Fresh Frozen Plasma (Octaplas®) and Topical Heparin in the Management of Ligneous Conjunctivitis
Anuradha Ganesh, MD; Patrick O. Watts, FRCOphth; Abdullah Mujaini, FRCSC; Shahab H. Agha, MS; Maha Mameesh, PhD; Hugh Jewsbury, FRCOphth; Philip Conor, FRCPath
Sultan Qaboos University Hospital AND University Hospital Wales
Muscat, Sultanate of Oman AND Cardiff, UK
Introduction: Ligneous conjunctivitis is a rare membranous conjunctivitis, associated with reduced plasminogen activity. We present successful management of recurrent ligneous conjunctivitis in two children.
Methods: Patient 1: A six-year-old Arab girl presented with bilateral eyelid swelling and yellowish-white masses under both eyelids, noted since the age of two years. Prior surgical excision had resulted in a recurrence. She was known to have congenital plasminogen deficiency. Patient 2: An 18-month-old Caucasian boy was diagnosed with bilateral hemorrhagic conjunctivitis at the age of three months. Six weeks following resolution, he presented with two pedunculated, vascular masses on left upper tarsal conjunctiva. Excision was followed by a recurrence.
Results: Patient 1: Firm, sessile, woody lesions were observed in the tarsal conjunctiva OU. Plasminogen level was 0.24 IU/ml (normal range 0.730-1.270 IU/ml). Surgical excision and amniotic membrane grafting under cover of perioperative fresh frozen plasma (FFP) transfusion was performed. Topical heparin, steroids, and cyclosporine were administered in the postoperative period. Patient 2: Plasminogen level was found to be low at 0.25 IU/L (normal 2.5-4.2 IU/L). Repeat excision was undertaken under cover of perioperative FFP transfusion. Complete resolution of the condition was noticed in both patients. Follow up one year later has showed no recurrence.
Discussion: The management of ligneous conjunctivitis is challenging. Local excision is invariably associated with recurrences.
Conclusion: Currently, in the absence of a commercially available plasminogen preparation, the use of FFP together with topical heparin and local surgical excision of the membranes offers a curative treatment for ligneous conjunctivitis.
References: 1. Watts P, Suresh P, Mezer E, et al. Effective treatment of ligneous conjunctivitis with topical plasminogen. Am J Ophthalmol 2002;133:451-5.
2. Azad N, Zafar S, Khan A. Successful treatment of ligneous conjunctivitis with topical cyclosporine and heparin. J AAPOS. 2009;13:519-20.
3. Fernandes M, Sridhar MS, Sangwan VS, Rao GN. Amniotic membrane transplantation for ocular surface reconstruction. Cornea. 2005;24:643-53