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Chen J, Wang Y, Yu L, Ren W, Sheng Y. Giant anterior scleral staphyloma caused by blunt ocular trauma: a case report. BMC Ophthalmol 2023; 23:457. [PMID: 37964186 PMCID: PMC10647092 DOI: 10.1186/s12886-023-03188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Anterior scleral staphyloma is a relatively rare disease characterized by thinning and expansion of sclera. We described the clinical presentation, diagnosis and treatment of a case with giant anterior scleral staphyloma caused by blunt ocular trauma. CASE PRESENTATION A 24-years-old male, presented with a black cyst-like mass protruding from the right eyeball for 9 years after a history of glass crush contusion. The ultrasound biomicroscopy examination showed two cysts in the right eyeball. The larger one was about 5.92 mm*4.69 mm in size and the scleral lacerations were connected to the posterior chamber below the cyst. For treatment, resection of the anterior scleral staphyloma and the scleral patch graft transplantation was performed. The vision of the patient was improved compared with that before surgery. There were no obvious complications. CONCLUSION The clinical presentation, diagnosis, and treatment of the case with giant anterior scleral staphyloma can provide a reference for the management of anterior scleral staphyloma. Surgical resection and scleral patch graft should be a good option for the treatment of giant anterior scleral staphyloma.
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Affiliation(s)
- JinBo Chen
- Ningbo Eye Hospital, Wenzhou Medical University, Ningbo, 315000, China
- Department of Ophthalmology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
- Clinical Research Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Yang Wang
- Department of Ophthalmology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
- Clinical Research Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - LongBin Yu
- Department of Ophthalmology, Fuyang First People's Hospital, Hangzhou, 310003, Zhejiang, China
| | - Weina Ren
- Department of Ophthalmology, The Affiliated People's Hospital of Ningbo University, The Eye Hospital of Wenzhou Medical University (Ningbo Branch), Ningbo, 315040, China
| | - Yan Sheng
- Department of Ophthalmology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
- Clinical Research Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
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Lun KW, Chew PTK, Lim DKA. Glaucoma drainage implant exposure: A review of aetiology, risks and repair considerations. Clin Exp Ophthalmol 2022; 50:781-792. [DOI: 10.1111/ceo.14144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Katherine W. Lun
- Department of Ophthalmology National University Health System Singapore
- Department of Ophthalmology National University of Singapore Singapore
| | - Paul T. K. Chew
- Department of Ophthalmology National University Health System Singapore
- Department of Ophthalmology National University of Singapore Singapore
| | - Dawn K. A. Lim
- Department of Ophthalmology National University Health System Singapore
- Department of Ophthalmology National University of Singapore Singapore
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Rajagopal R, Matai HD, Gopal L, Susvar P, Bhende PS. Anterior staphyloma repair following trauma and surgery - A retrospective review of techniques and outcomes over 25 years. Indian J Ophthalmol 2022; 70:2967-2971. [PMID: 35918955 DOI: 10.4103/ijo.ijo_3026_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To review surgical options, techniques, and outcomes of anterior staphyloma repair done following trauma and surgery. Methods This was a retrospective case study of patients who underwent staphyloma repair with scleral or tibial periosteal patch grafts following trauma and surgery with a minimum follow-up of 3 months postoperatively. Preoperative risk factors, choice of graft materials, surgical details, and outcomes in terms of graft uptake and tectonic integrity were analyzed. Results Seventeen eyes of 17 patients underwent successful staphyloma repair (scleral 15, tibial periosteal two). Mean follow-up was 47.1 months (3-159 months). Postoperative intraocular pressure rise noted in four eyes was controlled medically or surgically. Three patients underwent successful repeat patch grafting (graft melt one and recurrent ectasia two). Tectonic integrity of the eyeball was restored and maintained in all patients at the final follow-up. Conclusion Comprehensive evaluation of the risk factors, control of ocular comorbid conditions, and early and meticulous surgery can optimize results.
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Affiliation(s)
- Rama Rajagopal
- Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
| | - Hiren D Matai
- Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
| | | | - Pradeep Susvar
- Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
| | - Pramod S Bhende
- Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
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Reconstruction of the external auditory canal: The tragal flap revisited and review of contemporary reconstructive techniques. Am J Otolaryngol 2021; 42:103094. [PMID: 34102581 DOI: 10.1016/j.amjoto.2021.103094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary malignancies arising in the external auditory canal (EAC) are rare and usually are treated surgically. We review techniques to reconstruct the EAC following ablative surgery, and introduce a rarely utilized tragal skin flap which has particular advantages for reconstruction of limited anterior EAC defects. METHODS The terms "tragal flap", "external auditory canal", "preauricular tragal flap", "reconstructive techniques" were searched on PubMed and Google Scholar. RESULTS Our review identified one description of a tragal flap to reconstruct the EAC following resection of a malignancy. We add an additional case of a preauricular tragal flap to reconstruct the anterior EAC following resection of a recurrent basal cell carcinoma located in the EAC that led to a circumferential defect. CONCLUSION There are several surgical techniques that can be utilized to reconstruct the EAC. We describe a novel tragal flap used to reconstruct the anterior EAC following resection of a recurrent tumor.
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Wang Y, Liu J, Huang W, Xu Y, Cheng M, Shen Z. The best thickness of cornea graft from SMILE surgery as patch graft in glaucoma drainage implant surgery. Medicine (Baltimore) 2021; 100:e25828. [PMID: 34011047 PMCID: PMC8137079 DOI: 10.1097/md.0000000000025828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/05/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the best thickness of corneal slices acquired from femtosecond laser surgery-small incision lenticule extraction (SMILE surgery) as patch graft in glaucoma drainage implantation surgery. METHODS This study is a prospective randomized study. Patients who received glaucoma drainage implantation from September 2016 to November 2018 were observed. The patients were randomly divided into 3 groups. Group A included 102 cases (104 eyes), receiving 1 layer (120-150 μm) of allogeneic lamellar corneal tissue as the graft. Group B included 117 cases (120 eyes), receiving 2 layers of lamellar corneal tissue from one donor. Group C included 109 cases (111 eyes), using 3 layers of lamellar corneal tissue from 2 donors. The intraocular pressure, corneal graft, conjunctiva stromalysis, drainage tube exposure, and drainage plate were observed. RESULTS Patients were followed up for 6 to 33 months. The intraocular pressure was significantly reduced after surgery in all three groups. Conjunctiva stromalysis and drainage tubes were exposed in 3 eyes (3%) in group A and 1 eye (0.8%, a special case which has nystagmus and the plate was placed infratemporally) in group B, whereas no conjunctiva stromalysis or tube exposure was reported in group C. CONCLUSIONS The corneal graft acquired from SMILE surgery can effectively prevent drainage tube exposure and give patients a better cosmetic appearance. Two layers of lamellar corneal tissue (240-300 μm) may be the best suitable thickness because it can effectively reduce tube exposure and rejection. In some special cases, 3 layers of lamellar corneal tissue are needed.
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Affiliation(s)
- Yuhong Wang
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
- NHC Key Laboratory of Myopia (Fudan University)
- Key Laboratory of Myopia, Chinese Academy of Medical Science (Fudan University), Shanghai, China
| | - Jinkun Liu
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
| | - Weiyi Huang
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
| | - Yazhang Xu
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
| | - Meizhu Cheng
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
| | - Zhengwei Shen
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
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Zhang G, Nie M, Webster TJ, Zhang Q, Fan W. Ectopic chondrogenesis of nude mouse induced by nano gene delivery enhanced tissue engineering technology. Int J Nanomedicine 2019; 14:4755-4765. [PMID: 31308656 PMCID: PMC6613371 DOI: 10.2147/ijn.s199306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/06/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Many techniques and methods have been used clinically to relieve pain from cartilage repair, but the long-term effect is still unsatisfactory. Purpose: The objective of this study was to form an artificial chondroid tissue gene enhanced tissue engineering system to repair cartilage defects via nanosized liposomes. Methods: Cationic nanosized liposomes were prepared and characterized using transmission electron microscope (TEM) and dynamic laser light scattering (DLS). The rat mesenchymal stem cells (rMSCs) were isolated, cultivated, and induced by SRY (Sex-Determining Region Y)-Box 9 (Sox9) via cationic nanosized liposomes. The induced rMSCs were mixed with a thermo-sensitive chitosan hydrogel and subcutaneously injected into the nude mice. Finally, the newly-formed chondroid tissue obtained in the injection parts, and the transparent parts were detected by HE, collagen II, and safranin O. Results: It was found that the presently prepared cationic nanosized liposomes had the diameter of 85.76±3.48 nm and the zeta potential of 15.76±2.1 mV. The isolated rMSCs proliferation was fibroblast-like, with a cultivated confluence of 90% confluence in 5-8 days, and stained positive for CD29 and CD44 while negative for CD34 and CD45. After transfection with cationic nanosized liposomes, we observed changes of cellular morphology and a higher expression of SOX9 compared with control groups, which indicated that rMSCs could differentiate into chondrocyte in vitro. By mixing transfected rMSCs with the thermo-sensitive hydrogel of chitosan in nude mice, chondroid tissue was successfully obtained, demonstrating that rMSCs can differentiate into chondrogenic cells in vivo. Conclusion: This study explored new ways to improve the quality of tissue engineered cartilage, thus accelerating clinical transformation and reducing patient pain.
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Affiliation(s)
- Guangcheng Zhang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Mingjun Nie
- Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang, People's Republic of China
| | - Thomas J Webster
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA
| | - Qing Zhang
- Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang, People's Republic of China
| | - Weimin Fan
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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Long-term Safety and Efficacy of Conjunctival Pedicle Graft Revision Combined With Repeated Pericardium Allograft for Exposed Glaucoma Drainage Devices. J Glaucoma 2018; 27:910-913. [PMID: 30199464 DOI: 10.1097/ijg.0000000000001060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the safety and long-term results of conjunctival pedicle graft (CPG) technique for revision of exposed glaucoma drainage device (GDD). DESIGN Retrospective noncomparative case series. PATIENTS AND METHODS All patients with exposed GDD between 2011 and 2016 who underwent tube revision with CPG were included. Data from demographic variables, glaucoma subtype, previous surgeries, GDD type and location, patch graft nature, intraocular pressure, and intraoperative and long-term complications were collected. RESULTS Eight eyes from 7 patients met the inclusion criteria. Median age was 61 years old (range, 51 to 80), median time to erosion was 23.4 months (range, 5 d to 45.1 mo), median number of operations before exposure was 3 (range, 1 to 5), and 6 tubes had an inferior location (75%). Average follow-up after repair was 24.3 months (range, 5.2 to 59.8 mo). No significant intraoperative adverse events were noted and visual acuity, intraocular pressure, and number of medications remained unchanged at 1 month after repair in all cases. We report 1 case of repeated tube exposure 24 months after CPG in a 51-year-old Afro-Caribbean woman with 5 previous operations. CONCLUSIONS With an average follow-up of >2 years, we provide additional long-term evidence that CPG is a safe and effective technique for treating exposed tubes. We did not experience any complications and report 1 reexposure case in a young Afro-Caribbean patient with extensive previous conjunctival scarring.
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Olate-Pérez Á, Pérez-Torregrosa VT, Gargallo-Benedicto A, Escudero-Igualada R, Cerdà-Ibáñez M, Barreiro-Rego A, Duch-Samper A. Management of conjunctival perforation and late Seidel after XEN ® surgery. ACTA ACUST UNITED AC 2017; 93:93-96. [PMID: 29224970 DOI: 10.1016/j.oftal.2017.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 11/29/2022]
Abstract
CLINICAL CASE The case concerns a 78 year-old woman with a history of XEN® surgery, in whom a conjunctival perforation was observed at the implant level at 18-months of follow-up, for which surgical intervention was decided. During surgery a short subconjunctival portion was found (0.5mm). An unsuccessful attempt was made to extract it by traction, but the XEN® broke easily. Finally, it was decided to cut it to scleral level, and suture the conjunctiva. During the first week there was a decrease in intraocular pressure (6mmHg), to subsequently increase to 25, and deciding to start medical treatment. DISCUSSION Conjunctival exposure of the XEN® stent is a rare but potentially serious complication. To avoid it, a meticulous surgical technique is important when implanting it. If this occurs, it is important to identify the cause. If it is due to a short subconjunctival portion, a therapeutic alternative is to cut the implant at this level to avoid further complications.
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Affiliation(s)
- Á Olate-Pérez
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - V T Pérez-Torregrosa
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Gargallo-Benedicto
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - R Escudero-Igualada
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - M Cerdà-Ibáñez
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Barreiro-Rego
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Duch-Samper
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
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Abstract
Aqueous drainage device tube erosions require prompt intervention to prevent endophthalmitis. As the use of drainage devices in glaucoma surgery continues to increase, recognizing and managing tube erosions is a pertinent issue. This review provides a comprehensive overview of tube erosions, including the rates of erosion with various types of patch grafts, the risk factors associated with erosion, and approaches to repair in order to counsel and treat our patients to prevent endophthalmitis.
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Affiliation(s)
- Upneet Bains
- a Glaucoma Service, Department of Ophthalmology, Massachusetts Eye and Ear , Harvard Medical School , Boston , MA , USA
| | - Ambika Hoguet
- a Glaucoma Service, Department of Ophthalmology, Massachusetts Eye and Ear , Harvard Medical School , Boston , MA , USA
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“Double scleral tunnel in tandem” technique for glaucoma drainage tube implants. Int Ophthalmol 2017; 38:2349-2356. [DOI: 10.1007/s10792-017-0733-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/05/2017] [Indexed: 12/14/2022]
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Abstract
PURPOSE OF REVIEW Patch graft materials serve multiple purposes in glaucoma surgery. There are several choices of patch graft materials from which the surgeon can choose. Therefore, knowledge as to the choices and the potential risks and benefits of patch graft materials is imperative for the glaucoma surgeon. RECENT FINDINGS Recent studies evaluate both patch graft materials and techniques. This evaluation is timely as facility reimbursement changes may also impact utilization and technique. SUMMARY Successful operative outcomes require profound understanding of all potential risks and benefits of patch graft materials and surgical techniques.
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