OBJECTIVES: To assess the effectiveness of fibrin glue compared to sutures in conjunctival autografting for the surgical treatment of pterygium.
SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2016), Embase (January 1980 to October 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 14 October 2016.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) in any setting where fibrin glue was compared with sutures to treat people with pterygium.
DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results, assessed trial quality, and extracted data using standard methodological procedures expected by Cochrane. Our primary outcome was recurrence of pterygium defined as any re-growth of tissue from the area of excision across the limbus onto the cornea. The secondary outcomes were surgical time and complication rate. We graded the certainty of the evidence using GRADE.
MAIN RESULTS: We included 14 RCTs conducted in Brazil, China, Egypt, India, Malaysia, New Zealand, Philippines, Saudi Arabia, Sweden and Turkey. The trials were published between 2004 and 2016, and were assessed as a mixture of unclear and low risk of bias with three studies at high risk of attrition bias. Only adults were enrolled in these studies.Using fibrin glue for the conjunctival autograft may result in less recurrence of pterygium compared with using sutures (risk ratio (RR) 0.47, 95% CI 0.27 to 0.82, 762 eyes, 12 RCTs; low-certainty evidence). If pterygium recurs after approximately 10 in every 100 surgeries with sutures, then using fibrin glue may result in approximately 5 fewer cases of recurrence in every 100 surgeries (95% CI 2 fewer to 7 fewer cases). Using fibrin glue may lead to more complications compared with sutures (RR 1.92; 95% CI 1.22 to 3.02, 11 RCTs, 673 eyes, low-certainty evidence). The most common complications reported were: graft dehiscence, graft retraction and granuloma. On average using fibrin glue may mean that surgery is quicker compared with suturing (mean difference (MD) -17.01 minutes 95% CI -20.56 to -13.46), 9 RCTs, 614 eyes, low-certainty evidence).
AUTHORS' CONCLUSIONS: The meta-analyses, conducted on people with pterygium in a hospital or outpatient setting, show fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. There was low-certainty evidence to suggest a higher proportion of complications in the fibrin glue group.
OBJECTIVE: To report two cases of malignant melanoma in the eye, one in the conjunctiva and the other in the choroid.
CASES: The first case was in a 49-year-old lady who presented with a swelling on the inner side of left upper eyelid. The vision was 6/6. On everting the eyelid, multiple, pigmented, nodular swellings were noted on the tarsal conjunctiva. Excision biopsy confirmed the diagnosis of malignant melanoma of the conjunctiva. A pigmented nodular swelling occurred on the lower bulbar conjunctiva in the same eye one-and-a-half years after the first presentation. There were no secondary nodules in the body. Excision biopsy confirmed malignant melanoma of the conjunctiva. The second case was in a 72-year-old lady who presented with pain and bleeding in the right eye. There was no perception of light. The cornea was hazy and the details behind it could not be seen. There was micro perforation of the cornea with oozing of blood and secondary glaucoma. B-scan ultrasonography of the right eye revealed an intraocular tumour. The histopathology of the enucleated eyeball confirmed the diagnosis of malignant melanoma of the choroid.
CONCLUSION: In the case of conjunctival melanoma, the occurrence of tumour at multiple sites and absence of recurrence at the original site suggests the possibility of de novo origin of the tumour. Secondary glaucoma and bleeding may be the presenting features of melanoma in the choroid.
METHODS: 120 primary pterygium participants were selected from patients who visited an ophthalmology clinic. We adopted image analysis software in calculating the size of invading pterygium to the cornea. The marking of the calculated area was done manually, and the total area size was measured in pixel. The computed area is defined as the area from the apex of pterygium to the limbal-corneal border. Then, from the pixel, it was transformed into a percentage (%), which represents the CPTA relative to the entire corneal surface area. Intra- and inter-observer reliability testing were performed by repeating the tracing process twice with a different sequence of images at least one (1) month apart. Intraclass correlation (ICC) and scatter plot were used to describe the reliability of measurement.
RESULTS: The overall mean (N=120) of CPTA was 45.26±13.51% (CI: 42.38-48.36). Reliability for region of interest (ROI) demarcation of CPTA were excellent with intra and inter-agreement of 0.995 (95% CI, 0.994-0.998; P<0.001) and 0.994 (95% CI, 0.992-0.997; P<0.001) respectively. The new method was positively associated with corneal astigmatism (P<0.01). This method was able to predict 37% of the variance in CA compared to 21% using standard method.
CONCLUSIONS: Image analysis method is useful, reliable and practical in the clinical setting to objectively quantify actual pterygium size, shapes and its effects on the anterior corneal curvature.
METHOD: This is a case report of a 76-year-old Chinese female, presented as an emergency with spontaneous left eye bleeding. She had underlying uncontrolled hypertension, no other systemic illness and not on anticoagulant. She has a history of right eye cataract operation, right eye angle-closure glaucoma and left eye absolute glaucoma complicated with painless left blind eye. Ocular examination over left eye showed no light perception and demonstrated presence of fresh bleed, expulsion of lens and prolapsed uveal contents, while right eye examination was unremarkable. Patient subsequently underwent evisceration and was uneventful.
RESULTS: Routine blood investigations including coagulation profile came back as normal. Surgical findings include perforated cornea more than three-fourths with prolapsed uveal contents and fragile conjunctiva. No other significant macroscopic conditions were noted. Histology and culture came back with growth of Pseudomonas aeuroginosa with no evidence of malignancy.
DISCUSSION: SESCH is a rare but serious sight-threatening ocular condition associated with multiple risk factors including arteriosclerosis, vascular disease, glaucoma, diabetes, intraocular malignancy and diseased eye wall. The predisposing factors involved in this case include advanced age, glaucoma with persistent high intraocular pressure, uncontrolled hypertension and presence of infection.