Pterygium Resection with Amniotic Membrane Grafting in a Patient with Xeroderma Pigmentosum

Case Report

Austin J Clin Ophthalmol. 2016; 3(2): 1066.

Pterygium Resection with Amniotic Membrane Grafting in a Patient with Xeroderma Pigmentosum

Fahmy RM*

Department of Ophthalmology, Cairo University, Egypt and Department of Optometry, King Saud University, Saudi Arabia

*Corresponding author: Fahmy RM, Department of Optometry, King Saud University, P.O Box: 22452-Riyadh 11495, Saudi Arabia

Received: February 27, 2016; Accepted: June 03, 2016; Published: June 09, 2016

Abstract

Introduction: Xeroderma pigmentosum (XP) is a very rare skin disorder where a person is highly sensitive to sunlight, has premature skin aging and is prone to developing skin cancers. This is caused by a cellular hypersensitivity to ultraviolet (UV) light as a result of a defect in the DNA repair system, and is reported to be associated with ocular surface disorders such as conjunctival malignancy and pterygium. In our study, we report a case of successful surgical resection of pterygium with Amniotic Membrane Graft (AMG) in a XP patient.

Case: 15 years old girl, who is suffering from XP, presented to our clinic for treatment of her bilateral pterygium. Surgical resection was performed for a nasal, rapidly progressive pterygium in her left eye associated with multi-layer amniotic membrane grafting.

Examination: Re-epithelialization over the AMG was completed after 14 days. Best corrected visual acuity was improved after two months post operatively. No recurrence was noticed during one year of regular follow up.

Conclusions: AMG as an adjuvant to primary pterygium resection is effective in patient with XP. Further more, multi-layer AMG is beneficial in protecting bare sclera and medial rectus muscle from mechanical injury after pterygium resection.

Keywords: Amniotic membrane; Multi-layer graft; Pterygium; Xeroderma pigmentosum

Introduction

Xeroderma pigmentosum (XP) is a rare, autosomal recessive, precancerous skin disorder, and is characterized by cellular hypersensitivity to ultraviolet light as a result of defect in DNA repair system [1]. XP is proved to be linked to ocular surface disorders such as conjunctival tumors and pterygium [2]. Amniotic Membrane Graft (AMG) is validated to be useful in reconstructing many ocular surface disorders, including pterygium [3-5]. In our study, we report a case of successful surgical treatment of pterygium with multi-layer AMG in a XP patient.

Case Report

15 years old girl diagnosed with XP was presented to our clinic for treatment of her bilateral pterygium. Family history of XP was negative. Surgery was performed under general anesthesia for a rapidly progressive pterygium that was encroshing over the cornea of the left eye. The pterygium and underlying fibrous tissue were excised thoroughly, and abnormal scar tissue on the corneal surface was polished. Minimal cauterisation was used to control the bleeding. The size of the bare scleral bed (in mm 2) was measured in the position that the eye deviated away from the side of the lesion in order to have a maximum area of defect. Amniotic membrane was taken out of the preservation medium, marked with gentian violet, and cut to the proper size to cover the defect area. A total of three layers of AMG (multi-layer AMG) were used. The membrane was placed over the cornea with the epithelial/basement membrane surface on top. After the bare scleral area was dried with a cellulose sponge, fibrin glue was applied onto scleral surface and spread with the cannula. The membrane was transferred immediately over the scleral bed and fixated by pinching the edges of the membrane together with the surrounding conjunctiva. Also, the fibrin glue underneath the graft was spread with a muscle hook and excess glue was trimmed using Westcott scissors. The stability of the membrane was checked with a cellulose sponge, and additional glue was applied if necessary (Figure 1).

Citation: Fahmy RM. Pterygium Resection with Amniotic Membrane Grafting in a Patient with Xeroderma Pigmentosum. Austin J Clin Ophthalmol. 2016; 3(2): 1066. ISSN : 2381-9162