Chronic Inflammatory Granulomata after Intraoperative Use of GenTeal Gel during Strabismus Surgery
Raymond G. Areaux, Jr, MD; Amanda C. Maltry, MD
University of Minnesota
Introduction: Goals of strabismus surgery include acceptable binocular alignment, postoperative comfort, and limited complications. Corneal hydration reduces epitheliopathy and improves comfort. GenTeal gel (hydroxypropyl methylcellulose 0.3%, carbopol 980, phosphonic acid, sorbitol, sodium perborate 0.028%; Ciba Vision, Duluth, GA) is an ocular surface lubricant and has been advocated to maintain intraoperative corneal clarity in vitreo-retinal surgery . We report 2 cases of chronic inflammatory granulomata after intraoperative use of GenTeal gel during strabismus surgery.
Methods: Retrospective case series: A 5-year-old African-American boy and a 19-year-old Caucasian female underwent uncomplicated, virgin strabismus surgery via inferior fornix incisions. Corneal hydration was maintained with GenTeal gel in both cases.
Results: Alignment and healing were good at postoperative week 2. At postoperative month 3, each patient noted elevated yellow subconjunctival lesions with surrounding injection in the inferior fornix. The younger patient was asymptomatic and elected observation; the older patient chose excision. Histopathology showed amorphous collagen surrounded by inflammatory cells.
Discussion: A recent report documented chronic inflammatory subconjunctival granulomata after intraoperative use of GenTeal gel in vitreo-retinal surgery with large conjunctival incisions . Similar lesions have been reported after use of similar compounds during lipoplasty . Clinical presentation and histopathology were similar in our two cases. No such complications have occurred since intraoperative GenTeal was discontinued.
Conclusion: When GenTeal is used during strabismus surgery, copious irrigation is recommended to reduce the risk of developing postoperative granulomata. Alternative lubricants such as balanced salt solution or Goniosol should be considered for corneal hydration during eye surgery with open conjunctiva.
References: 1. Garcia-Valenzuela, E., et al., Reduced need for corneal epithelial debridement during vitreo-retinal surgery using two different viscous surface lubricants. Am J Ophthalmol, 2003. 136(6): p. 1062-6.
2. Dalvin, L.A., et al., Necrotizing Subconjunctival Granulomata and Intraoperative Use of Topical GenTeal Gel. Ophthalmology, 2016. 123(10): p. 2262-3.
3. Shanesmith, R.P., et al., Unusual palisading and necrotizing granulomas associated with a lubricating agent used in lipoplasty. Am J Dermatopathol, 2010. 32(5): p. 448-52.