Mise au point sur l’utilisation des colles tissulaires en ophtalmologie

[Pterygium surgery with sutureless, glueless conjunctival graft: Preliminary study at the Centre hospitalier universitaire de Cocody in Abidjan]

PURPOSE

To optimize the pterygium management by delineating the role of sutureless, glueless conjunctival graft.

MATERIALS AND METHODS

This was a prospective cohort study carried out at the Centre hospitalier universitaire de Cocody between October 1st, 2021 and March 31st, 2022. It analyzed a series of 36 cases of stage I, II and III pterygium by Cornand's classification, who underwent surgery by a sutureless conjunctival graft technique without biological glue.

RESULTS

Demographically, 33.3% of our study population were between 30 and 40 years of age, with a mean of 47.86 years. The patients showed a female preponderance, 53%, with a male:female ratio of 0.89. At the clinical level, 75% of our population presented for ocular redness, 84% had a nasal pterygium, and 75% were stage 2. In terms of postoperative course and appearance, we observed 80.55% graft stability, 5.56% graft retraction, 2.78% graft displacement, and 11.11% graft loss. At the conclusion of follow-up, we noted an 8.33% recurrence rate.

DISCUSSION

The use of intraoperative blood ensures patient safety and postoperative comfort. This technique demonstrates satisfactory results with primary, nasal pterygia.

CONCLUSION

Conjunctival autograft without sutures or biological glue might be a very promising surgical alternative in the surgical treatment of pterygium.

Two cases of perforated corneal ulcers complicating rheumatoid arthritis treated successfully by biological therapy

Background

Peripheral ulcerative keratitis (PUK) is a severe inflammatory ocular disease that can affect patients with a long history of rheumatoid arthritis (RA). The use of biotherapy has revolutionized the treatment of the RA and has provided encouraging outcomes especially in the treatment of PUK reported in few cases. In this article, we describe the case of two patients with the history of perforated corneal ulcer complicating RA treated successfully by biologic agents.

Case presentation

Case 1: A 45-year-old woman was diagnosed for over 17 years with sero-positive RA refractory to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). She had received one cycle of Rituximab with clinical and biological failure. In July 2017, she presented an active RA flare with a painful left eye and a decreased visual acuity. Ocular examination revealed a corneal perforation in the left eye and a pre-perforation in the right eye. She received an emergency bolus of methylprednisolone 1 g/day during three consecutive days and was followed by Infliximab. After thirteen months, Infliximab was effective on the rheumatic disease and on the corneal involvement as it stopped its gradual perforation in the right eye, and stabilized corneal ulcer in the left eye.

Case 2: A 68-year-old man had been diagnosed since 2010 with sero-positive RA refractory to csDMARDs complicated in July 2017 by corneal perforation in the right eye. He was hospitalized for his ocular involvement and his active RA. He received an emergency bolus of methylprednisolone 500 mg/day during three consecutive days and was followed by Rituximab. After six months, we observed the stabilization of the right eye corneal damage and the resolution of articular symptoms.

Conclusions

Our cases suggest the efficacy of Infliximab (case 1) and Rituximab (case 2) as a treatment of this severe and destructive keratolysis of the cornea complicating an active RA allowing to plan corneal graft. This positive therapeutic response will contribute to increase literature reports of this therapy success.

[Pterygium surgery by conjunctiva autograft with autologous blood fixation]

INTRODUCTION

Pterygium surgery is marked by the possibility of recurrences; one of the techniques which results in the least recurrences is conjunctival autograft. Fixation of the conjunctiva had traditionally been accomplished with sutures. In recent years, conjunctival grafting has also been performed with fibrin glue. Even more recently, with a view towards improving the quality of postoperative results, some surgeons recommend the use of autologous blood. This study aims to evaluate the stability of this latest method of graft fixation, while assessing its postoperative results.

METHODOLOGY

After diagnosis of pterygium, the patients underwent pterygium surgery with a conjunctival graft fixated with autologous blood. They were then monitored for one year, at 24h postoperatively, then seven days, 15 days, one month 3months, and every 3months thereafter.

RESULTS

In totl, 84.21 % of the patients demonstrated stable postoperative fixation; 5.26 % of patients experienced significant displacement of the graft. After one year of follow-up, 15.79 % of patients experienced recurrent pterygium. Recurrences were more frequent in younger patients and in patients with previous recurrence.

CONCLUSION

Pterygium surgery by conjunctival graft fixated with autologous blood is a safe surgery, with results similar to other pterygium surgery techniques with conjunctival autograft. However, this technique has the advantage less irritation, no risk of transmitting infection and lower cost.

Successful conjunctival socket expansion in anophthalmic patients until the age of 2 years: an outpatient procedure

Purpose

To report the results of a simple outpatient method for soft tissue socket expansion in young children with congenital anophthalmos.

Methods

Seventeen congenital anophthalmic sockets of 15 infants of a mean age of 4.2±4.4 months were fitted with specially designed serial solid acrylic shapes or hydrogel expanders using cyanoacrylate for eyelids closure when using the latter.

Results

At the age of 2 years, the mean horizontal eyelid length increased from a mean of 11.6±4.5 to 19.4±4.6 mm and the volume of the last expander from a mean of 0.6±0.2 to 2.0±0.3 cm². The specially designed acrylic shapes could be a substitute to the custom-made molds, which require general anesthesia.

Conclusion

Successful increase in the horizontal eyelid length as well as the conjunctival socket volume could be achieved by a simple outpatient procedure without the need for repeated hospitalization and general anesthesia in these infants.

[Conjunctival flap: Still a relevant procedure]

PURPOSE

To evaluate the technique of conjunctival flap for the treatment of ocular surface disorders.

PATIENTS AND METHODS

This is a retrospective study. Forty-three eyes of 43 patients had undergone conjunctival flap surgery performed during a 5-year period at the Rouen University Hospital. Thirty-one patients were followed regularly and could thus be included in this study. The indications and complications experienced by patients undergoing partial or total conjunctival flap surgery were reviewed.

RESULTS

The surgical indication was tectonic for 15 out of 31 patients (48.4%) including six corneal perforations, analgesic for nine out of 31 patients (29.0%) and aesthetic for 7 out of 31 patients (22.6%). All the operated patients experienced clinical improvement with a decrease in their pain or inflammation of the ocular surface, or an excellent cosmetic result. Complications were encountered in 6 eyes among the 31 patients (19.4%), and four required surgical revision.

CONCLUSION

Conjunctival flap is an underutilized technique. Its primary indication is ocular surface disease in eyes with poor visual potential. It represents an interesting alternative to more mutilating surgeries.