Mangayarkarasi, H (2020) An Observational study to Determine the Outcome of Excision followed by Amniotic Membrane Grafting in Giant Papillary Conjunctivitis. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Giant papillary conjunctivitis is the inflamation of the tarsal conjunctiva of the lids with formation of large sized papillae (upto 5 mm). Giant papillary conjunctivitis has been reported as a complication of contact lens wear since 1974.Prior to the widespread use of contact lens, this reaction was predominantly seen in patients with immunoglobulin mediated ocular allergies including allergic conjunctivitis and vernal conjunctivitis. It is also found in patients with exposed sutures, filtering blebs, scleral buckles, ocular prostheses, corneal foreign bodies, limbal dermoids .Intolerance to contact lens wear, complaining of increased mucus at the inner canthus at the time of CL removal. Redness, itching and decreased vision at times. This study contemplates the outcome of excision of giant papillary conjunctivitis followed by amniotic membrane graft. The recurrence rate of Giant Papillary Conjunctivitis after amniotic membrane grafting is less than 1%. AIM OF THE STUDY: The aim of the study is to observe the outcome of amniotic membrane grafting after excision of Giant papillary conjunctivitis.To look for recurrence of GPC after amniotic membrane grafting. MATERIALS AND METHODS: • Study Design: Prospective, observational study. • Sample Size: 30 patients. This study includes patients with GPC attending Ophthalmology outpatient department of GRH. • Study Period: 9 Months [December 2018 to August 2019] • Selection of Subjects: A total of 30 patients of the age group 15 – 50 years who are visiting the OPD or admitted in Ophthalmology department in GRH with the following inclusion and exclusion criteria are selected. METHODOLOGY: • All subjects were selected only after they provide informed consent for entry to the trial. • All patients underwent a complete ocular examination (which includes History taking, Best corrected visual acuity, slit lamp examination and staining, schirmers test, TBUT, tear meniscus height, tonometry by Goldmann applanation tonometer and fundus examination by direct ophthalmoscopy). • After obtaining informed consent, under local infiltration with 4% lignocaine and 1 : 1,00,000 adrenaline, giant papillae were excised using a 15 bard parker knife. • Preserved amniotic membrane from eyebank was used as inlay. • The membrane was placed over tarsal conjunctiva after excision of the giant papillae with epithelial side up and fashioned in to the shape of defect. • The edges of the amniotic membrane were secured with 8-0 vicryl sutures. Giant papillary conjunctivitis if left untreated leads to dry eye ,corneal shield ulcer. RESULTS: Out of the 30 studied patients, 43.3% (13patients) were less than 20yrs, 50% (15 patients)were between 20 to 30 yrs and 6.7% (2 patients)were more than 30 yrs. 60% of the patients were males (18patients) and 40% were females(12patients).26 patients(86.6%) had allergic etiology, 3 patients (10%)had discontinued contact lens wear due to symptoms and 1 patient (3.3%) used prosthetic. 25 patients had bilateral presentation and 5 patients had unilateral presentation. Out of the 55 eyes studied, Before excision and amniotic membrane grafting, occasional itching was present in 1 eye, frequent itching in 26 eyes, constant itching in 28 eyes and after the procedure 49 eyes had occasional itching, 4 eyes had frequent itching and 2 eyes had constant itching (P value < 0.001 significant). Before the procedure 4 eyes had mild watering, 24 eyes had moderate watering, 27 eyes had severe watering and after the procedure 25 eyes had no watering, 26 eyes had mild watering, 3 eyes had moderate watering and one eye had severe watering (P value < 0.001 significant). Mild photophobia was present in 2 eyes, moderate photophobia 28eyes, severe photophobia in 25 eyes before the procedure and after the procedure 52 eyes had no photophobia, 2 eyes had mild photophobia and one eye had moderate photophobia (P value < 0.001 significant). 3 eyes had mild foreign body sensation, 17 eyes had moderate foreign body sensation, 35 eyes had severe foreign body sensation before the procedure and after the procedure 26 eyes had mild foreign body sensation, 2 eyes had moderate foreign body sensation (P value < 0.001 significant). 32 eyes had moderate discharge, 23 eyes had severe discharge before the procedure and after the procedure 24 eyes had scanty discharge, 2 eyes had moderate discharge.8 eyes had mild limbal hyperplasia,2 eyes had severe limbal hyperplasia before the procedure and after the procedure 4 eyes had mild limbal hyperplasia (P value 0.157 not significant). Conjunctival hyperaemia was moderate in 20 eyes, severe in 35 eyes before the procedure and after the procedure 5 eyes had mild conjunctival hyperaemia,1 eye had moderate hyperaemia (P value < 0.001 significant). tarsal conjunctival papillary hypertrophy was moderate in 16 eyes, severe in 39 eyes before the procedure and after the procedure 2 eyes showed mild tarsal papillary hypertrophy (P value < 0.001 significant). superficial punctate keratopathy was mild in 4 eyes, moderate in 20 eyes, severe in 28 eyes before the procedure and after the procedure mild in 5 eyes, moderate in 1 eye (P value < 0.001significant). Corneal vascularisation was mild in 29 eyes, moderate in 9 eyes, severe in 2 eyes before the procedure and after the procedure 12 eyes had mild corneal vascularisation. graft loss was noted in two eyes (3.6%), recession occurred in 3 eyes(5.5% )and was taken up in 50 eyes (90.9%). Follow up examination showed recurrence in 2 eyes (3.6%) and no recurrence was seen in 53 eyes (96.4%) at the end of six months.(P value < 0.001 significant). The recurrence of GPC was noted in patients who had graft loss. Thus the recurrence rate of GPC after amniotic membrane grafting is 3.6% which is significantly lower. DISCUSSION: Giant papillary conjunctivitis refractory to medical management may lead to dry eye, superficial punctate keratopathy that coalesce into sterile shield shaped ulcer centered at the junction of middle and upper third of cornea,ptosis. Also there is risk of steroid related complications glaucoma, cataract, skin depigmentation and thinning of lids. CONCLUSION: The advantages of amniotic membrane grafting after excision of papillae in Giant Papillary Conjunctivitis are: - Cost effective. - Low recurrence rate. - Simple procedure not requiring additional surgical skill or instrumentation. - Offers anatomical and physiological restoration of ocular surface. - Day care surgery with minimal or no complications.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221713104 |
| Uncontrolled Keywords: | Giant Papillary Conjunctivitis, Amniotic Membrane Graft, Conjunctival Hyperaemia, Corneal Vascularisation, Photophobia, Limbal Hyperplasia Mastcell Stabilisers, Nonsteroidal Anti Inflammatory Agents. |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Feb 2021 09:13 |
| Last Modified: | 14 Feb 2021 09:13 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14175 |
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