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Tectonic corneal graft for conjunctival rhinosporidiosis with scleral melt.

Jacob P, Rose JS, Hoshing A, Chacko G - Indian J Ophthalmol (2011 May-Jun)

Bottom Line: On examination, the superior perilimbal sclera was ectatic with incarcerated uveal tissue covered by conjunctiva.Since the graft was not seen within the palpebral aperture, there was good cosmetic result.There was no recurrence at 6 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

ABSTRACT
A 16 year old girl presented with irritation and watering of the right eye for 3 months. On examination, the superior perilimbal sclera was ectatic with incarcerated uveal tissue covered by conjunctiva. The conjunctiva showed discreet, yellow white mucoid spots. Excision biopsy of the conjunctiva showed subepithelial spherules of sporangia containing numerous endospores, suggestive of rhinosporidiosis. Diathermy was applied to flatten the staphyloma. The ectatic area was covered with a corneal patch graft. The patient was started on prednisolone acetate eye drops and oral dapsone for 6 months. Corneal graft was well incorporated and conjunctivalized by 3 months. Since the graft was not seen within the palpebral aperture, there was good cosmetic result. The corneal graft had the added advantage of transparency which allowed visualization of the underlying tissue to diagnose early recurrence. There was no recurrence at 6 months.

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Related in: MedlinePlus

Photomicrograph of the conjunctival biopsy illustrating multiple subepithelial spores filled sporangia of varied sizes associated with a mild chronic inflammatory cell response (H and E, ×200)
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Figure 2: Photomicrograph of the conjunctival biopsy illustrating multiple subepithelial spores filled sporangia of varied sizes associated with a mild chronic inflammatory cell response (H and E, ×200)

Mentions: Intraoperatively, the involved conjunctiva was excised with a 1 mm margin except at the limbus where it was cut flush. The ectatic uveal tissue was heat cauterized to cause scarring and flattening. A 11 mm corneal button was used as a tectonic graft after scraping the endothelium and sutured onto healthy sclera with 8-0 nylon. The corneal epithelium was scraped and the surrounding conjunctiva was draped over it after mobilizing it by blunt dissection. Histopathological examination of the excised conjunctiva showed variably sized subepithelial spherules of sporangia containing numerous endospores. There was a mild nongranulomatous reaction of lymphocytes and plasma cells [Fig. 2] which confirmed the diagnosis. Since history, ocular and general examination did not point to any underlying autoimmune disease, no further investigations were done.


Tectonic corneal graft for conjunctival rhinosporidiosis with scleral melt.

Jacob P, Rose JS, Hoshing A, Chacko G - Indian J Ophthalmol (2011 May-Jun)

Photomicrograph of the conjunctival biopsy illustrating multiple subepithelial spores filled sporangia of varied sizes associated with a mild chronic inflammatory cell response (H and E, ×200)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3120253&req=5

Figure 2: Photomicrograph of the conjunctival biopsy illustrating multiple subepithelial spores filled sporangia of varied sizes associated with a mild chronic inflammatory cell response (H and E, ×200)
Mentions: Intraoperatively, the involved conjunctiva was excised with a 1 mm margin except at the limbus where it was cut flush. The ectatic uveal tissue was heat cauterized to cause scarring and flattening. A 11 mm corneal button was used as a tectonic graft after scraping the endothelium and sutured onto healthy sclera with 8-0 nylon. The corneal epithelium was scraped and the surrounding conjunctiva was draped over it after mobilizing it by blunt dissection. Histopathological examination of the excised conjunctiva showed variably sized subepithelial spherules of sporangia containing numerous endospores. There was a mild nongranulomatous reaction of lymphocytes and plasma cells [Fig. 2] which confirmed the diagnosis. Since history, ocular and general examination did not point to any underlying autoimmune disease, no further investigations were done.

Bottom Line: On examination, the superior perilimbal sclera was ectatic with incarcerated uveal tissue covered by conjunctiva.Since the graft was not seen within the palpebral aperture, there was good cosmetic result.There was no recurrence at 6 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

ABSTRACT
A 16 year old girl presented with irritation and watering of the right eye for 3 months. On examination, the superior perilimbal sclera was ectatic with incarcerated uveal tissue covered by conjunctiva. The conjunctiva showed discreet, yellow white mucoid spots. Excision biopsy of the conjunctiva showed subepithelial spherules of sporangia containing numerous endospores, suggestive of rhinosporidiosis. Diathermy was applied to flatten the staphyloma. The ectatic area was covered with a corneal patch graft. The patient was started on prednisolone acetate eye drops and oral dapsone for 6 months. Corneal graft was well incorporated and conjunctivalized by 3 months. Since the graft was not seen within the palpebral aperture, there was good cosmetic result. The corneal graft had the added advantage of transparency which allowed visualization of the underlying tissue to diagnose early recurrence. There was no recurrence at 6 months.

Show MeSH
Related in: MedlinePlus