A Clinical Study of Pterygium and Results of Treatment by Excision and Limbal Autograft or Augmented with Post-Op Mitomycin C

Aim: To prospectively analyze the clinical profile of pterygium and to compare results of management by excision with limbal conjunctival autograft or postoperative topical Mitomycin C drops. Methodology: Study was conducted over a period of 23 months, at a tertiary eye care hospital including 80 eyes of 80 patients who underwent surgery, out of which 40 underwent limbal conjunctival autograft and the remaining 40 underwent pterygium excision followed by Mitomycin C after fulfilling the inclusion criteria. A detailed history was taken and recorded regarding the disease with reference to age, occupation, residence, exposure to dust and hot wind. The extent of corneal involvement by the pterygium was noted. The patients were followed after one week and then monthly for a year. BCVA were noted on every visit and slit lamp examination was done for recurrence, sclera thinning and corneal vascularisation. Result: 80 eyes of 80 patients were enrolled with male preponderance, out of which 40 underwent limbal conjunctival autograft (gr. A) and the remaining 40 underwent pterygium excision followed by Mitomycin C (gr. B). All patients were in the age group of 23 to 70 years. The study showed a higher incidence of pterygium in the age group of 41-50 years with male preponderance probably due to chronic dryness, and exposure to ultraviolet light, dust, and hot winds. The right eye was more affected than the left eye, and nasal side was more involved than the temporal side. The recurrence among group A was 2 out of 40 with a recurrence rate of 5% and among group B was 3 out of 40 with a recurrence rate of 7.5%. Scleral thinning was seen in two cases (5%) in patients who underwent pterygium excision followed by Mitomycin C. Conclusion: Conjunctival limbal autograft and postoperative MMC (0.02%) are both safe and effective adjuncts to primary pterygium surgery. The main prejudices against autografting are the expertise and time required for the procedure. The recent use of biologic adhesives to fixate the autograft in place may simplify the procedure. Age of the patients was strongly associated with recurrence regardless of which procedure was used. More research needs to be done to delve into this seemingly innocuous pathology of conjunctiva to effectively manage the disease condition.

Xeroderma pigmentosa with ocular association: Case report

Xeroderma pigmentosum is a rare, autosomal recessive disease caused by a defect in DNA repair. Patients with xeroderma pigmentosum often have cutaneous and ocular sun sensitivity, freckle-like skin pigmentation, multiple skin and eye cancers, and, in some patients, progressive neurodegeneration. Xeroderma pigmentosum predominantly affects the ultraviolet (UV) exposed ocular surface, resulting in eyelid atrophy and cancers, corneal dryness, exposure keratopathy, and conjunctival tumors. General features included parental consanguinity (40%), familiarity (60%), onset of symptoms in the first 2 years (50%), malignant skin neoplasms (60%), and carcinoma of the tongue (20%). Among the ocular features, 50% of patients presented with photophobia. Lid freckles or atrophic skin lesions were seen in all patients. Lower lid tumours were seen in 30%, chronic conjunctival congestion in 40%, corneal opacification in 40%, squamous cell carcinoma of limbus in 20%, bilateral pterygium in 40%, and visual impairment in 50%. We report the clinical history and ocular pathology of a boy who is having xeroderma pigmentosum with ocular manifestations. The ophthalmic manifestations of xeroderma pigmentosum are discussed and reviewed with respect to this report and other cases in the literature. These cases illustrate the role of DNA repair in protection of the eyes from UV damage and neuron degeneration of the retina.

Fungal sinusitis with ocular involvement: Case report

Rhino-orbital-cerebral mucormycosis (ROCM) is an acute, often fatal, fungal infection caused by members of the class Zygomycetes and the order Mucorales. The genus Rhizopus accounts for most cases of ROCM. The disease is characterized by fungal hyphal invasion of blood vessels resulting in thrombosis and infarction of the nasal, paranasal sinus, orbital, and cerebral tissues. The most commonly associated condition is diabetes mellitus;other associated conditions include immunocompromised states, renal disease, deferoxamine use and acidotic states. The most frequent sites of infection are pulmonary, rhinocerebral, cutaneous and disseminated. Rhino-orbital and Rhino-cerebral are two forms of the disease. As such the condition is a medical emergency. Early recognition and treatment are essential because it may lead to death in a few days. CROP usually begins in the palate or paranasal sinuses and rapidly spreads to the orbital contents. Proptosis, loss of vision and ophthalmoplegia occur and death from cerebral involvement commonly ensues. The fungus tends to invade arteries and cause thrombosis and tissue infarction. Rhizopus is the most commonly isolated genus in CROP, accounting for almost all cases. The diagnosis can be strongly suspected by the characteristic clinical manifestations. Therapy includes the treatment of the underlying disease, surgical excision of the necrotic tissue containing fungal elements and the systemic administration of amphotericin-B. Here we report the clinical features of a 32-years-old man presented mucormycosis.