Technique of amniotic membrane transplant dressing in the management of acute Stevens-Johnson syndrome.

PURPOSE: To report the technique of amniotic membrane transplantation dressing during the acute phase of Stevens-Johnson syndrome. METHODS: Interventional case report. We report the clinical presentation, surgical technique and clinical outcome of a patient with acute Stevens-Johnson syndrome and progressive tarsal conjunctival epithelial loss. RESULTS: A 10-year-old girl presented with extensive corneal, bulbar and tarsal conjunctival epithelial loss and severe ocular pain during the acute phase of Stevens-Johnson syndrome. Fornix cleaning and daily rodding was not tolerated, and there was no response to medical drug therapy. Emergency amniotic membrane transplant surgery was performed in both eyes. The conjunctival epithelium recovered completely and the ocular surface remained moist. There was almost complete resolution of ocular pain in the immediate postoperative period. There were no surgical complications and no signs of ocular cicatrisation after 6 months. CONCLUSIONS: In the acute phase of severe Stevens-Johnson syndrome, conservative measures of daily fornix cleaning and rodding may not be practical. AMT dressing may be successfully used to reduce ocular inflammation, promote epithelialisation and prevent ocular cicatrisation.

Complicated removal of corneal foreign bodies 18 months after laser in situ keratomileusis.

We present a 39-year-old young engineer who developed flap complications after removal of corneal foreign bodies 18 months after successful laser in situ keratomileusis. The right eye had a flap scar and debris in the interface, and the left eye had a central rust ring and debris in the interface. Attempted removal of the flap in the left eye lifted off a large area around the rust ring, and the ring was left in place. One week after treatment with topical antibiotics, the eye was white and the rust ring had begun to disappear. The ring was successfully removed without complications the following week.

Refractory glaucoma--tube or diode?

BACKGROUND: The aim of the present study was to assess the relative effectiveness of tube surgery and cyclodiode laser in terms of achieving intraocular pressure control. METHODS: A retrospective study was undertaken to compare patients undergoing double plate Molteno tube implantation with patients undergoing diode cyclophotocoagulation. Intraocular pressure (IOP) was documented at 7 days prior to surgery and postoperatively at various time points. Surgical success was defined as a final IOP between 6 (inclusive) and 21 mmHg (inclusive), without the use of topical medication, while 'qualified' success was defined as IOP within the same range with the use of topical medication. RESULTS: Twenty-eight diode patients and 26 tube patients were included for the study. An average follow up of 150 weeks (range = 21-322 weeks) was available. Mean preoperative IOP was 37 +/- 12 mmHg for the tube group and 39 +/- 16 mmHg for the diode group (t = 0.51, P = 0.61). The final IOP was 17 +/- 12 mmHg for the tube group and 21 +/- 13 mmHg for the diode group (t = 0.35, P = 0.73). Surgical success was achieved in 46% of tube eyes and 11% of diode eyes, while qualified success was achieved in 81% of tube eyes compared with 64% of eyes in the diode group. Two eyes which underwent diode became phthisical. CONCLUSIONS: IOP control may be achieved in a greater number of patients with tube surgery. The possible benefits of IOP control in diode patients need to be weighed against the risks of long-term visual loss and the need for multiple re-treatments in this group.

Mitomycin C eliminates the short-term intraocular pressure rise found following Molteno tube implantation.

PURPOSE: Molteno implants remain popular for treating recalcitrant glaucomas. This study aimed to assess the effect of mitomycin C (MMC) use with Molteno tube implantation upon intraocular pressure (IOP) control and complication rates. In particular, the study aimed to assess any change that MMC might have upon the postoperative hypertensive phase. METHODS: A retrospective case record study was conducted of all patients undergoing double plate Molteno implant surgery by one surgeon over 5 years. Eyes with recalcitrant glaucoma unresponsive to previous surgery, or deemed unlikely to succeed with trabeculectomy, underwent double plate Molteno tube implantation. Eyes that had MMC (0.3 mg/mL, 3 min) applied to Tenon's capsule over the secondary plate were compared with eyes that underwent surgery without adjunctive MMC application. RESULTS: Twenty-seven eyes received MMC and were similar to 26 eyes not receiving MMC in terms of glaucoma subtype, age, sex, previous surgery, preoperative IOP and postoperative IOP lowering agents. Those not receiving MMC had raised IOP 31-90 days post implantation compared with MMC treated eyes (P < 0.01) and more often received oral antifibrosis medication (P < 0.05). Complications were no more common with MMC except for initial overdrainage. Significant systemic complications from the use of oral antifibrosis medication were common. CONCLUSIONS: The findings suggest a useful role for MMC. Caution is advised in case selection for MMC use. Mitomycin C treatment over the secondary plate alone permits removal of this plate if MMC-related complications occur without requiring removal of the whole implant.