – 7 …”

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confidence: 99%

Evaluation of the Safety and Efficacy of a Low-Temperature Plasma Surgical System for Pterygium

Huang

Zhong

et al. 2020

Cornea

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Purpose: Surgical excision is the standard treatment for pterygium. This study was conducted to evaluate the safety and efficacy of a novel technique using low-temperature plasma (LTP) for excision and hemostasis in pterygium surgery. Methods: A prospective, comparative, and randomized clinical trial was conducted on 60 patients (60 eyes) undergoing pterygium excision with conjunctival autografts using fibrin glue. Patients were equally divided into the following 2 groups: a control group and a LTP group. Postoperative follow-up visits were scheduled on day 1, week 1, and months 1 and 3, and recurrence was evaluated at 1 year. Patients were examined for operative time, best corrected visual acuity, conjunctival autograft inflammation (CAI), graft stability (GS), pain, recurrence, and final appearance. Factors related to pterygium recurrence and final appearance were analyzed. Results: Mean operative times were shorter in the LTP group (16.7 ± 3.4 min) than those in the control group (20.1 ± 4.7 min, P = 0.002). LTP eyes had milder CAI than control eyes at postoperative day 1 ( P = 0.000) and week 1 ( P = 0.000). Patients in the LTP group exhibited better GS ( P = 0.01) and milder pain ( P = 0.04) than those in the control group on day 1. Two control patients (6.7%) and no (0%) LTP patients experienced recurrence ( P = 0.08). GS and CAI were the significant factors contributing to recurrence (GS: R = 0.425, P = 0.001; CAI: R = 0.309, P = 0.016). Conclusions: LTP to replace surgical blades and disposable cautery for ablation and hemostasis is safe and efficient for pterygium surgery, resulting in shorter operative time, milder inflammation, and better graft stability without increasing complication risk.

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Severe scleral dellen as an early complication of pterygium excision with simple conjunctival closure and review of the literature

Cited by 8 publications

References 7 publications

Curcuma longa Is Able to Induce Apoptotic Cell Death of Pterygium-Derived Human Keratinocytes

Curcuma longa Is Able to Induce Apoptotic Cell Death of Pterygium-Derived Human Keratinocytes

Severe Corneoscleral Dellen Following Uneventful Bilateral Pterygia Excision in a Nigerian Adult: A Case Report

Evaluation of the Safety and Efficacy of a Low-Temperature Plasma Surgical System for Pterygium

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