Ligneous Conjunctivitis

Yıl 2015, , 140 - 146, 15.07.2015

Sibel İnan

https://doi.org/10.18229/ktd.37368

Öz

Ligneous conjunctivitis is one of the very rarely
seen conjunctivitis and a clinical picture that is
difficult to manage for both patient and physician. Ligneous conjunctivitis, often bilateral, is
characterized by pseudomembran formation
with ligneous-like appearance. It is seen as fibrin-rich and firm material covering the all area
of the palpebral conjunctiva with overlying yellow mucoid discharge when lids are inverted.
Lesions have a tendency of recurrence even if
treated suitably. Association of ligneous conjunctivitis with systemic plasminogen deficiency has been shown. Lesions may also develop
in the other mucosal structures of the body.
Concurrent or accompanied systemic pathologies together with its presentation have been
reported. New treatment modalities have been
tried to apply for management of ligneous conjunctivitis in individual case reports in recent
years. It is important to early and correct diagnosis of this type of conjunctivitis as well as suitable management. Update information about
presentation, history, etiopatogenesis and management of ligneous conjunctivitis has been
given in this review article

Anahtar Kelimeler

Ligneous, Conjunctivitis, Etiopathogenesis, Clinic Presentation, Management

Lignöz Konjonktivit

Öz

Lignöz konjonktivit oldukça nadir görülen konjonktivitlerden olup hem hasta hem de hekim için üstesinden gelmesi zorluk oluşturan bir tablodur. Sıklıkla iki gözü de tutan lignöz konkonktivit odunumsu görünümümde yalancı membran oluşumu ile karakterizedir. Göz kapakları ters çevrildiğinde tüm konjonktivayı kaplamış olarak görülen lezyon, fibrinden zengin olup sarımsı mukoid bir akıntı ile örtülmüş olabilir. Lezyon tedavi edilse bile tekrarlama eğilimindedir. Lignöz konjonktivitin plazminojen defekti ile ilişkili olduğu gösterilmiştir. Lezyonlar konjonktiva dışında vücuttaki diğer mukozalarda da ortaya çıkabilir. Lignöz konjonktivite eşlik eden diğer sistemik patolojiler de bildirilmiştir. Son yıllarda tedavisinde yeni yöntemler uygulanmaya çalışılmaktadır. Az rastlanan bu konjonktivit türünün zamanında ve doğru teşhis edilip tedavisinin doğru yönetilmesi önem arz etmektedir. Makalede lignöz konjonktivitin klinik, tarihçe, patogenez ve güncel tedavileri ile ilgili bilgiler verilmiştir.

Anahtar Kelimeler

Lignöz, Konjoktivit, Etiyopatogenez, Klinik, Tedavi

Kaynakça

• McGrand JC, Rees DM, Harry J. Ligneous con- junctivitis. Br J Ophthalmol 1969;53:373381
• Schuster V,Seregard S. Ligneous conjunctivi- tis. Surv Ophthalmol 2003;48:369-88
• Hidayat AA, Riddle PJ. Ligneous conjunctivi- tis. A clinicopathologic study of 17 cases. Oph- talmology 1987;94:949-59.
• Holland EJ, Chan CC, Kuwabara T et al. Immu- nohistologic findings and results of treatment with cyclosporine in ligneous conjunctivitis. 17. Parunovic A, Stefanovic D. Conjunctivitis lig- Am J Ophtalmol 1989;107:160-166. nosa an hydrocephalus (an unusual association
• Kaan G, Ozden O. Therapeutic use of topical cyclosporine. Ann Ophthalmol 1993:25;182186.
• Energin F, Yakan B, Kaya M ve ark. Odunsu konjonktivitte histopatolojik ve ultrastrüktürel type 1 plasminogene deficiency. Eur J Pediatr. bulgular ile siklosporin tedavisi. MN Oftalmoloji B, 1995;2:308-311.
• Girard LJ, Veselinoviç A, Font RL. Ligneous Prenatal diagnosis in a family with severe type conjunctivitis after pingueculae removal in a 1 plasminogen deficiency, ligneous conjuctivi- adult. Cornea 1989;8:7-14.
• Schuster V, Mingers AM, Seidenspinner S. Homozygous mutations in the plasminogen 20. Ozcelik U, Akçören Z, Anadol D et al. Pulmo- gene of two unrelated girls with ligneous con- nary involvement in a child with ligneous con- junctivitis. Blood 1997;90:958-966.
• Bateman JB, Pettit TH, Isenberg SJ et al. Ligneous conjunctivitis : an autosomal reces- sive disorder. J Pediatr Ophthalmol Strabismus 1986;23:137-140.
• Yazıcı B, Yıldız M, Irfan T. Induction of bila- teral ligneous conjunctivitis with the use of a Human homozygous type 1 plasminogen de- prosthetic eye. Int Ophthalmol 2011;31:25-8. ficiency and ligneous conjunctivitis. APMIS
• Kanski JJ and Bowling B .Clinical Ophthal- mology. Chapter 5: Conjunctivitis, Seventh Edi- tion, Elsevier & Saunders, London 2011:158-160.
• De Cock R. Membranaous, pseudomemb- raneous and ligneous conjunctivitis. Dev Oph- thalmol 1997;28:32-45.
• Marcus DM, Walton D, Donshik P et al. Lig- neous conjunctivitis with ear involvement. Arch Ophtalmol 1990;108:514-519.
• Cohen SR. Ligneous conjunctivitis: an op- htalmic disease with potentially fatal trache- obronchial obstruction. Laryngeal and trache- obronchial features. Ann Otol Rhinol Laryngol 1990;99(7Pt1):509-512. of 2 diseases). Vestn Ophtalmol 1993;109:30-1.
• Çiftçi E, İnce E, Akar N et al. Ligneous conjun- ctivitis,hydrocephalus,hydrocele and pulmo- nary involvement in a child with homozygous Schuster V, Seidenspinner S, Müller C. et al. tis and congenital hydrocephalus Prenat Diagn 1999;19:483-7 junctivitis and homozygous type 1 plasminogen deficiency. Pediatr Pulmonal 2001;32:179-183.
• Mingers AM, Heinburger N, Zeitler P et al. Homozygous type 1 plasminogen deficiency. Semin Thromb Hemost 1997;23:259-269.
• Mingers AM, Philapitsch A, Zeitler P et al. 1999;107;62-72.
• Schuster V, Seidenspinner S, Zeitler P. et al Compound-heterozygous mutations in the plasminogen predispose to the development of ligneous conjunctivitis. Blood 1999; 93:3457- 34
• Gülkılık G, Engin G, Kocabora S. et al. Odun- su konjonktivitli bir olguda oral tutulumla birlik- te düşük plazminojen aktivitesi. MN Oftalmoloji 2004;11:168-70.
• Diamond JP, Chandra A, Williams C et al. 36. Weinstock SM, Kieler RA. Bulbar ligneous Tranexamic asid-associated ligneous conjuncti- conjunctivitis after pterygium removal in an el- vitis with gingival and peritoneal lesions. Br. J Ophtalmol 1991;75:753-754.
• Schwart GS, Holland EJ. Induction of ligne- ous conjunctivitis by conjunctival surgery. Am J Ophthalmol 1995;120:253-254.
• Hiremath M, Elder J, Newall F. et al. Heparin in the long-term management of ligneous con- junctivitis: a case report and review of literature. Blood Coagul Fibrinolysis 2011;22:606-9.
• De Cock R, Ficher LA, Dart JG et al. Topical heparin in the treatment of ligneous conjuncti- vitis. Ophthalmology 1995;12:1654-59.
• Azad N, Zafar S, Khan A. Succesful treatment of ligneous conjunctivitis with topical cyclospo- rine and heparine. J AAPOS 2009;13:519-20.
• Holland EJ, Olsen TW, Ketcham JM et al.To- pical Cyclosporine A in the treatment of an- terior segment inflamatory disease. Cornea 1993;12:413-419.
• Uslu H, İskeleli G, Arslan OŞ ve ark. Özelliği pical plasmin and topical plasminogen. Cornea 2003; 22:760-2 olan lignöz konjonktivitli iki olgu. Türk Oftalmo- loji Gazetesi 2001;31:4-8.
• Fraundler FT, Roy FH. Current Ocular The- rapy Section 19 .In: Romain De Cock. Lig- neous conjunctivitis. W.B. Saunders Company 43. Borabino S, Rolando M. Amniotic membra- 2000:336-337. ne transplantation in a case of ligneous conjun
• Coşkun M, Ayıntap E, Keskin U ve ark. Lig- nöz konjonktivitte membran eksizyonu sonrası topikal siklosporin A kullanılan iki olgu. Turkiye Klinikleri J Ophthalmol 2011;20:162-5.
• Tabbara KF. Prevention of ligneous conjun- ctivitis by topical and subconjunctival fresh fro- zen plazma. Am J Ophthalmol 2004; 138:299- 300.
• Gürlü VP, Demir M, Alimgil ML et al. Systemic and topical fresh frozen plasma treatment in a newborn with ligneous conjunctivitis. Cornea 2008; 27:501-3. derly man. Am J Ophtalmol 1975;79:913-5.
• Melikian HE. Treatment of ligneous conjun- ctivitis. Ann Ophtalmol 1985:17;763-5.
• Cohen Tervaert D, Cruysberg JR, Deutman AF et al. Ligneous conjunctivitis. Doc Ophtal- mol 1986;64:5-11.
• Kraft J, Lieb W, Zeitler P. Ligneous conjunc- tivitis in a girl with severe type 1 plasminogen deficiency. Graefes Arch. Clin Exp Ophthalmol 2000;238:797-800.
• Watts P, Suresh P, Mezer E et al. Effective tre- atment of ligneous conjunctivitis with topical plasminogen. Am J Ophthalmol 2002;133;451
• Sekeroğlu HT, Yağmur M, Erdem E ve ark. Dirençli bir lignöz konjonktivit olgusunda intra- venöz ve topikal taze donmuş plazma tedavisi: Lignöz konjonktivitlere genel bir bakış. Turkiye Klinikleri J Ophthalmol 2012;21:58-60 ctivitis. Am J Ophthalmol 2004;137:752-753.
• Fuentes-Paez G, Herreras JM, del C Mendez M. et al. Ligneous conjunctivitis in a patient with Crohn’s disease. Clin Ophtalmol 2008;2:203-6.
• Suzuki T, Ikewaki J, Awata H et al. The first two Japanese cases of severe type 1 congenital plasminogen deficiency with ligneousconjun- ctivitis:succesfull treatment with direct throm- bin inhibitör and fresh plasma. Am J Hemat. 2009;84:363-5.