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Giant papillary conjunctivitis after keratoplasty

A Sugar, R F Meyer

    American Journal of Ophthalmology
    |February 1, 1981
    PubMed
    Summary

    Giant papillae on the upper eyelid conjunctiva, associated with exposed sutures after penetrating keratoplasty, resolved after suture removal. This suggests a mechanical cause, though an immunologic basis is also possible.

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    Area of Science:

    • Ophthalmology
    • Corneal Surgery
    • Immunology

    Background:

    • Giant papillae of the upper tarsal conjunctiva are observed in vernal conjunctivitis and contact lens-induced giant papillary conjunctivitis.
    • A similar condition has been noted in patients following penetrating keratoplasty.

    Purpose of the Study:

    • To investigate a syndrome of giant papillae in patients who underwent penetrating keratoplasty with interrupted nylon sutures.
    • To determine the cause and effective treatment for this conjunctival reaction.

    Main Methods:

    • Observation of 11 patients who developed symptoms after penetrating keratoplasty with interrupted nylon sutures.
    • Clinical examination including assessment of symptoms like itching and discharge.
    • Evaluation of conjunctival scrapings for eosinophils.
    • Surgical intervention involving the removal of exposed sutures.

    Main Results:

    • Patients presented with minimal itching, mild mucous discharge, mild blepharoptosis, and giant papillae.
    • These symptoms were associated with exposed nylon suture ends.
    • Removal of the exposed sutures led to complete resolution of the conjunctival condition.
    • Conjunctival scrapings from a subset of patients revealed eosinophils.

    Conclusions:

    • Exposed nylon sutures after penetrating keratoplasty can induce a syndrome of giant papillae.
    • The condition appears to be primarily mechanical, related to suture irritation.
    • While an immunologic basis involving eosinophils is possible, mechanical factors are strongly implicated.
    • Suture removal is an effective treatment for this post-keratoplasty complication.

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