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Dítě J, Netuková M, Procházková A, Poláchová M, Krivosheev K, Studený P. Scleral Grafts in Ophthalmic Surgery. A Review. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2024; 80:1-8. [PMID: 38925901 DOI: 10.31348/2024/11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
AIM To summarize the history and current trends in the use of scleral grafts in ophthalmology. MATERIALS AND METHODS We conducted a review of the literature through the MEDLINE and Cochrane Library databases. The search terms were "sclera", "graft", and "surgery". The search resulted in 1596 articles, of which we evaluated 192 as relevant. The relevant articles were sorted chronologically and according to the method of using scleral grafts, which enabled the development of a review article. RESULTS The sclera has been routinely used in ophthalmology since the 1950s in many different indications. Some of these indications have become practically obsolete over time (for example, use in the surgical management of retinal detachment), but a large number still find application today (especially use in glaucoma or oculoplastic surgery, or as a patch for a defect in the sclera or cornea). CONCLUSION Even though allogeneic sclera is currently used less frequently in ophthalmology compared to other tissue banking products and the range of its indications has partially narrowed, it remains a useful material due to its availability and properties.
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Penagos S, Zapata N, Castro JJ, Hidron A, Agudelo CA. Rhinosporidiosis in the Americas: A Systematic Review of Native Cases. Am J Trop Med Hyg 2021; 105:171-175. [PMID: 33999851 DOI: 10.4269/ajtmh.20-1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/15/2021] [Indexed: 11/07/2022] Open
Abstract
Rhinosporidiosis is a chronic mucosal infection caused by Rhinosporidium seeberi, an aquatic protistan parasite. It presents as nasal or ocular polypoidal or vascularized masses. It is endemic in tropical and subtropical areas, especially in South Asia; R. seeberi´s endemicity in the Americas is often overlooked. The objective of this study was to describe the demographic and clinical characteristics of patients with rhinosporidiosis in the Americas, its management, and patient outcomes. This study is a systematic review of cases of human rhinosporidiosis in the Americas reported in the literature from 1896 to February 28, 2019. This review screened 1,994 reports, of which 115 were eligible for further analysis. The selected reports described 286 cases of human rhinosporidiosis between 1896 and 2019. Cases were diagnosed in Brazil (32.2%), Colombia (24.4%), Paraguay (12.6%), and the United States (11.9%). The majority of the cases (91%) occurred in geographic areas with altitudes < 1,000 m above sea level and in areas with median temperatures ≥ 25°C (67.3%). Most of the patients presented nasal (65%) and ocular involvement (35%). Surgical treatment was provided for 99.6% of patients, but 19.8% of them recurred. This review describes the under-recognized geographic distribution and clinical presentation of rhinosporidiosis in the Americas and highlights clinical differences to cases in Asia, specifically in reference to a higher prevalence of ocular disease and higher relapse rates.
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Affiliation(s)
- Sara Penagos
- 1School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Natalia Zapata
- 1School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia.,2Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Juan José Castro
- 1School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia.,2Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Alicia Hidron
- 1School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia.,2Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Carlos Andrés Agudelo
- 1School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia.,3Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia.,4Hospital San Vicente Fundación, Rionegro, Colombia
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Costa EF, Pinto LM, Campos MAG, Gomes TM, Silva GEB. Partial regression of large anterior scleral staphyloma secondary to rhinosporidiosis after corneoscleral graft - a case report. BMC Ophthalmol 2018; 18:61. [PMID: 29486755 PMCID: PMC5830333 DOI: 10.1186/s12886-018-0725-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/20/2018] [Indexed: 11/20/2022] Open
Abstract
Background Rhinosporidiosis is a rare chronic infection of the mucous membranes caused by the Rhinosporidium seeberi. Approximately 15% of cases of rhinosporidiosis are ocular, occurring mainly in the tarsal conjunctiva. There are only 11 cases of scleral melt with staphyloma formation associated with bulbar conjuctival oculosporidiosis and none of them was associated with partial regression of the scleral ectasia after a corneoscleral tectonic graft. Case presentation a 13-year-old girl with a progressively increasing black mass in the upper nasal part above the cornea of the left eye. The biomicroscopy revealed an oval, bluish mass measuring 10x10x5 mm with congestion of the overlying conjunctiva. Conjunctival biopsy showed sporoblasts of Rinosporidium seeberi. Treatment was conducted by conjunctival resection and tectonic corneoscleral graft (13x13mm) over the staphyloma. Within 1 year of follow-up the patient presented a partial staphyloma reduction, 9x9x2.5 mm, and the patch detached from the lesion. A novel surgical approach was done reducing the corneal patch and no recurrence was seen after 9 months. Conclusions This case is one of the largest anterior scleral staphylomas secondary to rhinosporidiosis described in the literature. Scleral anterior staphyloma partial regression is an unusual outcome after a tectonic corneoscleral graft. Infection resolution and graft covering of thinned area contributed to scleral reepithelization.
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Affiliation(s)
- Elaine Fiod Costa
- Departamento de Medicina I, Universidade Federal do Maranhão, Praça Gonçalves Dias, 21 - Centro, São Luis,, MA, 65020-240, Brazil.
| | - Luciano Moreira Pinto
- Departamento de Oftalmologia, Universidade Federal de São Paulo, Rua Botucatu, 821 - Vila Clementino, São Paulo, SP, 04023-062, Brazil
| | - Marcos Adriano Garcia Campos
- Departamento de Medicina I, Universidade Federal do Maranhão, Praça Gonçalves Dias, 21 - Centro, São Luis,, MA, 65020-240, Brazil
| | - Thais Mota Gomes
- Departamento de Medicina I, Universidade Federal do Maranhão, Praça Gonçalves Dias, 21 - Centro, São Luis,, MA, 65020-240, Brazil
| | - Gyl Eanes Barros Silva
- Departamento de Medicina I, Universidade Federal do Maranhão, Praça Gonçalves Dias, 21 - Centro, São Luis,, MA, 65020-240, Brazil
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Abstract
Rhinosporidiosis is a rare infection caused by Rhinosporidium seeberi, an organism classified in its own class, mesomycetozoea. It commonly affects mucus membranes namely the nasal mucosa, pharynx and the conjunctiva. We present the case of an 8-year-old female who presented with a flat, red, vascular, fleshy, pedunculated mass arising from the tarsal conjunctiva of the right upper eyelid. The mass was completely excised. On histopathological examination, multiple sporangia were seen in various stages of degeneration, consistent with rhinosporidiosis. The diagnosis of rhinosporidiosis is based solely on its microscopic features, and the treatment is surgical excision. This condition is endemic in the temperate regions of the Indian subcontinent, but it has been known to occur even in the colder regions of North America and Eastern Europe. Although a rare clinical entity, the possibility of rhinosporidiosis must be borne in mind when evaluating any polypoidal conjunctival mass.
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Affiliation(s)
| | | | | | - Milind N Naik
- Department of Ophthalmic Plastic Surgery, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Ganekal S, Dorairaj S, Hegde S, Jhanji V. Conjunctival rhinosporidiosis. J AAPOS 2013; 17:432-3. [PMID: 23871136 DOI: 10.1016/j.jaapos.2013.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 03/04/2013] [Accepted: 03/13/2013] [Indexed: 10/26/2022]
Abstract
A 12-year-old boy presenting with redness and foreign body sensation in his right eye was found to have a granular, pedunculated mass in the upper palpebral conjunctiva near the lid margin. After the mass was excised, the conjunctiva healed completely, with mild overlying scarring. At 6 weeks' follow-up, there was no evidence of recurrence. Histopathological examination of the mass revealed multiple sporangia characteristic of conjunctival rhinosporidiosis.
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Jacob P, Rose JS, Hoshing A, Chacko G. Tectonic corneal graft for conjunctival rhinosporidiosis with scleral melt. Indian J Ophthalmol 2011; 59:251-3. [PMID: 21586855 PMCID: PMC3120253 DOI: 10.4103/0301-4738.81046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 16 year old girl presented with irritation and watering of the right eye for 3 months. On examination, the superior perilimbal sclera was ectatic with incarcerated uveal tissue covered by conjunctiva. The conjunctiva showed discreet, yellow white mucoid spots. Excision biopsy of the conjunctiva showed subepithelial spherules of sporangia containing numerous endospores, suggestive of rhinosporidiosis. Diathermy was applied to flatten the staphyloma. The ectatic area was covered with a corneal patch graft. The patient was started on prednisolone acetate eye drops and oral dapsone for 6 months. Corneal graft was well incorporated and conjunctivalized by 3 months. Since the graft was not seen within the palpebral aperture, there was good cosmetic result. The corneal graft had the added advantage of transparency which allowed visualization of the underlying tissue to diagnose early recurrence. There was no recurrence at 6 months.
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Affiliation(s)
- Pushpa Jacob
- Department of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Abstract
PURPOSE To report a case of severe scleral melting in a patient with carotid artery obstruction. METHODS This is an observational case report. We reviewed the patient's chart and the available literature on ocular melting and ocular ischemia. RESULTS A 71-year-old man with a history of carotid vascular disease and a blind left eye due to a previous vascular accident developed scleral melting of the right eye. Despite frequent lubricants, systemic immunosuppressives, and repeated conjunctiva transplants, the thinning progressed and his visual acuity deteriorated. Intensive screening for possible underlying diseases revealed no infectious or collagen vascular disease. Magnetic resonance angiography, however, showed a subtotal obstruction of the right internal carotid artery. Further investigations revealed coronary artery obstruction. Carotid surgery combined with coronary artery bypass grafting was performed, and a stable ocular situation was achieved. CONCLUSIONS Although a causal factor cannot always be determined, corneoscleral melting should be regarded as a manifestation of underlying systemic or ocular disorders. In the absence of more common causes of corneoscleral melting, a thorough workup is warranted and might reveal life-threatening disorders.
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Affiliation(s)
- Jan H Schotveld
- Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands.
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Abstract
Fungi may infect the cornea, orbit and other ocular structures. Species of Fusarium, Aspergillus, Candida, dematiaceous fungi, and Scedosporium predominate. Diagnosis is aided by recognition of typical clinical features and by direct microscopic detection of fungi in scrapes, biopsy specimens, and other samples. Culture confirms the diagnosis. Histopathological, immunohistochemical, or DNA-based tests may also be needed. Pathogenesis involves agent (invasiveness, toxigenicity) and host factors. Specific antifungal therapy is instituted as soon as the diagnosis is made. Amphotericin B by various routes is the mainstay of treatment for life-threatening and severe ophthalmic mycoses. Topical natamycin is usually the first choice for filamentous fungal keratitis, and topical amphotericin B is the first choice for yeast keratitis. Increasingly, the triazoles itraconazole and fluconazole are being evaluated as therapeutic options in ophthalmic mycoses. Medical therapy alone does not usually suffice for invasive fungal orbital infections, scleritis, and keratitis due to Fusarium spp., Lasiodiplodia theobromae, and Pythium insidiosum. Surgical debridement is essential in orbital infections, while various surgical procedures may be required for other infections not responding to medical therapy. Corticosteroids are contraindicated in most ophthalmic mycoses; therefore, other methods are being sought to control inflammatory tissue damage. Fungal infections following ophthalmic surgical procedures, in patients with AIDS, and due to use of various ocular biomaterials are unique subsets of ophthalmic mycoses. Future research needs to focus on the development of rapid, species-specific diagnostic aids, broad-spectrum fungicidal compounds that are active by various routes, and therapeutic modalities which curtail the harmful effects of fungus- and host tissue-derived factors.
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Affiliation(s)
- Philip A Thomas
- Department of Ocular Microbiology, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli 620001, India.
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Abstract
A unilateral scleral staphyloma in an 18-month-old, female spayed Domestic Short-haired cat was treated with excision, primary closure and fascial graft. Other ocular abnormalities noted on examination included iris coloboma, anterior cortical cataract, focal lens equator flattening and retinal dysplasia. The staphyloma was presumed to be congenital in origin.
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Affiliation(s)
- Brian J Skorobohach
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville 37966-4544, USA.
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