Treatment of ligneous conjunctivitis with amniotic membrane transplantation and topical cyclosporine

Amniotic membrane transplantation: structural and biological properties, tissue preparation, application and clinical indications

The amniotic membrane is a single epithelial layer of the placenta. It has anti-inflammatory, anti-scarring, anti-angiogenic and possibly bactericidal properties. The basement membrane of the amniotic membrane acts as a substrate to encourage healing and re-epithelialisation. It has been used in many ocular surface diseases including persistent epithelial defects (corneal or conjunctival), chemical or thermal burns, limbal stem cell deficiency, cicatrising conjunctivitis, ocular graft versus host disease, microbial keratitis, corneal perforation, bullous keratopathy, dry eye disease, corneal haze following refractive surgery and cross-linking, band keratopathy, ocular surface neoplasia, pterygium surgery, and ligneous conjunctivitis. This review provides an up-to-date overview of amniotic membrane transplantation including the structural and biological properties, preparation and application, clinical indications, and commercially available products.

Combined medical and surgical approach in the management of ligneous conjunctivitis in a pediatric patient: A case report

INTRODUCTION

Ligneous conjunctivitis (LC), a rare chronic conjunctivitis linked to plasminogen deficiency, poses challenges in research and management due to its complexity. This case report details the combined medical and surgical approach in managing LC in a 1.5-year-old female with congenital hydrocephalus, plasminogen deficiency, and glaucoma.

CASE PRESENTATION

The patient's LC required a comprehensive treatment plan involving systemic and topical therapies, surgical intervention, and fresh frozen plasma (FFP) infusions via a central line.

DISCUSSION

Managing LC necessitates a comprehensive, individualized approach due to its rarity and lack of standardized treatments. Various therapies have shown promise, but their availability, cost, and potential side effects vary. FFP infusions played a crucial role in managing plasminogen deficiency, but the potential complications associated with central lines must be considered. Ongoing clinical trials aim to improve LC treatment, but until results are available, clinicians must rely on existing evidence and clinical judgment.

CONCLUSION

This case underscores the complexity of managing LC and the significance of adopting an individualized treatment strategy. Regular follow-ups are crucial for flexibility and adaptability in treatment plans to address potential recurrences. Further research is necessary to validate these findings and assess the long-term effectiveness of the combined approach.

Conjuntivitis leñosa

Objetivo: presentar y describir el cuadro clínico de un paciente con conjuntivitis leñosa en el Hospital de San José de Bogotá.  Diseño: estudio descriptivo, retrospectivo y reporte de caso. Metodología: revisión y análisis de la literatura con referencia al diagnóstico de la patología, con variables en lo posible similares a las encontradas en el paciente, con el propósito de caracterizar la condición y determinar el manejo satisfactorio. Descripción: paciente de 19 años con manifestación temprana (desde el nacimiento) consistente en aparición de lesiones tipo papila, de tamaño gigante, en conjuntiva tarsal superior en ambos ojos. Al examen oftalmológico se evidenciaron papilas confluentes con masas lobuladas dependientes de la conjuntiva tarsal superior. La biopsia confirmó el diagnóstico de conjuntivitis leñosa congénita.

Ligneous conjunctivitis in a patient of juvenile colloid milia: A rare association

We present to you, case of a 10-year-old female with h/o redness, watering since 8 months. Her vision was 20/30 in right eye and 20/70 in left eye. Conjunctiva had plenty of purulent discharge and palpebral conjunctiva was studded with membranous lesions. She was found to have multiple hyperpigmented papulopustular lesions over face, palms and legs. She was started with topical moxifloxacin and lubricating drops. Patient was followed-up after 15 days. At that time her conjunctiva had formation of a woody pseudomembrane. Excision of the lesions and skin biopsy was done and sent for hislopathological examination. Findings of histopathological examination were suggestive of ligneous conjunctivitis and juvenile colloid milia. We have started this patient with long-term cyclosporine drops and tear supplements. In next visit, the membrane was resolved. Hence, we continued with the same treatment, but again the woody membrane recurred.