Prophylactic Removal and Microbiological Evaluation of Calcified Plaques After Pterygium Surgery
Narrative Responses:
Purpose
To investigate microbiological characteristics of prophylactically removed calcified plaques which developed after pterygium excision, and to evaluate clinical outcomes of scleral reconstruction for underlying scleral defects after plaque removal.
Methods
Fourteen eyes of 13 patients presenting a exposed calcified plaque after pterygium excision were prospectively enrolled in this study. Under local anesthesia, calcified plaques were completely removed and divided into small pieces which were smeared on slides and inoculated into various culture medias for microbiological evaluations. Underlying scleral defects were reconstructed using conjunctival autograft, amniotic membrane transplantation and scleral patch grafting according to the size and depth of the defects. Risk factors for microbiological growth were analyzed.
Results
At surgery, the mean age of the patients was 70.9 ± 5.9 years (58-79 years) and 30.8% (4 of 13) were male. The mean time interval between previous pterygium excision and calcified plaque removal was 19.9 ± 14.7 years (2-40 years). Five of fourteen (35.7%) removed plaques showed a growth of microorganisms and Stenotrophomonas maltophilia, which was grown up in 3 of 5 (60%) culture positive eyes, was the most frequently isolated microorganism. The mean size of calcified plaques was the only risk factor for culture positive result. During the postoperative follow-up periods, there were neither infection signs nor serious complications.
Conclusion
Microorganisms could grow in the long-standing, exposed, especially large calcified plaques after pterygium surgery. Therefore, prophylactic removal of exposed plaques and scleral surface reconstruction might be necessary to maintain ocular health.