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

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: 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

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

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: To compare the effect of using fibrin glue or 10-0 nylon sutures on the clinical outcome of patients undergoing pterygium excision and conjunctival autografting. METHODS: We retrospectively reviewed the medical records of 52 eyes from 46 patients who underwent pterygium excision and conjunctival autografting and were followed up for more than 3 months. The operation duration, postoperative inflammation, complications, and recurrence rates were compared between groups of 20 patients (22 eyes) for whom fibrin glue was used (fibrin glue group) and 26 patients (30 eyes) for whom suturing was performed with 10-0 nylon (suture group) in pterygium excision and conjunctival autografting. RESULTS: The operation duration was 27.71 (5.22) minutes in the fibrin glue group and 43.30 (8.18) minutes in the suture group (p = 0.000). Seven days after the operation, the fibrin glue group showed milder conjunctival inflammation than the suture group (p = 0.000). Postoperative complications and corneal recurrence rates were not statistically different between the two groups. CONCLUSIONS: The use of fibrin glue in pterygium excision with conjunctival autografting is likely to be a more effective, safer procedure than suturing.
Adult ; Aged ; Aged, 80 and over ; Conjunctiva/*transplantation ; Female ; Fibrin Tissue Adhesive/*pharmacology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Pterygium/*surgery ; Retrospective Studies ; Suture Techniques/*instrumentation ; *Sutures ; Time Factors ; Tissue Adhesives/pharmacology ; Transplantation, Autologous

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: The purpose of this study was to investigate the possibility that a dynamic facial composite flap with sensory and motor nerves could be made available from donor facial composite tissue. METHODS: The faces of 3 human cadavers were dissected. The authors studied the donor faces to assess which facial composite model would be most practicable. A "panorama facial flap" was excised from each facial skeleton with circumferential incision of the oral mucosa, lower conjunctiva and endonasal mucosa. In addition, the authors measured the available length of the arterial and venous pedicles, and the sensory nerves. In the recipient, the authors evaluated the time required to anastomose the vessels and nerve coaptations, anchor stitches for donor flaps, and skin stitches for closure. RESULTS: In the panorama facial flap, the available anastomosing vessels were the facial artery and vein. The sensory nerves that required anastomoses were the infraorbital nerve and inferior alveolar nerve. The motor nerve requiring anstomoses was the facial nerve. The vascular pedicle of the panorama facial flap is the facial artery and vein. The longest length was 78mm and 48mm respectively. Sensation of the donor facial composite is supplied by the infraorbital nerve and inferior alveolar nerve. Motion of the facial composite is supplied by the facial nerve. Some branches of the facial nerve can be anastomosed, if necessary. CONCLUSION: The most practical facial composite flap would be a mid and lower face flap, and we proposed a panorama facial flap that is designed to incorporate the mid and lower facial skin with and the unique tissue of the lip. The panorama facial composite flap could be considered as one of the practicable basic models for facial allotransplantation.
Arteries ; Cadaver ; Conjunctiva ; Facial Nerve ; Facial Transplantation ; Humans ; Lip ; Mandibular Nerve ; Mouth Mucosa ; Mucous Membrane ; Sensation ; Skeleton ; Skin ; Tissue Donors ; Veins

PURPOSE: To evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium. METHODS: Thirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations. RESULTS: The mean patient age was 57.9+/-10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05+/-5.78 weeks. The mean surgery time was 18.04+/-5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive. CONCLUSIONS: The use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms . Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.
Adult ; Aged ; Aged, 80 and over ; Conjunctiva/*transplantation ; Female ; Fibrin Tissue Adhesive/*therapeutic use ; Follow-Up Studies ; Humans ; *Limbus Corneae ; Male ; Middle Aged ; Postoperative Complications ; Pterygium/*surgery ; Tissue Adhesives/*therapeutic use ; Transplantation, Autologous

PURPOSE: To investigate the short-term efficacy of topical immunosuppressive agents on the survival of cultivated allo-conjunctival equivalents. METHODS: Twenty-five eyes of New Zealand white rabbits were included. Temporal conjunctivae were trephined to a diameter of 7.5 mm, and then cultured allo-conjunctival epithelial cells on amniotic membrane were transplanted onto them. Various immunosuppressants including steroid, cyclosporine, and rapamycin were applied topically four times a day for a week. Epithelial defects and graft edema were graded daily. Numbers of inflammatory cells were measured in H&E. PKH26 and cytokeratin 4 and 7 were immunostained. RESULTS: Earlier epithelialization was observed in 1% steroid-treated eyes and defects persisted significantly in 0.5% CsA applied eyes. In histology, PKH26 positive cells considered as donor cells were only found in 1% steroid or 0.01% rapamycin applied eyes. 1% steroid- or 0.01% rapamycin-applied eyes both showed positive staining for keratin-4 and -7. Inflammatory cells were less found in 1% steroid or 0.01% rapamycin treated eyes. CONCLUSIONS: Topical steroid or rapamycin can help to suppress acute inflammation and enhance the acute survival of transplanted conjunctival cells.
Administration, Topical ; Animals ; Cell Count ; *Cell Transplantation ; Cells, Cultured ; Conjunctiva/*cytology ; Cyclosporine/pharmacology ; Epithelial Cells/metabolism/*transplantation ; Female ; Fluorescent Antibody Technique, Indirect ; Graft Survival/*drug effects ; Immunosuppressive Agents/*pharmacology ; Keratin-4/metabolism ; Keratin-7/metabolism ; Male ; Organic Chemicals/metabolism ; Prednisone/pharmacology ; Rabbits ; Sirolimus/pharmacology ; Transplantation, Homologous