A Sharma

Sutureless and glue-free conjunctival autograft in pterygium surgery: a case series

AimsForeign materials used in ocular surface surgery may lead to local complications such as discomfort, scarring, or infection. Plasma-derived products such as fibrin glue may produce possible hypersensitivity reactions whereas the risk of viral transmission remains. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures.MethodsAfter pterygium excision and fashioning of the autologous conjunctival graft, the recipient bed is encouraged to achieve natural haemostasis and relative dessication before graft placement. Excessive haemorrhage in the graft bed is tamponaded. Graft adherence and positioning is examined 20u2009min after surgery.ResultsA total of 15 eyes of 12 patients (mean (SD) age 73.7 (11.2) years), 8 females underwent SGF autologous conjunctival graft post-pterygium excision. Mean graft area was 24(1.5)u2009mm2. Mean follow-up time was 9.2 (2.2) months. Cosmesis was excellent in all cases and visual acuity improved in one patient. There were no intra- or post-operative complications requiring further treatment.ConclusionThis simple technique for pterygium surgery may prevent potential adverse reactions encountered with the use of foreign materials and in this small series provided safe and comparable results to current methods.

Subconjunctival triamcinolone acetonide in the management of ocular inflammatory disease.

PURPOSEnTo review the existing evidence that supports the subconjunctival use of triamcinolone acetonide (TA) in the treatment of various ophthalmic diseases.nnnMETHODSnA literature search was performed for published articles about the pharmacokinetic (PK) and pharmacodynamic characteristics of triamcinolone, as well as its potential ophthalmic use, focused mainly in the subconjunctival mode of delivery. Search terms included corticosteroids, triamcinolone, ocular, subconjunctival, and ophthalmic.nnnRESULTSnCorticosteroids represent the mainstay of treatment of ocular inflammation, exerting their action by affecting multiple pathways of the inflammatory response, making them particularly effective in the majority of cases. However, due to the number and severity of the side effects associated with their use, they have to be given with caution. Corticosteroids can be given topically, subconjunctivally, intraocularly, and systemically to treat a variety of ocular diseases with specific pharmacological and PK characteristics. Triamcinolone is one of the most widely used corticosteroids in the treatment of ocular inflammation. This glucocorticoid used subconjunctivally was proven to be particularly safe and effective in some common and important inflammatory ophthalmic diseases such as anterior scleritis, uveitis, and corneal graft rejection. Further, there are other indications for its successful use where data exist, but somehow less abundant.nnnCONCLUSIONSnThis article highlights the potential of TA to complement the treatment armamentarium of anterior segment inflammation.

Neodymium:YAG laser peripheral iridotomy as a possible cause of zonular dehiscence during phacoemulsification cataract surgery

Neodymium:YAG laser peripheral iridotomy as a possible cause of zonular dehiscence during phacoemulsification cataract surgery

Fingerprick autologous blood: a novel treatment for dry eye syndrome

PurposeDry eye syndrome (DES) causes significant morbidity. Trials of blood-derived products in treatment of the condition show promising results. However, their production is expensive and time-consuming. We investigate fingerprick autologous blood (FAB) as an alternative low-cost, readily accessible treatment for DES.Patients and methodsProspective, non-comparative, interventional case series. In total, 29 eyes of 16 DES patients (2 males and 14 females) from two NHS sites in the United Kingdom. Patients instructed to clean a finger, prick with a blood lancet, and apply a drop of blood to the lower fornix of the affected eye(s), 4 times daily for 8 weeks then stop and review 4 weeks later. Follow-up visits occurred ~3 days, 2, 4, 8 weeks into therapy, and 4 weeks post-cessation. At each visit, visual acuity, corneal staining, Schirmer’s test, tear break-up time (TBUT), and ocular comfort index (OCI) were measured, and photographs taken. Results were analysed using Student’s paired t-test.ResultsAt 8 weeks, there was improvement in mean Oxford corneal staining grade (3.31 to 2.07 (P<0.0001)), TBUT (5.00 to 7.80u2009s (P<0.05)), visual acuity (0.08 to 0.01 LogMAR equivalent (P<0.05)), and OCI score (56.03 to 39.72 (P<0.0001)). There was no statistically significant change in Schirmer’s test results. Four weeks post-cessation versus immediately after completion of FAB therapy, mean staining grade worsened from 2.07 to 2.86 (P<0.0001). OCI score worsened from 39.72 to 44.67 (P<0.05).ConclusionsIn our limited case series FAB appears to be a safe and effective treatment for DES.

Subconjunctival triamcinolone for the treatment of corneal graft rejection and new vessels

1367-0484/

Surgical iridotomy in aphakic eyes and eyes with anterior chamber intraocular lenses

– see front matter 2008 British Contact Lens Association. Published by doi:10.1016/j.clae.2008.06.009 The authors present a 48-year-old woman who had a rejection episode 6 weeks after routine descemet stripping automated endothelial keratoplasty (DSAEK) for pseudophakic bullous keratopathy. Hourly topical prednisolone acetate (Pred Forte, Allergan) was started. Two weeks later the donor and host corneal oedema had not cleared and new vessels had grown into the interface (Fig. 1). The patient insisted on being compliant with her treatment regimen. A 20 mg subconjunctival injection of Triamcinolone Acetonide (TA) (Kenalog, Bristol-Myers Squibb) was given and the Pred Forte

Hydration of the anterior stroma in phacoemulsification cataract surgery

UNLABELLEDnWe describe a simple technique to create a peripheral surgical iridotomy using a microvitreoretinal blade. The blade passes perpendicular to the iris dilator fibers to create a permanent opening.nnnFINANCIAL DISCLOSUREnNo author has a financial or proprietary interest in any material or method mentioned.

Reply to Yip et al

We describe a simple technique to hydrate the anterior stroma in cataract surgery using a 30-gauge needle. At the end of phacoemulsification, the needle is inserted into the stroma to create a watertight seal of the clear corneal incision.

Reply to: Costa DC et al

Sir, n nWe read with great interest the paper by Yip et al1 concluding that laser peripheral iridotomy (LPI) for primary angle closure (PAC) is not independently associated with cataract progression. n nThe authors mention that cataract surgery may be an alternative treatment for occludable angles, potentially addressing both PAC and cataract blindness with one procedure. The potential complications from intraocular surgery, though, are greater than those from LPI. However, LPI has complications such as intraocular haemorrhage and inflammation, intraocular pressure (IOP) spikes, glare, diplopia, and corneal damage. These are primarily not sight threatening, but have to be always taken into consideration. n nAnother potential complication is cataract formation, and this has been extensively reviewed by Yip et al. Despite their conclusion, there is still some controversy on this matter, with some authors supporting the opposite.2, 3 Thus, one must always be aware of such a theoretical risk after LPI. Except for the disturbances in aqueous flow in patients undergoing LPI, we suggest that, using higher-energy settings, inaccurate focusing of the laser beam, excessive or undertreated post-LPI uveitis, previous intermittent angle-closure episodes with IOP elevation, and other anatomical parameters, yet to be recognised, could be considered as possible stimuli of crystalline lens disturbance with consequent opacification. n nA potential complication of Nd:YAG LPI was reported by us recently.4 This involves damage to the zonules with subsequent dehiscence during routine phacoemulsification cataract surgery, affecting an otherwise healthy female with narrow angles. Our paper includes reports suggesting the same effect of LPI (both with Nd:YAG and with argon lasers), resulting in spontaneous dislocation of the crystalline lens.4 We suggested that Nd:YAG LPI may be regarded as an isolated risk factor for structural zonular damage and instability of the crystalline lens, and appropriate precautions should be taken during intraocular surgery. Regardless of the opacification being the result of the LPI, age-related or of any other cause, zonular damage could have considerable implications in subsequent cataract surgery, especially in cases where the zonules are already compromised, such as in pseudoexfoliation syndrome, previous ocular trauma, and congenital systemic diseases like Marfans syndrome.5 n nConsidering the large number of patients who would potentially benefit from prophylactic LPI, potential adverse sequelae of such a procedure must not be underestimated. More specifically, the possibility of cataract progression and zonular instability after LPI has important implications for patients at risk of angle closure. Choosing between primary cataract surgery and LPI is the main consideration in such cases. The therapeutic approach should be individualised and treatment benefits must always be balanced against eventual complications. n nFinally, we would like to congratulate the authors for their excellent contribution on a very important field of ophthalmology.

Subconjunctival injection of triamcinolone acetonide in the management of corneal graft rejection and new vessels.

A 62-year-old Caucasian male with chronic narrow angle glaucoma who was known preoperatively to be taking the aa-1 antagonist, Alfusozin also underwent trabeculectomy surgery, but IFIS was anticipated. Before the sclerostomy, two limbal paracentesis incisions were made at the 3 and 9 o’clock positions using a 151 blade, through which iris hooks were used to draw the pupil into a fish mouth position (see Figures 2 and 3). The surgical peripheral iridectomy was easily performed on a taut superior iris. There was no spontaneous, flaccid iris prolapse. The hooks were removed after closure of the scleral flap and the two limbal side ports were hydrated. The iris returned to its preoperative position. The procedure was controlled and uncomplicated.