A Scleral Soft Contact Lens Designed for the Postoperative Management of Pterygium Surgery

Arenas, Eduardo; Garcia, Sergio

doi:10.1097/01.icl.0000226947.66077.37

Cited by 15 publications

(6 citation statements)

References 13 publications

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“…Anyways, both methods proved to be efficient in controlling postoperative pain and favoring corneal reepithelization. 163 – 165 Anti-inflammatory eye drops, such as corticosteroids and NSAID, and artificial tears represent commonly used molecules for controlling pain and favoring corneal healing after pterygium surgery. It has been observed that nepafenac 0.1% eye drops administered thrice a day for 3 days (in association with postoperative therapy with topical ciprofloxacin, fluorometholone, and artificial tears) provided a significant pain reduction when compared with placebo after pterygium excision with autologous conjunctival graft.…”

Section: Clinical Perspectivesmentioning

confidence: 99%

How to minimize pterygium recurrence rates: clinical perspectives

Nuzzi¹,

Tridico²

2018

OPTH

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The main treatment for pterygium is surgical removal. However, pterygium surgery is concerned with high rates of postoperative recurrence. Predicting factors of recurrence are not fully understood, yet, but they probably depend on a multitude of patient-related, clinical, and/or surgical factors. Several adjuvant treatments have been proposed to reduce postoperative pterygium recurrence, including different antimetabolites, antiangiogenetic factors, and radiation therapy. The purpose of this review is to collect the current evidence regarding application and limits of different therapeutic approaches for preventing postoperative recurrence of pterygium, giving insights and perspectives for better management of this disease. In the light of the current evidence, pterygium surgery cannot disregard wound coverage with conjunctival autografting or rotational flap combined with adjuvant treatments. The rotational flap technique is associated with shorter surgical time rates and prevents graft displacement and necrosis, given its vascular pedicle. Amniotic membrane may still be reserved in case of great conjunctival defects or insufficient conjunctiva. Repeated subconjunctival antivascular endothelial growth factor injections can be considered as an effective and safe adjuvant treatment. Moreover, management of postoperative pain is crucial. Innovative treatment strategies will probably target different molecular pathways, considering recent findings regarding pterygium pathogenesis, to improve better understanding and develop universally shared guidelines. Great importance shall be dedicated to the identification of novel molecular biomarkers and favoring factors of recurrence, in order to achieve a customized surgical treatment for each patient and obtain maximal reduction of postoperative recurrence.

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Section: Clinical Perspectivesmentioning

confidence: 99%

How to minimize pterygium recurrence rates: clinical perspectives

Nuzzi¹,

Tridico²

2018

OPTH

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“…The idea of using soft scleral lenses for therapeutic purposes is not new. Arenas and Garcia reported the use of soft scleral lenses with diameters varying from 17.5 to 19 mm for post‐operative management of pterygium. Silicone hydrogels are frequently used to treat recurrent corneal erosions and persistent epithelial defects or to facilitate epithelial healing after PRK .…”

Section: Discussionmentioning

confidence: 99%

Silicone hydrogel mini‐scleral contact lenses in early stage after corneal collagen cross‐linking for keratoconus: a retrospective case series

Severinsky

Wajnsztajn

Frucht‐Pery

2013

Clinical and Experimental Optometry

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Background:The aim was to the evaluate performance of a novel silicone hydrogel miniscleral contact lens (SHmS) for optical correction of keratoconus in the early stages after the corneal collagen cross-linking procedure (CXL). Methods: We retrospectively analysed the visual acuity improvement and corneal adaptation in the first 10 eyes of nine patients fitted with SHmS lenses one to 3.5 months after corneal collagen cross-linking. The lenses were designed to rest over the patients' sclera and peri-limbal cornea and vault the central cornea with minimal support over it. Visual acuities with manifest refraction and contact lenses, refractive and topographical values (Kmin and Kmax) were evaluated on lens dispensing and after six month of lens wearing. Ocular physiological responses were evaluated using the Institute of Eye Research (IER) grading scales. Results: SHmS fitting was performed 2.1 Ϯ 0.97 (SD) months after collagen cross-linking. Mean follow up was 10.9 Ϯ 4.41 months (range six to 18 months). Mean decimal visual acuity with SHmS was 0.66 Ϯ 0.22 (approximately 6/9 Snellen fraction, range 0.3 to 0.1) or 0.75 Ϯ 0.14 (approximately 6/8.1, range 0.5 to 1.0), when omitting two amblyopic eyes. Nine (90 per cent) eyes were successfully fitted, that is, able to wear the lenses for 10 hours per day or longer. Mean wearing time was 11.7 hours (range six to 14) per day. No corneal neovascularisation or papillary reaction was found in all fitted eyes. Conclusions: SHmS contact lenses provide successful visual rehabilitation shortly after corneal collagen cross-linking. This new soft contact lens design with scleral fixation and minimal apical touch was demonstrated to be safe shortly after collagen cross-linking, as the avoidance of contact with the treated zone minimises contact lens influence on corneal recovery.

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“…This will permit the introduction of a special 18-mm diameter cannula to the central vitreous cavity, and aspirate approximately 1 mL of the vitreous fluid [Figure 2c and d]To maintain normal IOP, sodium hyaluronate is introduced into the AC, and a slow resection of the recipient's corneo-sclera is initiated, trying to separate the possible anterior synechias at the same time with a fine round-edged spatulaBleeding into the AC should be avoided with the use of small Weck-Cel pieces until the new AC has been formed [Figure 2e]Once the resection of the recipient's cornea reaches 180°, the AC should be restored by trying to liberate the synechias and normalize its boundary. In some cases when the lens is opaque, it should be removed in an extracapsular fashion with an intraocular lens (IOL) implantationOnce the scleral borders are completely dry and are without blood, a viscoelastic material (sodium hyaluronate) is placed over the iris surface, the donor sclero-cornea is placed and adjusted, and three 7-0 vicryl sutures are placed [Figure 2f]The fibrin glue is now prepared, and is placed with a curved jeweler's forceps under the scleral flap without moving the graft, which is allowed to remain still for 3 min [Figure 2g]The two conjunctival flaps previously prepared with the mosquito forceps and 7-0 vicryl sutures are closed and anchored to the limbus of the donor's sclero-cornea [Figure 2h]A giant 22-mm soft contact lens (Surgilens ® ) is placed over the recipient's eye globe[16] [Figure 3a]The surgery is finished by placing two temporary eyelid sutures (temporary tarsorrhaphy) with 8-0 polypropylene cardiovascular suture, to partially close the eyelids [Figure 3b and c]The surgery is then completed with the eye covered with a bandage patch and an eye protection shield.…”

Section: Description Of the Surgical Proceduresmentioning

confidence: 99%

“…A giant 22-mm soft contact lens (Surgilens ® ) is placed over the recipient's eye globe[16] [Figure 3a]…”

Section: Description Of the Surgical Proceduresmentioning

confidence: 99%

Lamellar sclerokeratoplasty: Review of the literature and description of a special technique using fibrin glue and a giant hydrophilic contact lens

Arenas

Mieth²

2019

Taiwan J Ophthalmol

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Lamellar sclerokeratoplasty is a surgical procedure described since 1979 by Lim in China and reported by different surgeons in the world. Our purpose is to report a modified technique in which not only the whole cornea with a scleral rim is utilized, but the importance of including the whole Schlemm's canal area is also insisted; therefore, a new aqueous humor drainage pathway can be restored. The technique is designed for cases in which not only the whole cornea is decompensated, but also have untreatable glaucoma. This procedure replaces the entire anterior segment with a clear donor cornea including the limbus and part of the trabecular meshwork. We present the results of visual acuity by the logMAR scale of 55 cases from 110 patients receiving this surgical technique. The results describe 39 cases that had visual improvement after more than 1 year of follow-up and 16 cases that did not improve in their visual acuity. Large-diameter sclerokeratoplasty is an alternative and therapeutic option to eliminate the entire corneal pathology, while obtaining structural and even optical results with a lower immunological reaction. It can be considered an option in cases that are not suitable for standard grafting procedures.

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A Scleral Soft Contact Lens Designed for the Postoperative Management of Pterygium Surgery

Abstract: This novel design facilitates postoperative recovery and reduces the chance of recurrence after pterygium surgery. The authors have been using this type of lens in their clinical practice for more than 4 years.

Cited by 15 publications

References 13 publications

How to minimize pterygium recurrence rates: clinical perspectives

How to minimize pterygium recurrence rates: clinical perspectives

Silicone hydrogel mini‐scleral contact lenses in early stage after corneal collagen cross‐linking for keratoconus: a retrospective case series

Lamellar sclerokeratoplasty: Review of the literature and description of a special technique using fibrin glue and a giant hydrophilic contact lens

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