Treatment of corneal dellen with a large diameter soft contact lens

Kymionis, George D.; Plaka, Argyro; Kontadakis, Georgios A.; Astyrakakis, Nikolaos

doi:10.1016/j.clae.2011.07.002

Cited by 14 publications

(6 citation statements)

References 6 publications

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“…Corneal Dellen is an uncommon complication of extensive blebs [2,20] and its satisfactory treatment is extremely important to prevent corneal ulceration and subsequent potential perforation [2]. If lubrication is ineffective, a contact lens (conventional or bandage) can be used [21] but its adequate fitting is often challenging in these cases due to bleb-related conjunctival irregularity [22], so definitive reductive surgery should be taken into account.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management for Refractory Bleb Dysesthesia

Dyrda

Antón

Figueroa-Vercellino

et al. 2020

Journal of Ophthalmology

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Purpose. To present long-term results of modified bleb-limiting conjunctivoplasty as a successful treatment for intractable bleb dysesthesia and to review the literature on the surgical management of dysesthetic bleb. Methods. Consecutive case series and literature review. We present four cases of surgically reduced painful blebs. Our technique consisted of the following steps: (1) conjunctival, radial incision to the bare sclera in the desired limit of the bleb; (2) suturing with buried, interrupted sutures at the nearest edge of the filtering bleb; (3) lower limbal peritomy including unwanted area of the extended bleb; (4) dissection and removal of the underlying fibrous tissue when present; (5) conjunctival and resorbable sutures. In addition, a systematic literature review was performed. Only reports presenting outcomes of surgical treatment of bleb dysesthesia after filtering procedure were included in review. Results. Four eyes were included consecutively in the study in a period of 4 years. On average, they developed circumferential bleb dysesthesia 9.3 ± 4.7 months after uneventful combined phacotrabeculectomy with Mitomycin C as primary procedure. Surgical reduction was decided after failure of lubricants in controlling ocular discomfort. Two cases showed a dense fibrous tissue beneath the conjunctiva that was excised to ensure filtration. In all cases, a rapid disappearance of symptoms with very good aesthetic and functional outcome was observed. After 12-month follow-up, patients remained asymptomatic and maintained intraocular pressure of 10.7 ± 1.2 mmHg without treatment. A systematic review of the literature obtained 15 eligible case series (n = 123) with rates of success within 46–100%, favoring less aggressive approaches to reduce bleb size. Conclusion. Bleb dysesthesia is a rare complication of filtering glaucoma surgery. This modified bleb-limiting conjunctivoplasty technique (with removal of subjacent fibrous tissue if present) is able to target the underlying etiology providing ocular discomfort relief while maintaining bleb function and may be considered as first-choice surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Surgical Management for Refractory Bleb Dysesthesia

Dyrda

Antón

Figueroa-Vercellino

et al. 2020

Journal of Ophthalmology

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“…Eye patching could restrict the motion of eyelid by increasing the willing to close the eye and therefore enhance epithelial repair and relieve pain or foreign body sensation. BCLs cover the corneal surface thus reducing exposure between the eyelid and cornea and protect the cornea from exposure or from the irritation caused by rubbing the eye, thereby facilitating corneal epithelium healing [27]. Silicone hydrogel materials with high oxygen transmissibility, specifically designed for continuous wear, could secure enhanced wound healing and epithelial cell reproduction [28].…”

Section: Itemmentioning

confidence: 99%

Comparative Evaluation of Bandage Contact Lenses and Eye Patching after Bilateral Cataract Surgery

Jing

Deng

Wang

et al. 2021

Journal of Ophthalmology

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Purpose. To comparatively evaluate the safety and satisfaction of bandage contact lens (BCL) and eye patching in patients after cataract surgery. Methods. Sixteen (32 eyes) patients who planned to undergo bilateral cataract surgery were recruited. The two eyes of each patient were randomly divided into 2 groups. Group A and Group B were instructed to wear BCLs immediately at the end of the surgery until one week and eye patch immediately after surgery until one day, respectively. Visual analog scales of ten specific symptoms, Visual Function Index (VF-14) questionnaire, and best-corrected visual acuity (BCVA) were conducted on the first day before the surgery and Day 1 and Day 7 after surgery. Oculus keratography was conducted on the first day before surgery and on Day 7. Patient satisfaction was determined on Day 1. Moreover, bacterial species in the conjunctival sac, meibomian gland secretions, and BCLs were subsequently identified using 16S rRNA gene sequencing. Results. The patient satisfaction scores of Group A were higher than Group B. Group A were more motivated to choose the same treatment and were more likely to recommend BCLs to others. No statistically significant differences were found in bacterial culture positivity between the groups. The differences in ocular signs and symptoms between the two groups were not statistically significant. There were no significant differences in the BCVA and VF-14 between the groups at any time point. Conclusions. BCLs could be safely and effectively used in patients after cataract surgery.

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“…Treatment consists of artificial tears, eye ointment, and patching. Bandage contact lens application has also been used to support the repair process [10]. If left untreated, this condition may lead to corneal perforation.…”

Section: Introductionmentioning

confidence: 99%

Resolution of Corneal Dellen After an Uneventful Pterygium Surgery with Punctal Cautery

Sharma

Bajoria

Patnaik

et al. 2020

Cureus

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Corneal dellen are a rare and serious complication after primary pterygium surgery with conjunctival limbal autograft (CLAG) with fibrin glue without antimetabolites. Dellen are caused by interruptions of the tear film and local dehydration of the cornea. If untreated, they may lead to corneal perforation. We describe the case of a patient who developed corneal dellen 15 days after uneventful pterygium excision with CLAG with fibrin glue without the use of antimetabolites. There was no satisfactory response to lubricants and patching, and the patient had no associated systemic risk factors. As the thinning increased, cyanoacrylate glue with bandage contact lens was applied, but the dellen reappeared seven days after glue removal. Dellen finally resolved with thermal punctal cautery applied to both puncta. Dellen most commonly respond to artificial tears, antibiotic ointment, and patch application. However, in refractory cases, punctal cauterization can be considered as a good option to increase tear pooling in the area of dellen, thereby promoting healing.

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Treatment of corneal dellen with a large diameter soft contact lens

Cited by 14 publications

References 6 publications

Surgical Management for Refractory Bleb Dysesthesia

Surgical Management for Refractory Bleb Dysesthesia

Comparative Evaluation of Bandage Contact Lenses and Eye Patching after Bilateral Cataract Surgery

Resolution of Corneal Dellen After an Uneventful Pterygium Surgery with Punctal Cautery

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