Subconjunctival and topical plasminogen drops as definitive and safe treatment in recurrent ligneous conjunctivitis: reducing the concern of taking these patients to the surgery room

Session Details

Session Title: Cornea: Medical

Session Date/Time: Tuesday 10/10/2017 | 08:00-10:30

Paper Time: 08:12

Venue: Room 3.6

First Author: : D.Ortiz-Vaquerizas SPAIN

Co Author(s): :    J. Puig Galy   A. Andrade   S. Martin Nalda   L. Bisbe           

Abstract Details

Purpose:

To describe a new technique for ligneous conjunctivitis treatment with topical and subconjunctival plasminogen preparation.

Setting:

Ligneous Conjunctivitis is a rare condition characterized by chronic membranous conjunctivitis due to a systemic plasminogen deficiency. Several treatment options have been reported, such as corticosteroids, heparin, hyaluronidase, cyclosporine, contraceptives, and plasminogen. However, only the last one has demonstrated consistent efficacy in resolution and prevention of re-formation of the lesions.

Methods:

A 47-year-old Turkish female was referred with a 2-year history of recurrent yellowish vascularised plaque at the left upper lid. Examination revealed the exophytic lesion and fibrosis across the entire length of the tarsal conjunctiva in both eyes. Eversion of upper eyelids was too painful to be performed. Both corneas had superficial punctate keratitis. Haematology department was consulted and blood test revealed plasminogen deficiency (5.1 mg/dl, normal is 6-26 mg/dl; plasminogen activity 11%). Polymerase chain reaction for Chlamydia was negative. Ligneous conjunctivitis was diagnosed and cyclosporine A 1% (aqueous solution) every 12 hours was started. Neither lesions nor symptoms improved.

Results:

Plasminogen drops were prepared and applied every 2 hours after mixing them with sodium hyaluronate solution (Biolon®). Lesions decreased in both eyes and the exophytic one became more delineated, but stopped decreasing after 3-month treatment. Surgical excision was decided, applying intraoperative plasminogen drops on the surgical bed and injecting plasminogen solution in the subconjunctival space to prevent the worsening of the eyelid condition after the surgical injury. The 3-month follow-up showed no recurrence of the lesions and patient is still completely asymptomatic despite having discontinued the drops.

Conclusions:

Ligneous Conjunctivitis is a consequence of a wound healing disorder. Lesions appear or are exacerbated after trauma, surgery or other inflammatory processes. Plasminogen treatment is the only effective option, and in our case plasminogen with sodium hyaluronate drops applied every 2 hours reduced the symptoms and improved the lesions. It seems that when this patients need surgery, a good option to reduce the risk of recurrence after the surgical injury is to apply topical and subconjunctival plasminogen preparation intraoperatively. To the best of our knowledge, this last option has not been published yet.

Financial Disclosure:

NONE