Prophylactic removal and microbiological evaluation of calcified plaques after pterygium surgery
Tai Jun Kim1, Hyuk Jin Choi2,3,4, Mee Kum Kim1,5
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Purpose:
The aim of this study was to investigate microbiological characteristics of prophylactically removed calcified plaques developed after pterygium excision, and to evaluate risk factors for the growth of microorganisms.
Methods:
Only exposed calcified plaques developed at the same site of previous pterygium excision were prospectively removed in 15 eyes of 14 patients. Plaques were completely removed, divided into small pieces and evaluated for microbiological identification. Underlying scleral defects were reconstructed using a conjunctival autograft, amniotic membranes and scleral patch grafts according to the size and depth of the defects. Based on the results of microbiologic cultures, eyes were divided into two groups and risk factors for microbial growth were analyzed.
Results:
At surgery, the mean age of the patients was 71.2 ± 5.8 years and 71.4 % were females. The mean time interval between pterygium excision and calcified plaque removal was 19.3 ± 13.8 years. Six of 15 (40 %) removed plaques showed bacterial growth, and Stenotrophomonas maltophilia was the most frequently isolated microorganism. The size of calcified plaques was the only risk factor for culture-positive results (p = 0.045). Underlying scleral defects were successfully repaired without any serious complication.
Conclusions:
Microorganisms can be isolated from calcified plaques developed at the site of previous pterygium excision, and the size of plaques is the only risk factor for culture-positive results. To remove potential source of infection, prophylactic removal of calcified plaques and scleral surface reconstruction should be considered, especially when the plaques are exposed and large.
Insights
Microorganisms, including Stenotrophomonas maltophilia, can grow in calcified plaques after pterygium excision. Larger plaque size increases infection risk, suggesting prophylactic removal is beneficial.
Area of Science:
- Ophthalmology
- Microbiology
- Surgical Reconstruction
Background:
- Calcified plaques can develop after pterygium excision.
- These plaques may harbor microorganisms, posing an infection risk.
- Understanding the microbiological profile and risk factors is crucial for patient management.
Purpose of the Study:
- To investigate the microbiological characteristics of calcified plaques removed after pterygium excision.
- To identify risk factors associated with microbial growth in these plaques.
- To evaluate the outcomes of surgical reconstruction following plaque removal.
Main Methods:
- Prospective removal of exposed calcified plaques from 15 eyes of 14 patients.
- Microbiological identification of isolated microorganisms from plaque samples.
- Scleral defect reconstruction using conjunctival autografts, amniotic membranes, or scleral patch grafts.
- Analysis of risk factors for microbial growth based on culture results.
Main Results:
- Bacterial growth was detected in 40% of removed plaques.
- Stenotrophomonas maltophilia was the most frequently isolated bacterium.
- Plaque size was the sole significant risk factor for positive microbial cultures (p=0.045).
- Surgical reconstruction of scleral defects was successful with no major complications.
Conclusions:
- Microorganisms are frequently isolated from post-pterygium excision calcified plaques.
- Plaque size is a key risk factor for microbial colonization.
- Prophylactic removal of exposed, large calcified plaques, coupled with scleral reconstruction, is recommended to prevent infection.
