Objective: This study aims to determine recurrence and complication rates among patients who underwent three current pterygium treatment techniques: preoperative subpterygeal injection of mitomycin C, intraoperative application of mitomycin with pterygium excision and pterygium excision with conjunctival autograft. Methods: This is a randomized controlled clinical trial in a tertiary hospital. We included patients with diagnosed primary pterygium and who underwent either: A = pre-operative injection of 0.02% mitomycin C one month prior to pterygium excision; B = pterygium excision with intraoperative mitomycin C application; or C = pterygium excision with conjunctival autograft. Results: We included 111 patients: a total of 120 eyes randomized to 3 groups (A, B, C) at 40 eyes per group. After 24 months of follow-up, there was no significant difference in the recurrence rates among the groups (6/40 [15%] in groups A and B and 2/40 cases [5%] in group C; P=0.29). No complications were noted in groups B and C, while 1 case of scleral thinning was noted in group A. There was no significant difference in the complication rates among the three procedures (P=1.00). Conclusion There were no significant differences in the recurrence and complication rates among the three techniques. Careful patient selection and follow-up are recommended to prevent complications such as scleral thinning.
Pterygium Of Conjunctiva And Cornea ; Pterygium ; Mitomycin ; Autografts ; Conjunctiva ; Conjunctivitis ; Transplantation, Autologous

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; CONJUNCTIVA/TRANSPLANTATION ; CONJUNCTIVA/SURGERY ; TRANSPLANTATION, AUTOLOGOUS ; OPHTHALMOLOGIC SURGICAL PROCEDURES ; PTERYGIUM/SURGERY ; HUMAN ; MALE ; FEMALE

PURPOSE: We report a case of the granulocytic sarcoma located at the conjunctival fornix in a 10-year-old girl with acute myeloid leukemia, who was in complete remission after bone marrow transplantation. METHODS: A 10-year-old girl had a 1-week history of firm, dark brown conjunctival mass at lower fornix and mild lid swelling of the right eye. Several months previously she had had some chalazions at lower lid and a history of acute myeloid leukemia that was currently in complete remission after bone marrow transplantation. Other ocular manifestations were not specific. Excision of the conjunctival mass and a biopsy for diagnostic and therapeutic purposes were performed. RESULTS: The 12 x 6 x 5 mm-sized mass was totally excised. The pathologic examination was consistent with granulocytic sarcoma. Three weeks after the biopsy, the patient had a relapse of acute myeloid leukemia. She died 2 months later while undergoing intensive therapy. CONCLUSIONS: This condition should be considered in the diagnosis of granulocytic sarcoma in patients with a history of acute myeloid leukemia.
Biopsy ; Bone Marrow Transplantation ; Chalazion ; Child ; Conjunctiva* ; Diagnosis ; Female ; Humans ; Leukemia, Myeloid, Acute ; Recurrence ; Sarcoma, Myeloid*

No abstract available.
Aged ; Amnion/*transplantation ; Conjunctiva/*surgery ; Female ; Glaucoma/surgery ; Humans ; Intraoperative Complications/*surgery ; Trabeculectomy/*adverse effects

PURPOSE: To emphasize the importance of conjunctival flap or amniotic membrane covering on the scleral allograft for scleral necrosis following pterygium excision. METHODS: Five eyes in four patients showed signs of impending perforation caused by scleral necrosis following pterygium excision, with strontium irradiation in four eyes and with instillation of mitomycin C in the other eye for preventing recurrence of pterygium. All cases were transplanted human sclera stored at -20 degrees C in Eye-Bank. Among them, the patient's own conjunctiva was used to cover the scleral allograft with interrupted sutures in four eyes, where in the other eye the scleral allograft was alternatively covered over by using human amniotic membrane stored at -70 degrees C. RESULTS: The results of all five cases were very successful without any complications during an average follow-up of 19 months (range 6~25 months). CONCLUSIONS: Based on the clinical experiences of these five cases, we concluded that the covering of the scleral allograft with conjunctiva or amniotic membrane is a very important procedure to ensure the successful viability of the scleral allograft, which is a natural structure of the conjunctiva and sclera.
Allografts* ; Amnion ; Conjunctiva ; Follow-Up Studies ; Humans ; Mitomycin ; Necrosis* ; Pterygium* ; Recurrence ; Sclera ; Strontium ; Sutures ; Transplantation, Homologous*

OBJECTIVE: To compare the recurrence rate after conjunctival autograft alone versus conjunctival autograft with mitomycin-C in the treatment of primary and recurrent pterygium.
METHODS: This was a prospective, randomized, interventional comparative study of patients with primary and recurrent pterygium who were randomized to receive either simple excision with conjunctival autograft (CA) or simple excision with CA and mitomycM-C applied. They were followed up for 6 months and observed for recurrence of the pterygium. Statistical analyses were used to compare the 2 groups.
RESULTS: Fifty-eight patients (62 eyes) diagnosed with primary and recurrent pterygium were evaluated. The mean age was 44.81 ± 12.35 years (range 25 to 70 years). Thirty eyes were treated with conjunctival autograft (15 primary, 15 recurrent) and 32 eyes (17 primary, 15 recurrent) with conjunctival autograft combined with Mtraoperati-ve application of low-dose raitomycin. -C (0.02% for 3 minutes). The mean follow-up period was 25 ± 1.40 months (range 24 to 28 months). There was a 3.22% recurrence rate (2 eyes) from the recurrent pterygium group. There was no significant difference 11.1  the rate of recurrence (p = 0.53) between the 2 treatments for both primary and recurrent pterygium. No mitomycM C-related complication was observed during the length of the study.
CONCLUSION: Conjunctival autograft surgery alone for primary and recurrent pterygium is effective and safe in reducing the recurrence rate of pterygium within" 6 months.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Pterygium ; Mitomycin ; Autografts ; Conjunctiva ; Transplantation, Autologous

PURPOSE: Interleukin (IL)-22 is a cytokine involved in epithelial cell regeneration. Currently, no research studies have analyzed the distribution of the three distinct IL-22–secreting cell populations in human or mouse conjunctiva. This study investigated the distribution of the three main populations of IL-22–secreting immune cells, αβ Th cells, γδ T cells, or innate cells (innate lymphoid cells [ILCs] or natural killer cells), in conjunctival associated lymphoid tissues (CALTs) in human and mouse models. METHODS: We collected discarded cadaveric bulbar conjunctival tissue specimens after preservation of the corneo-limbal tissue for keratoplasty from four enucleated eyes of the domestic donor. The bulbar conjunctiva tissue, including the cornea from normal (n = 27) or abraded (n = 4) B6 mice, were excised and pooled in RPMI 1640 media. After the lymphoid cells were gated in forward and side scattering, the αβ Th cells, γδ T cells, or innate lymphoid cells were positively or negatively gated using anti-CD3, anti-γδ TCR, and anti–IL-22 antibodies, with a FACSCanto flow cytometer. RESULTS: In normal human conjunctiva, the percentage and number of cells were highest in αβ Th cells, followed by γδ T cells and CD3–γδ TCR – IL-22+ innate cells (presumed ILCs, pILCs) (Kruskal-Wallis test, p = 0.012). In normal mice keratoconjunctiva, the percentage and total number were highest in γδ T cells, followed by αβ Th cells and pILCs (Kruskal-Wallis test, p = 0.0004); in corneal abraded mice, the population of αβ Th cells and pILCs tended to increase. CONCLUSIONS: This study suggests that three distinctive populations of IL-22–secreting immune cells are present in CALTs of both humans and mice, and the proportions of IL-22+αβ Th cells, γδ T cells, and pILCs in CALTs in humans might be differently distributed from those in normal mice.
Animals ; Antibodies ; Cadaver ; Conjunctiva ; Cornea ; Corneal Transplantation ; Epithelial Cells ; Humans ; Interleukins ; Lymphocytes ; Lymphoid Tissue* ; Mice ; Regeneration ; T-Lymphocytes ; Tissue Donors

PURPOSE: In the field of ophthalmology, the conjunctival autograft is a useful therapeutic material in many cases, but the small size of the autograft is a disadvantage. Therefore, we evaluated the feasibility of taking an expanded sample of conjunctival tissue using a subtenon's silicone implant. MATERIALS AND METHODS: We included a total of nine rabbits; eight rabbits were operative cases, and one was a control. A portion of conjunctival tissue from the control rabbit, which did not undergo surgery, was dissected and examined to determine whether it was histologically different from the experimental group. The surgical procedure was performed on eight rabbits via a subtenon's insertion of a silicone sponge in the left superior-temporal portion; after surgery, we dropped antibiotics into the eyes. We sacrificed a pair of rabbits every three days (on days 3, 6, 9, and 12) after surgery, removed the expanded conjunctival tissues with the silicone sponge implants, and measured their sizes. RESULTS: The mean size of the expanded conjunctival tissues was 194.4mm(2). On the third day, we were able to harvest a 223.56mm(2) section of conjunctival tissue, which was the most expanded sample of tissue in the study. On the twelfth day, we removed a 160.38mm(2) section of conjunctival tissue, which was the least expanded sample of tissue. Statistically, there were no significant differences in the mean dimensions of the expanded conjunctival tissues for each time period. Microscopic examinations showed no histological differences between the expanded conjunctival tissues and the normal conjunctival tissues. CONCLUSION: The results reveal that this procedure is a useful method to expand the conjunctiva for grafting and transplantation.
Animals ; Conjunctiva/*growth & development/*surgery/transplantation ; Corneal Diseases/surgery ; Feasibility Studies ; Female ; *Prostheses and Implants ; Rabbits ; Silicones ; Tissue Expansion/*methods ; Transplantation, Autologous/methods

BACKGROUNDThe recurrence of pterygium after surgery is high. A variety of adjunctive treatment approaches have been developed to improve the clinical efficacy and many related articles have been published. This study aimed to determine the risk for postoperative pterygium recurrence comparing autologous conjunctival transplantation (ACT) versus mitomycin C (MMC).

METHODSRelevant literature published until December 2010 in Medline, Embase, Cochrane, Cochrane library, Science Citation Index, and Google Scholar were searched. Qualified random clinical trial (RCT) studies on the comparison of recurrence rate of pterygium after ACT and MMC treatment were included in this study.

RESULTSEight RCTs with 663 eyes entered the final analysis. The recurrent rate of pterygium was 8.7% (30/343) for ACT and 18.75% (60/320) for MMC. Using fixed-effect meta analysis, we found that the recurrence was significantly lower after ACT than MMC treatment (odds ratio (OR) = 0.40, 95% confidence index (CI), 0.25 - 0.63, P < 0.0001). In sensitivity analyses, we employed random-effects model and excluded studies of low quality or studies in which MMC was administrated after the operation. All the sensitivity analyses confirmed that ACT led to lower recurrence rates than MMC. Sub-group analysis revealed that the recurrence rate was 20.2% (20/99) and 27.65% (26/94) for conjunctival autograft (CA) and MMC respectively, and no significant difference in the recurrence rate was detected (OR = 0.65, 95%CI 0.33 - 1.28, P = 0.22). However, we found that conjunctival limbal autograft (CLA) had lower recurrence rate than MMC (OR = 0.26, 95%CI 0.14 - 0.48, P = 0.0001).

CONCLUSIONCLA has better therapy efficacy against the recurrence of pterygium than MMC.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Conjunctiva ; transplantation ; Humans ; Middle Aged ; Mitomycin ; therapeutic use ; Pterygium ; therapy ; Randomized Controlled Trials as Topic ; Transplantation, Autologous

PURPOSE: To report a case of ocular surface squamous cell carcinoma with intraorbital extension in a patient with renal transplantation and long-term immunosuppressive therapy. CASE SUMMARY: A 59-year-old Korean male presented with a whitish mass in the medial limbus and conjunctiva of the right eye. The patient had undergone renal transplantation 17 years prior due to lupus nephritis and was on systemic immunosuppression with daily prednisolone (10 mg), tacrolimus (5 mg), and mycophenolate sodium (720 mg). The complete excision of the mass was performed and mitomycin C application and amniotic membrane transplantation on the excised area were combined. Histopathological examination revealed the mass was squamous cell carcinoma. There were no abnormal findings on the orbit computed tomography (CT). The patient was additionally treated with topical interferon alpha 2b 6 months postoperatively. One year later, a mass recurred at the same site in the right eye. The complete excision of the mass, mitomycin C application, cryotherapy, and amniotic membrane transplantation were performed. Orbit CT showed a 1.9 cm-sized intraorbital mass involving the medial rectus of the right eye. The orbital exenteration was performed and the intraorbital mass was histologically proven to be squamous cell carcinoma. CONCLUSIONS: Ocular surface squamous neoplasia in patients with renal transplantation and long-term immunosuppressive therapy should be monitored closely for the possibility of orbital invasion.
Amnion ; Carcinoma, Squamous Cell* ; Conjunctiva ; Cryotherapy ; Humans ; Immunosuppression* ; Interferon-alpha ; Kidney Transplantation ; Lupus Nephritis ; Male ; Middle Aged ; Mitomycin ; Orbit ; Prednisolone ; Sodium ; Tacrolimus