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Treatment of ligneous conjunctivitis with plasminogen eyedrops. Ophthalmology 2022; 129:955-957. [PMID: 35346720 DOI: 10.1016/j.ophtha.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
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Maamri A, Zemova E, Moslemani K, Flockerzi F, Seitz B. Recurrent ligneous conjunctivitis after cataract surgery in a 67-year-old male patient: a case report. BMC Ophthalmol 2022; 22:103. [PMID: 35247993 PMCID: PMC8897893 DOI: 10.1186/s12886-022-02329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Ligneous conjunctivitis is a rare form of chronic pseudomembranous conjunctivitis which usually starts during infancy. We report on an unsual case of recurrent ligneous conjunctivitis after cataract surgery in a 67-year-old male patient. Methods The equipment used for the slit-lamp images was a Haag Streit slit lamp BX900 Sn 00,406 with 16 × magnifications. The used batch number of the camera was sn00406 and the software was from the company CCS Pawlowski Merge Eye. There were no filters used. The images were saved with a resolution of 300 DPI. Neither downstream nor averaging was used to enhance the resolution of the image in the case presentation section or the figure legend. The equipment used for the cross-sectional histologic images was a Zeiss Axioskop 40 microscope with an objective lens Zeiss A-Plan × 20/0.45 (Zoom 6.3 × TV 2/3″″C). The used camera was AxioCam MRc5 and the software was ZEN 3.2. The cross-sectional histologic images were saved with a resolution of 2584 × 1936 Pixels. Neither downstream nor averaging was used to enhance the resolution of the image in the case presentation section or the figure legend. Case presentation This is a rare case report of ligneous conjunctivitis in a 67-year-old male patient who presented a recurrent conjunctival granuloma after five excisions following cataract surgery in his left eye. We performed a tumor excision with free conjunctival autograft. The histology showed a fibrin crust including macrophages, granulocytes, lymphocytes, and reactively altered squamous cell nests. These findings were consistent with a ″pseudomembrane in conjunctivitis lignosa″. We administered a topical combination of plasminactivator, heparin, cortisone and cyclosporine. Conclusion This treatment with the combination of plasminactivator, heparin, cortisone and cyclosporine has proven to be effective in preventing the recurrence of ligneous conjunctivitis.
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Mérigot C, Viard C, Pechmeja J, Eyvrard F, Sorli SC. [Pharmaceutical supply of human plasminogen replacement therapy for the treatment of ligneous conjunctivitis: Logistics for a university hospital]. J Fr Ophtalmol 2021; 44:1008-1020. [PMID: 34049718 DOI: 10.1016/j.jfo.2020.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
In order to treat a pediatric patient with ligneous conjunctivitis secondary to congenital plasminogen deficiency, a supply of topically administered replacement human plasminogen has been required. In the absence of market approval, this blood-derived drug is managed by a temporary authorisation for nominative use, allowing monthly hospital dispensations. To ensure regulatory compliance and proper use of the drug, it took two years of interactions between various hospital departments and the laboratory to define the pharmaceutical supply chain in our hospital and allow the patient to receive treatment. The main difficulties lie in respecting the cold chain of this drug stored frozen in the bottles not ready for use. Transportation from the laboratory to the patient's home via the hospital pharmacy is carried out in calibrated conditions, ensuring a temperature below -20°C for 72h. Reception and dispensing steps were combined into a single pharmaceutical service in order to optimise transport time while ensuring the safety and traceability of the drug lots. Each month, a date is scheduled between the hospital pharmacy, the laboratory and the family to ensure that delivery and dispensing take place on the same day. Appropriate use and handling are explained to the family. However, two issues remain to be addressed by the manufacturer to facilitate future use of human plasminogen: the thermostability problem, which does not allow stays away from home longer than three days, and self-administration by the child, which is unlikely to be feasible due to handling difficulties.
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Affiliation(s)
- C Mérigot
- Service pharmacie essais cliniques-autorisation temporaire d'utilisation- rétrocessions, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - C Viard
- Service pharmaceutique référent de la pédiatrie, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - J Pechmeja
- Service ophtalmologie, hôpital Pierre-Paul-Riquet, centre hospitalier universitaire de Toulouse, place du Docteur-Baylac, 31059 Toulouse, France
| | - F Eyvrard
- Service pharmacie essais cliniques-autorisation temporaire d'utilisation- rétrocessions, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - S C Sorli
- Service pharmacie essais cliniques-autorisation temporaire d'utilisation- rétrocessions, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
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Anterior Segment Surgeries Under Topical Fresh Frozen Plasma Treatment in Ligneous Conjunctivitis. Cornea 2020; 40:299-302. [PMID: 33290319 DOI: 10.1097/ico.0000000000002573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the efficacy of topical fresh frozen plasma (FFP) therapy on clinical symptoms, findings, and prognosis after anterior segment surgeries in patients with ligneous conjunctivitis (LC). METHODS Retrospective case note review. RESULTS Eleven eyes of 7 cases whose remission was not achieved after medical treatment such as topical corticosteroids, cyclosporine A, and heparin were included in the study. The median age of admission was 19 (1-49) years, median duration of FFP treatment was 48 (15-79) months, median follow-up period was 62 (16-114) months, and median age at symptom onset was 12 (4-252) months. Diagnosis was made according to clinical presentations, plasminogen activities, and response to treatment. Topical FFP that was prepared in our clinic was used in all cases. Surgeries (membrane excision, eyelid surgery, deep anterior lamellar keratoplasty, and cataract surgery) were performed after at least 1 month of FFP treatment. Prosthetic contact lens was applied to one eye. During the follow-up period, recurrences requiring membrane excision and side effects from topical FFP were not observed. CONCLUSIONS LC is a rare membranous conjunctivitis that proceeds with remissions and recurrences. When it was shown that the etiology of LC is plasminogen deficiency, FFP became the only treatment option targeting the etiology. In this study, we observed that the topical FFP is an effective treatment method that prevents recurrence and ensures regression of membranes and safer anterior segment surgeries in LC.
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Martins TGDS, Martins TGDS, Martins DGDS, Kuba MCF. Treatment of ligneous conjunctivitis with heterologous serum. EINSTEIN-SAO PAULO 2019; 17:eRC4714. [PMID: 31215592 PMCID: PMC6559777 DOI: 10.31744/einstein_journal/2019rc4714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/20/2018] [Indexed: 11/10/2022] Open
Abstract
Ligneous conjunctivitis is a rare form of chronic and recurrent bilateral conjunctivitis, in which thick membranes develop on the tarsal conjunctiva and on other mucosae. We report the case of a 55-year old female patient with bilateral ligneous conjunctivitis who was successfully treated with 50% heterologous serum. There was no recurrence or side effects after one-year follow-up. We suggest the use of 50% heterologous serum should be further studied to better determine its efficacy as a treatment option for ligneous conjunctivitis.
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Sartori MT, Sivolella S, Di Pasquale I, Saggiorato G, Perini A, Boscaro F, Fabris F. Prophylactic protocol for dental care in ligneous gingivitis due to severe plasminogen deficiency: Case report and review of literature. Haemophilia 2019; 25:693-698. [DOI: 10.1111/hae.13745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Maria T. Sartori
- Clinical Medicine I, Department of Medicine University of Padua Padua Italy
| | - Stefano Sivolella
- Section of Dentistry, Department of Neurosciences University of Padua Padua Italy
| | | | - Graziella Saggiorato
- Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine University of Padua Padua Italy
| | - Alessandro Perini
- Section of Dentistry, Department of Neurosciences University of Padua Padua Italy
| | - Francesca Boscaro
- Clinical Medicine I, Department of Medicine University of Padua Padua Italy
| | - Fabrizio Fabris
- Clinical Medicine I, Department of Medicine University of Padua Padua Italy
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Shamim MM, Weissman HM, Al-Mohtaseb ZN. Treatment of Ligneous Conjunctivitis Using Topical Plasminogen Therapy in an 8-Week-Old Female Infant. J Pediatr Ophthalmol Strabismus 2018; 55:e30-e32. [PMID: 30180242 DOI: 10.3928/01913913-20180806-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/25/2018] [Indexed: 11/20/2022]
Abstract
An 8-week-old female infant presented with bilateral eyelid swelling and conjunctival membranes. She was diagnosed as having ligneous conjunctivitis. The membranes were excised but recurred despite topical cyclosporine, heparin, fresh frozen plasma, and systemic fresh frozen plasma transfusions. Topical plasminogen prevented membrane recurrence and intravenous plasminogen therapy treated systemic manifestations of the disease. [J Pediatr Ophthalmol Strabismus. 2018;55:e30-e32.].
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Raimann R, Moya R, Anguita R, Kobus R, Pérez M, Gonzalez P. Clinical, histopathological, and genetic aspects in one case of ligneous conjunctivitis. Ophthalmic Genet 2018; 39:642-644. [DOI: 10.1080/13816810.2018.1502791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Rolf Raimann
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
- Departamento de Oftalmología, Centro de la visión, Clínica las Condes, Santiago, Chile
| | - Rene Moya
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
- Departamento de Oftalmología, Centro de la visión, Clínica las Condes, Santiago, Chile
| | - Rodrigo Anguita
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
| | - Rudolf Kobus
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
| | - Marcela Pérez
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
- Departamento de Oftalmología, Centro de la visión, Clínica las Condes, Santiago, Chile
| | - Patricio Gonzalez
- Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
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Baithun M, Freeman-Wang T, Chowdary P, Kadir RA. Ligneous cervicitis and endometritis: A gynaecological presentation of congenital plasminogen deficiency. Haemophilia 2018; 24:359-365. [PMID: 29436075 DOI: 10.1111/hae.13418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital plasminogen deficiency is a rare autosomal recessive condition. Plasminogen deficiency is thought to result in an inability of fibrin breakdown and therefore accumulation of fibrin and formation of ligneous changes. Ligneous lesions can form on a number of mucosal membranes including the cervix and endometrium. METHODS We report the case of a 25-year-old woman with type 1 plasminogen deficiency with ligneous cervicitis and endometritis and her treatment and clinical course over the last few years. We then review the current literature of ligneous cases of the female genital tract and discuss available treatment options. KEY RESULTS We found 30 reported cases of ligneous lesions affecting the female genital tract, with the cervix being the most affected part. A number of treatment options have been tried by our patient and other cases in the literature. These include use of the combined oral contraceptive pill, fresh frozen plasma infusion, topical plasmin and plasminogen and trial use of plasminogen concentrate. CONCLUSIONS This is a chronic condition requiring a multidisciplinary approach. There is currently no definitive treatment for the condition, current trials with plasminogen concentrate replacement therapy may provide a promising option for these patients in the future.
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Affiliation(s)
- M Baithun
- Department of Obstetrics and Gynaecology, The Royal Free Foundation NHS Trust, London, UK
| | - T Freeman-Wang
- Department of Obstetrics and Gynaecology, The Whittington NHS Trust, London, UK
| | - P Chowdary
- Katharine Dormandy Haemophilia and thrombosis Centre, The Royal Free Foundation NHS Trust, London, UK
| | - R A Kadir
- Department of Obstetrics and Gynaecology, The Royal Free Foundation NHS Trust, London, UK.,Katharine Dormandy Haemophilia and thrombosis Centre, The Royal Free Foundation NHS Trust, London, UK
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Topical Plasminogen as Adjunctive Treatment in Recurrent Ligneous Conjunctivitis. Ophthalmic Plast Reconstr Surg 2017; 33:e37-e39. [DOI: 10.1097/iop.0000000000000694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Conforti FM, Di Felice G, Bernaschi P, Bartuli A, Bianco G, Simonetti A, Buzzonetti L, Valente P, Corsetti T. Novel plasminogen and hyaluronate sodium eye drop formulation for a patient with ligneous conjunctivitis. Am J Health Syst Pharm 2016; 73:556-61. [PMID: 27045067 DOI: 10.2146/ajhp150395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The development, analysis, and first clinical use of a novel eye drop formulation of plasminogen and hyaluronate sodium for the treatment of a patient with ligneous conjunctivitis (LC) are described. SUMMARY LC is a chronic inflammatory disorder of the eye that can in rare cases lead to corneal involvement and subsequent blindness. Topically administered plasminogen is an effective treatment for LC; however, the lack of a specific and validated formulation of plasminogen for topical treatment can constitute a gap in the quality of care. A novel formulation of plasminogen and hyaluronate sodium for the treatment of LC was developed by combining commercially available products. Through a series of tests, including microbiological, viscosity, and pH analyses, the novel eye drop formulation was demonstrated to have constant activity (3.3 IU/mL or greater), to be microbiologically stable (i.e., sterile), and to be safe enough for daily administration. The first clinical application of the novel eye drop formulation was in the case of a nine-year-old girl with LC affecting both eyes. Initially, the girl's parents administered two drops every three hours to the left eye each day while the girl was awake. On examination after 30 days of daily use of the eye drop formulation, the patient was found to have a clear cornea and no membrane development on the conjunctiva; the formulation was subsequently administered in both eyes, with positive results. CONCLUSION A new formulation of plasminogen plus hyaluronate sodium was developed, tested, and used successfully in a girl with LC.
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Affiliation(s)
| | - Giovina Di Felice
- Laboratory Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Paola Bernaschi
- Laboratory Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Andrea Bartuli
- Pediatrics Medicine Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Giuseppe Bianco
- Healthcare Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Alessandra Simonetti
- University-Hospital Pediatric Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Luca Buzzonetti
- Department of Surgery, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Paola Valente
- Department of Surgery, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Tiziana Corsetti
- Healthcare Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy.
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Baiula M, Spampinato S. Phase II drugs under investigation for allergic conjunctivitis. Expert Opin Investig Drugs 2014; 23:1671-86. [DOI: 10.1517/13543784.2014.944640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nye M, Rudner S, Bielory L. Emerging therapies in allergic conjunctivitis and dry eye syndrome. Expert Opin Pharmacother 2013; 14:1449-65. [DOI: 10.1517/14656566.2013.802773] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pignataro G, Vinciguerra A, Cuomo O, Sirabella R, Di Renzo GF, Scorziello A. Conjunctival instillation of plasminogen eliminates ocular lesion in B6.129P2-Plg(tm1Jld) transgenic mice, a model of ligneous conjunctivitis. Pharmacol Res 2013; 74:45-8. [PMID: 23684723 DOI: 10.1016/j.phrs.2013.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
Ligneous conjunctivitis is a severe and rare chronic "idiopathic membraneous" conjunctivitis, characterized by the formation of pseudomembranes mostly on the palpebral surfaces that progressively replace the normal mucosa. Evidence has been provided that ligneous conjunctivitis is caused by a severe systemic plasminogen deficiency with decreased plasminogen antigen and decreased plasminogen functional activities. Objective of the present study is to verify the hypothesis that a topical eye application of plasminogen is able to ameliorate the consequences of this disease. Here we report the results of pre-clinical studies performed to investigate the therapeutic effectiveness of an eye-drop plasminogen preparation in B6.129P2-Plg(tm1Jld) transgenic mice, a model of ligneous conjunctivitis. The entity of protection mediated by plasminogen was evaluated by measuring the extent of the eye lesion by means of a computerized system and dedicated software. The results of the present study clearly showed that the administration for six times a day of plasminogen eye-drop solution in the lesioned eye of animals knock-out for plasminogen gene and developing ligneous conjunctivitis caused a dose and time related reduction of the extent of the ocular lesion. These findings may pave the road for the pharmacological treatment of the ocular lesion associated to the ligneous conjunctivitis that at the present is surgically treated by removing the pseudomembranes generated on the eye.
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Affiliation(s)
- G Pignataro
- Division Pharmacology, Department of Neuroscience, School of Medicine, "Federico II" University of Naples, Via Pansini, 5, 80131 Naples, Italy
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Tok OY, Kocaoglu FA, Tok L, Burcu A, Ornek F. Treatment of ligneous conjunctivitis with amniotic membrane transplantation and topical cyclosporine. Indian J Ophthalmol 2012. [PMID: 23202401 PMCID: PMC3545139 DOI: 10.4103/0301-4738.103800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ligneous conjunctivitis (LC) is a rare form of bilateral chronic recurrent disease in which thick membranes form on the palpebral conjunctiva and other mucosal sites. We report the clinical features and describe the management of two cases. Case 1 was an 8-month-old patient with bilateral membranous conjunctivitis. Case 2 was a 5-year-old patient with unilateral membranous conjunctivitis, esotropia, mechanical ptosis and complicated cataract, and had been treated with a number of medications. Histological investigation of the membrane in both cases showed LC. Treatments with amniotic membrane transplantation and institution of topical cyclosporine have shown good response. There has been complete resolution of the membranes with no recurrence at the end of 40- and 28-month follow-ups, respectively. No treatment related side effects were seen. Thus, it appears that amniotic membrane transplantation and topical cyclosporine are effective alternatives for the treatment of LC.
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Affiliation(s)
- Ozlem Yalcin Tok
- Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University, Turkey
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Ku JY, Lichtinger A, Yeung SN, Kim P, Cserti-Gazdewich C, Slomovic AR. Topical fresh frozen plasma and heparin treatment of ligneous conjunctivitis in a Canadian hospital setting. Can J Ophthalmol 2012; 47:e27-8. [DOI: 10.1016/j.jcjo.2012.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gupta SR, Chaudhry Z, Kumar V, Saran RK, Augustine J. Ligneous Periodontitis and Conjunctivitis With Hyper-Immunoglobulin E Syndrome. Clin Adv Periodontics 2012. [DOI: 10.1902/cap.2012.110060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sivolella S, De Biagi M, Sartori MT, Berengo M, Bressan E. Destructive membranous periodontal disease (ligneous gingivitis): a literature review. J Periodontol 2011; 83:465-76. [PMID: 21859319 DOI: 10.1902/jop.2011.110261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Destructive membranous periodontal disease, or ligneous gingivitis, is a rare condition involving nodular gingival enlargement with ulceration and periodontal tissue destruction. This review gives a brief account of the cases reported in the literature. An effort is also made to define the periodontal disease caused by plasminogen deficiency with a view to its potential inclusion in the classification of periodontal diseases. METHODS A MEDLINE/PubMed and manual search was conducted to find papers describing ≥1 case of ligneous disease involving the oral mucosa. RESULTS We identified 23 articles reporting 35 cases. For each patient, we analyzed various characteristics, including age, sex, age of onset, oral symptoms, histologic features, plasminogen levels (functional activity, plasma antigen), genetic features, treatment, and results of treatment during the reported follow-up. CONCLUSIONS Ligneous gingivitis is a rare periodontal disorder closely associated with ligneous conjunctivitis and plasminogen deficiency. Its diagnosis may be supported by the finding of genetic mutations responsible for the condition. Research is focusing on the future development of an effective therapy capable of arresting the destructive evolution of the disease. Additional studies, investigating features such as probing depth and attachment loss, are needed for the appropriate classification of this periodontal disease.
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Affiliation(s)
- Stefano Sivolella
- Department of Oral Surgery, University of Padova, Institute of Clinical Dentistry, Padova, Italy.
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Neff KD, Holland EJ, Schwartz GS. Ligneous Conjunctivitis. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Plasminogen deficiency has emerged as a well-recognized disorder in which reduced levels of plasminogen lead to the development of pseudo membranes on mucosal surfaces, with subsequent end-organ damage of the affected tissue. Ligneous conjunctivitis is the most recognizable, well-documented, and common presentation of the clinical syndromes associated with plasminogen deficiency, although numerous other organs have been reported to be affected. Interestingly, while plasminogen deficiency was initially believed to be related to development of venous thromboembolic disease, more recent data suggest that decreased plasminogen levels may not, in and of themselves, increase the risk of thrombosis. Two types of plasminogen deficiency have been described in the literature. Type I represents a quantitative deficiency and type II a qualitative deficiency. It appears that hypoplasminogenaemia (type I deficiency) is the type most associated with pseudomembrane disease. A variety of genetic mutations has been identified recently and is reported to lead to these disorders. These defects have been identified in diverse populations, with no specific ethnic predilection. However, this disorder may have increased prevalence in areas and communities where consanguinity is more common. Despite the fact that the characteristic lesions are now better recognized and plasminogen levels are accurately and easily measured, adequate treatment of the clinical manifestations of this disorder is lacking. For ligneous conjunctivitis, a plasminogen concentrate formulated into an ophthalmologic preparation has been found to be an effective local therapy. Unfortunately, no plasminogen concentrate is currently available commercially for either systemic or local therapy.
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Affiliation(s)
- R Mehta
- Department of Clinical Medicine, Section of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Biswas J, Billingham K, Biswas S, Hirschowitz L, Bisson D. Ligneous cervicitis: an unusual cause of post-coital bleeding in a postmenopausal woman. J OBSTET GYNAECOL 2009; 29:163-5. [PMID: 19274564 DOI: 10.1080/01443610802667211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J Biswas
- Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
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Reply:. Cornea 2009. [DOI: 10.1097/ico.0b013e31818754bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fresh Frozen Plasma Treatment of Ligneous Conjunctivitis: Use of Heparin and Allogeneic Serum. Cornea 2009; 28:122-3; author reply 123. [DOI: 10.1097/ico.0b013e31818754ac] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fine G, Bauer K, Al-Mohaya M, Woo SB. Successful treatment of ligneous gingivitis with warfarin. ACTA ACUST UNITED AC 2008; 107:77-80. [PMID: 18996031 DOI: 10.1016/j.tripleo.2008.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 07/30/2008] [Accepted: 08/02/2008] [Indexed: 11/15/2022]
Abstract
Ligneous gingivitis is a rare condition characterized by inflammation and nodular gingival enlargement secondary to fibrin deposits in the gingival that results from plasminogen deficiency. Several therapeutic approaches have been used with limited success. We report a case of a patient with homozygous plasminogen deficiency and ligneous gingivitis that was initially refractory to local care and systemic antibiotics, but later improved with the addition of warfarin.
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Affiliation(s)
- Gregg Fine
- Department of Medicine, Hematology/Oncology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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Altinkaya SO, Uzunlar O, Talas BB, Ozat M, Bilge U. Ligneous cervicovaginitis. Taiwan J Obstet Gynecol 2008; 47:363-6. [PMID: 18936011 DOI: 10.1016/s1028-4559(08)60146-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Systemic and Topical Fresh-Frozen Plasma Treatment in a Newborn With Ligneous Conjunctivitis. Cornea 2008; 27:501-3. [DOI: 10.1097/ico.0b013e318162a8e0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McLean NSJ, Ward DA, Hendrix DVH, Donnell RL, Ilha MRS. Ligneous conjunctivitis secondary to a congenital plasminogen deficiency in a dog. J Am Vet Med Assoc 2008; 232:715-21. [DOI: 10.2460/javma.232.5.715] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Plasminogen (plg) deficiency has been classified as (i) hypoplasminogenemia or 'true' type I plg deficiency, and (ii) dysplasminogenemia, also called type II plg deficiency. Both forms, severe hypoplasminogenemia and dysplasminogenemia, are not causally linked to venous thrombosis. Dysplasminogenemia does not lead to a specific clinical manifestation and probably represents only a polymorphic variation in the general population, mainly in Asian countries. Severe hypoplasminogenemia is associated with compromised extracellular fibrin clearance during wound healing, leading to pseudomembraneous (ligneous) lesions on affected mucous membranes (eye, middle ear, mouth, pharynx, duodenum, upper and lower respiratory tract and female genital tract). Ligneous conjunctivitis is by far the most common clinical manifestation. More than 12% of patients with severe hypoplasminogenemia exhibit congenital occlusive hydrocephalus. In milder cases of ligneous conjunctivitis, topical application of plg-containing eye drops, fresh frozen plasma, heparin, corticosteroids or certain immunosuppressive agents (such as azathioprine) may be more or less effective. Oral treatment with sex hormones was successful in two female patients with ligneous conjunctivitis. In severe cases with possibly life-threatening multi-organ involvement, true therapeutic options are not available at present. The plg-knockout mouse is a useful tool to study the many different properties of plg in a variety of settings, such as wound healing, tissue repair and tissue remodeling, virulence and invasiveness of certain bacteria in the human host, tumor growth and dissemination, as well as arteriosclerosis.
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Affiliation(s)
- V Schuster
- Hospital for Children and Adolescents, Medical Faculty of Leipzig University, Liebigstrasse 20a, Leipzig, Germany.
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Kurtulus I, Gokbuget A, Efeoglu A, Cintan S, Tefs K, Schuster V, Scully C. Hypoplasminogenemia with ligneous periodontitis: a failed local therapeutic approach. J Periodontol 2007; 78:1164-75. [PMID: 17539733 DOI: 10.1902/jop.2007.060422] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Hypoplasminogenemia is a rare condition that is associated with ligneous conjunctivitis, a form of chronic conjunctivitis characterized by firm, fibrin-rich, pseudomembranous lesions on the tarsal conjunctivae and oral lesions. Pseudomembranes may develop on the gingivae, and there may be periodontal involvement. METHODS Several therapeutic approaches have been developed to treat such patients, but they have had limited effect. We used gingivectomies, topical heparin, and corticosteroids to treat periodontal lesions in an 18-year-old girl. RESULTS This approach had no benefit. CONCLUSION The question remains about how best to manage patients with hypoplasminogenemia.
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Affiliation(s)
- Idil Kurtulus
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
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Toker H, Toker MI, Goze F, Turgut M, Yilmaz A. A ligneous periodontitis and conjunctival lesions in a patient with plasminogen deficiency. ACTA ACUST UNITED AC 2007; 103:e35-8. [PMID: 17449295 DOI: 10.1016/j.tripleo.2007.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 12/25/2006] [Accepted: 01/01/2007] [Indexed: 11/30/2022]
Abstract
Destructive membranous periodontal disease is a rare and poorly defined entity that is a part of a systemic disease due to accumulation of fibrin material. The disease is characterized by gingival enlargement and periodontal tissue destruction that leads to rapid bone loss despite treatment efforts. We present a case with ligneous periodontitis and conjunctivitis.
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Affiliation(s)
- Hulya Toker
- Department of Periodontology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
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Pierro VSS, Vazquez-Sullca R, Vieira ASB, Takiya CM, Carakushansky G, Feres-Filho EJ. Ligneous Periodontitis and Ehlers-Danlos Syndrome. J Periodontol 2006; 77:123-8. [PMID: 16579713 DOI: 10.1902/jop.2006.77.1.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Generalized membranous gingival enlargement due to an accumulation of fibrin deposits associated with severe alveolar bone loss (ligneous periodontitis) is a rare condition, and plasminogen deficiency seems to play a central role in its pathogenesis. However, this condition has not been described in association with syndromes. This article reports a case of ligneous periodontitis in a boy with the classic type of Ehlers-Danlos syndrome (EDS). METHODS A 12-year-old white male presented with generalized gingival overgrowth and severe alveolar bone loss. A physical examination revealed clinical signs of EDS (velvety skin with mild hyperextensibility, marked hypermobility of the limb joints, atrophic scars on his knees, and easy bruising), which is associated with a positive family history for joint hypermobility. A biopsy of gingival tissues was submitted for routine histology, hematoxylin and eosin (H&E), and direct immunofluorescence (antifibrinogen). An evaluation of plasminogen activity was also performed. RESULTS Histopathology revealed chronic periodontitis with fibrinoid material deposition, and direct immunofluorescence proved to be positive for fibrin. Functional plasminogen was reduced. A conclusive diagnosis of ligneous periodontitis due to plasminogen deficiency associated with the classic type of EDS was rendered. CONCLUSIONS Ehlers-Danlos syndrome can be associated with ligneous periodontitis. In the present case, the histologic examination represented an important tool in the differential diagnosis, because it ruled out EDS type VIII as the associated systemic factor to periodontal breakdown.
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Affiliation(s)
- Viviane S S Pierro
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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