Cosmetic Regional Conjunctivectomy With Postoperative Mitomycin C Application With or Without Bevacizumab Injection

Delayed manifestation of bilateral scleral thinning after I-BRITE® procedure and review of literature for cosmetic eye-whitening procedures

“…Cosmetic ocular-whitening procedures have been associated with complication rates as high as 82.9% 2. Postoperative complications demonstrate a high degree of variability with respect to subtype, severity, latency interval, and management technique (Table 1).…”

“…Other reported complications include lymphangiectasis (0.1%), extraocular muscle fiber exposure (0.04%), dry eye (0.6%), chronic conjunctival epithelial defects (1%), decreased vision (1.8%), granuloma formation, and corneal ulceration 1–3. In 2011, the Korean Ministry of Health and Welfare issued an order for discontinuation of the regional conjunctivectomy procedure,2 and the American Society of Cataract and Refractive Surgery issued a clinical alert in March 2014 recommending use of alternative procedures for treatment of conjunctival hyperemia 3…”

“…Cosmetic eye-whitening procedures for the treatment of chronic conjunctival hyperemia have recently become a topic of interest due to accumulating evidence of severe postoperative complications associated with their practice 1,2. A large proportion of patients have undergone the so-called regional conjunctivectomy procedure in South Korea, along with many patients in the US who have undergone a similar procedure known as I-BRITE ® (Boxer Wachler Vision Institute, Beverly Hills, CA, USA).…”

“…Each respective procedure entails resection involving significant amounts of bulbar conjunctiva with or without resection of Tenon’s capsule components within the nasal and temporal regions of the palpebral fissure, with concomitant intraoperative and postoperative mitomycin C (MMC) administration topically, subconjunctivally, or both 1. There are a multitude of worrisome postoperative complications that have been reported in association with these procedures, including, but not limited to: scleral thinning with or without calcified plaques, diplopia induced by fibrovascular growth, necrotizing scleritis, and elevated intraocular pressure (IOP) 1,2. Herein, we report a case of bilateral scleral thinning with associated calcified plaque formation in a patient who had undergone a cosmetic eye-whitening procedure 4 years prior to presentation.…”

Scleral thinning after I-BRITE procedure treated with amniotic membrane graft

“…2,4 A multitude of postoperative complications have been reported in association with these procedures, including, but not limited to, scleral thinning with or without calcified plaques, chronic dysfunctional tear syndrome, dry eyes, diplopia induced by fibrovascular growth, necrotizing scleritis, and elevated intraocular pressure. 4,5 The Korean Ministry of Health and Welfare issued an order for discontinuation of the regional conjunctivectomy procedure, 3 and the American Society of Cataract and Refractive Surgery issued a clinical alert in March 2014 recommending use of alternative procedures for treatment of conjunctival hyperemia. 6 In addition to creating a predisposition for the development of necrotizing scleritis/infectious scleritis, 7,8 MMC has been known to cause scleral ulcerations/calcifications, corneal edema, limbal stem cell deficiency, and iritis, with a highly variable postoperative onset of symptoms, ranging from days to years.…”