Complications of Cosmetic Eye Whitening

Article Type
Article
Changed
Thu, 01/10/2019 - 13:46
Display Headline
Complications of Cosmetic Eye Whitening
In Partnership With Cosmetic Surgery Forum
Author(s)
Ann Q. Tran, MD
Catherine Hoeppner, BS
Nandini Venkateswaran, MD
Daniel S. Choi, MD
Wendy W. Lee, MD, MS

First introduced in 2008 as a surgical treatment of chronic conjunctival injection, cosmetic eye whitening became popularized in South Korea1 and has been performed in more than 1800 patients in the United States.1-3 Individuals with healthy eyes who elect to undergo this procedure often present with concerns of hyperemia, undesirable ocular pigmentation, or pingueculas. An initial report from Kim4 described 571 patients who underwent regional conjunctivectomy for persistent irreversible hyperemic conjunctiva with a 94.6% postoperative satisfaction rate. In contrast, over the last 5 years, various reported permanent complications raised concerns of the risk-benefit ratio of this cosmetic procedure.

The procedure involves performing a localized conjunctivectomy with or without removal of the Tenon capsule.4 Brimonidine tartrate is given for vascular constriction. When conjunctivectomy is performed in the right eye, the medial conjunctiva is incised from the 2-o’clock to 5-o’clock positions and the lateral conjunctiva is incised from the 10-o’clock to 7-o’clock positions. After the conjunctiva and Tenon capsule are excised, hemostasis is achieved with electrocauterization. Postoperative management may consist of topical mitomycin C (MMC) 0.02% 4 times daily for 2 to 5 days along with topical steroids. The addition of bevacizumab 1.25 mg/mL also has been described.5

In this report, we provide a comprehensive review of the complications of cosmetic eye whitening based on a review of the literature. Clinicians in both aesthetic practice and ophthalmology should be aware of the potential complications to accurately educate their patients about the possible risks and benefits of this procedure.

Methods

A review of PubMed articles indexed for MEDLINE (January 2009 to July 2017) using the search terms cosmetic eye whitening, cosmetic wide conjunctivectomy, I-Brite, and chronic hyperemic conjuctiva was conducted to evaluate the number of reports of complications from cosmetic eye whitening. A total of 10 articles were included in the study based on a review of abstracts. Non–English-language abstracts were not reviewed.

Results

Based on a review of 10 articles commenting on the complications of cosmetic eye whitening, a total of 2400 patients had undergone a cosmetic conjunctivectomy with various postoperative complications and recurrences (Table).4-13 The most commonly recurring complications based on the reported frequencies in the articles included chronic conjunctival epithelial defects, scleral thinning, calcific plaques, dry eye syndrome, diplopia (sometimes requiring strabismus surgery), and elevated intraocular pressure.

Kim4 was the first to report this surgical technique for irreversible hyperemic conjunctiva (N=1815). The reported success rate in South Korea was overwhelmingly high at 94.6%. In a mean (SD) follow-up time of 12.9 (7.8) months (range, 2–27 months), less than 20% of patients required surgical revision. During this time, the most common postoperative complications included elevation in intraocular pressure (17.2%), conjunctival granuloma (8.4%), transient vision decrease (7.5%), pigment deposition (5.3%), scleral calcifications (3.9%), and diplopia secondary to conjunctival adhesions (1.6%). No permanent defects were reported, and complications improved with surgical and medical management.4

Contrary to the findings of Kim,4 a large number of complications were seen; thus, on March 4, 2011, the Korean Ministry of Health & Welfare issued a declaration to discontinue the procedure under Article 49 of the Medical Service Act. Medical records from the single clinic in Korea from November 2007 to May 2010 were reviewed.5 One of the largest reviews of cosmetic eye whitening complications reviewed 1713 patients who underwent conjunctivectomy plus topical MMC with or without bevacizumab injection. Pterygium and chronic conjunctival hyperemia were the most common diagnoses that prompted patients to undergo treatment. Over an average follow-up period of 10.9 months, the overall complication rate was 82.9%, with severe complications being fibrovascular conjunctival proliferation (43.8%), recurrent hyperemic conjunctiva (28.1%), intraocular pressure (13.1%), scleral thinning with calcified plaques (6.2%), scleral thinning (4.4%), and diplopia (3.6%). A total of 56.9% of patients reported being satisfied with the cosmetic outcome of the surgery.5

In some of the smaller case series and case reports we reviewed, more vision-threatening complications have been described. Infectious endophthalmitis, infectious scleritis, and necrotizing scleritis have all been reported as complications of cosmetic eye whitening.8,10

 

 

Comment

The pathophysiology of the complications of cosmetic eye whitening stem from the disruption of the normal conjunctiva, destruction of the vascularization to the sclera, and loss of limbal stem cells. Mitomycin C is a topical antimetabolite antibiotic agent that inhibits DNA synthesis. This relatively safe and inexpensive product has decreased the recurrence rate in pterygium surgery as early as 1963.14,15 Complications of MMC in pterygium surgery include infectious scleritis, necrotizing scleritis, calcium formation, and even scleromalacia, occurring at incidence rates as low as 1.4%.16 These risks are balanced against the medical necessity of using MMC. Given the elective nature of cosmetic eye whitening, these complications in a cosmetic setting may not be justified.

The debate of the use of this procedure continues to occur in ophthalmologic societies. Both the Korean Ministry of Health & Welfare and the American Society of Cataract Refractive Surgery do not condone the use of regional conjunctivectomy for cosmetic eye whitening.5,17 Evidence shows that complications from cosmetic conjunctivectomy can be devastating and unnecessary given its elective nature. Although some complications (eg, dry eye syndrome, pain, discomfort) may be considered mild, the number of potentially serious complications brings the usefulness of the procedure into question.

This review is a launchpad to inform the medical community of the potential downside to conjunctivectomy for cosmetic eye whitening with the hope that it can initiate meaningful risk-benefit discussions between providers and physicians.

References
  1. Kim BH. Cosmetic eye whitening. Poster presented at: American Society of Cataract and Refractive Surgery; April 4-9, 2008; Chicago, IL.
  2. Kim BH. Cosmetic eye whitening by regional conjunctivectomy. Poster presented at: European Society of Cataract & Refractive Surgeons; September 13-17, 2008; Berlin, Germany.
  3. Raiskup F, Solomon A, Landau D, et al. Mitomycin C for pterygium: long term evaluation. Br J Ophthalmol. 2004;88:1425-1428.
  4. Kim BH. Regional conjunctivectomy with postoperative mitomycin C to treat chronic hyperemic conjunctiva. Cornea. 2012;31:236-244.
  5. Lee S, Go J, Rhiu S, et al. Cosmetic regional conjunctivectomy with postoperative mitomycin C application with or without bevacizumab injection [published online April 6, 2013]. Am J Ophthalmol. 2013;156:616-622.
  6. Rhiu S, Shim J, Kim EK, et al. Complications of cosmetic wide conjunctivectomy combined with postsurgical mitomycin C application. Cornea. 2012;31:245-252.
  7. Kwon HJ, Nam SM, Lee SY, et al. Conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy. Cornea. 2013;32:821-825.
  8. Leung TG, Dunn JP, Akpek EK, et al. Necrotizing scleritis as a complication of cosmetic eye whitening procedure. J Ophthalmic Inflamm Infect. 2013;3:39.
  9. Shin HY, Kim MS, Chung SK. The development of scleromalacia after regional conjunctivectomy with the postoperative application of mitomycin C as an adjuvant therapy. Korean J Ophthalmol. 2013;27:208-210.
  10. Vo RC, Stafeeva K, Aldave AJ, et al. Complications related to a cosmetic eye-whitening procedure. Am J Ophthalmol. 2014;158:967-973.
  11. Moshirfar M, McCaughey MV, Fenzl CR, et al. Delayed manifestation of bilateral scleral thinning after I-BRITE® procedure and review of literature for cosmetic eye-whitening procedures. Clin Ophthalmol. 2015;9:445-451.
  12. Jung JW, Kwon KY, Choi DL, et al. Long-term clinical outcomes of conjunctival flap surgery for calcified scleromalacia after periocular surgery. Cornea. 2015;34:308-312.
  13. Saldanha MJ, Yang PT, Chan CC. Scleral thinning after I-BRITE procedure treated with amniotic membrane graft. Can J Ophthalmol. 2016;51:e115-e116.
  14. Seiler T, Schnelle B, Wollensak J. Pterygium excision using 193-nm excimer laser smoothing and topical mitomycin C. Ger J Ophthalmol. 1992;1:429-431.
  15. Singh G, Wilson MR, Foster CS. Long-term follow-up study of mitomycin eye drops as adjunctive treatment of pterygia and its comparison with conjunctival autograft transplantation. Cornea. 1990;9:331-334.
  16. Lam DS, Wong AK, Fan DS, et al. Intraoperative mitomycin C to prevent recurrence of pterygium after excision: a 30-month follow-up study. Ophthalmology. 1998;105:901-904; discussion 904-905.
  17. ASCRS Cornea Clinical Committee. Clinical alert: eye-whitening procedure: regional conjunctivectomy with mitomycin-C application [press release]. Fairfax, VA: American Society of Cataract and Refractive Surgery. http://www.ascrs.org/node/1352. Accessed January 22, 2015.
Article PDF
CT100003024_e.PDF
Author and Disclosure Information

From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Florida.

The authors report no conflict of interest.

This case was part of a presentation at the 8th Cosmetic Surgery Forum under the direction of Joel Schlessinger, MD; November 30-December 3, 2006; Las Vegas, Nevada. Dr. Choi was a Top 10 Fellow and Resident Grant winner.

Correspondence: Wendy W. Lee, MD, MS, 900 NW 17th St, Miami, FL 33136 ([email protected]).

Issue
Cutis - 100(3)
Publications
Cutis
MDedge Dermatology
Topics
Aesthetic Dermatology
Page Number
E24-E26
Sections
For Residents
Author(s)
Ann Q. Tran, MD
Catherine Hoeppner, BS
Nandini Venkateswaran, MD
Daniel S. Choi, MD
Wendy W. Lee, MD, MS
Author(s)
Ann Q. Tran, MD
Catherine Hoeppner, BS
Nandini Venkateswaran, MD
Daniel S. Choi, MD
Wendy W. Lee, MD, MS
Author and Disclosure Information

From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Florida.

The authors report no conflict of interest.

This case was part of a presentation at the 8th Cosmetic Surgery Forum under the direction of Joel Schlessinger, MD; November 30-December 3, 2006; Las Vegas, Nevada. Dr. Choi was a Top 10 Fellow and Resident Grant winner.

Correspondence: Wendy W. Lee, MD, MS, 900 NW 17th St, Miami, FL 33136 ([email protected]).

Author and Disclosure Information

From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Florida.

The authors report no conflict of interest.

This case was part of a presentation at the 8th Cosmetic Surgery Forum under the direction of Joel Schlessinger, MD; November 30-December 3, 2006; Las Vegas, Nevada. Dr. Choi was a Top 10 Fellow and Resident Grant winner.

Correspondence: Wendy W. Lee, MD, MS, 900 NW 17th St, Miami, FL 33136 ([email protected]).

Article PDF
CT100003024_e.PDF
Article PDF
CT100003024_e.PDF
In Partnership With Cosmetic Surgery Forum
In Partnership With Cosmetic Surgery Forum

First introduced in 2008 as a surgical treatment of chronic conjunctival injection, cosmetic eye whitening became popularized in South Korea1 and has been performed in more than 1800 patients in the United States.1-3 Individuals with healthy eyes who elect to undergo this procedure often present with concerns of hyperemia, undesirable ocular pigmentation, or pingueculas. An initial report from Kim4 described 571 patients who underwent regional conjunctivectomy for persistent irreversible hyperemic conjunctiva with a 94.6% postoperative satisfaction rate. In contrast, over the last 5 years, various reported permanent complications raised concerns of the risk-benefit ratio of this cosmetic procedure.

The procedure involves performing a localized conjunctivectomy with or without removal of the Tenon capsule.4 Brimonidine tartrate is given for vascular constriction. When conjunctivectomy is performed in the right eye, the medial conjunctiva is incised from the 2-o’clock to 5-o’clock positions and the lateral conjunctiva is incised from the 10-o’clock to 7-o’clock positions. After the conjunctiva and Tenon capsule are excised, hemostasis is achieved with electrocauterization. Postoperative management may consist of topical mitomycin C (MMC) 0.02% 4 times daily for 2 to 5 days along with topical steroids. The addition of bevacizumab 1.25 mg/mL also has been described.5

In this report, we provide a comprehensive review of the complications of cosmetic eye whitening based on a review of the literature. Clinicians in both aesthetic practice and ophthalmology should be aware of the potential complications to accurately educate their patients about the possible risks and benefits of this procedure.

Methods

A review of PubMed articles indexed for MEDLINE (January 2009 to July 2017) using the search terms cosmetic eye whitening, cosmetic wide conjunctivectomy, I-Brite, and chronic hyperemic conjuctiva was conducted to evaluate the number of reports of complications from cosmetic eye whitening. A total of 10 articles were included in the study based on a review of abstracts. Non–English-language abstracts were not reviewed.

Results

Based on a review of 10 articles commenting on the complications of cosmetic eye whitening, a total of 2400 patients had undergone a cosmetic conjunctivectomy with various postoperative complications and recurrences (Table).4-13 The most commonly recurring complications based on the reported frequencies in the articles included chronic conjunctival epithelial defects, scleral thinning, calcific plaques, dry eye syndrome, diplopia (sometimes requiring strabismus surgery), and elevated intraocular pressure.

Kim4 was the first to report this surgical technique for irreversible hyperemic conjunctiva (N=1815). The reported success rate in South Korea was overwhelmingly high at 94.6%. In a mean (SD) follow-up time of 12.9 (7.8) months (range, 2–27 months), less than 20% of patients required surgical revision. During this time, the most common postoperative complications included elevation in intraocular pressure (17.2%), conjunctival granuloma (8.4%), transient vision decrease (7.5%), pigment deposition (5.3%), scleral calcifications (3.9%), and diplopia secondary to conjunctival adhesions (1.6%). No permanent defects were reported, and complications improved with surgical and medical management.4

Contrary to the findings of Kim,4 a large number of complications were seen; thus, on March 4, 2011, the Korean Ministry of Health & Welfare issued a declaration to discontinue the procedure under Article 49 of the Medical Service Act. Medical records from the single clinic in Korea from November 2007 to May 2010 were reviewed.5 One of the largest reviews of cosmetic eye whitening complications reviewed 1713 patients who underwent conjunctivectomy plus topical MMC with or without bevacizumab injection. Pterygium and chronic conjunctival hyperemia were the most common diagnoses that prompted patients to undergo treatment. Over an average follow-up period of 10.9 months, the overall complication rate was 82.9%, with severe complications being fibrovascular conjunctival proliferation (43.8%), recurrent hyperemic conjunctiva (28.1%), intraocular pressure (13.1%), scleral thinning with calcified plaques (6.2%), scleral thinning (4.4%), and diplopia (3.6%). A total of 56.9% of patients reported being satisfied with the cosmetic outcome of the surgery.5

In some of the smaller case series and case reports we reviewed, more vision-threatening complications have been described. Infectious endophthalmitis, infectious scleritis, and necrotizing scleritis have all been reported as complications of cosmetic eye whitening.8,10

 

 

Comment

The pathophysiology of the complications of cosmetic eye whitening stem from the disruption of the normal conjunctiva, destruction of the vascularization to the sclera, and loss of limbal stem cells. Mitomycin C is a topical antimetabolite antibiotic agent that inhibits DNA synthesis. This relatively safe and inexpensive product has decreased the recurrence rate in pterygium surgery as early as 1963.14,15 Complications of MMC in pterygium surgery include infectious scleritis, necrotizing scleritis, calcium formation, and even scleromalacia, occurring at incidence rates as low as 1.4%.16 These risks are balanced against the medical necessity of using MMC. Given the elective nature of cosmetic eye whitening, these complications in a cosmetic setting may not be justified.

The debate of the use of this procedure continues to occur in ophthalmologic societies. Both the Korean Ministry of Health & Welfare and the American Society of Cataract Refractive Surgery do not condone the use of regional conjunctivectomy for cosmetic eye whitening.5,17 Evidence shows that complications from cosmetic conjunctivectomy can be devastating and unnecessary given its elective nature. Although some complications (eg, dry eye syndrome, pain, discomfort) may be considered mild, the number of potentially serious complications brings the usefulness of the procedure into question.

This review is a launchpad to inform the medical community of the potential downside to conjunctivectomy for cosmetic eye whitening with the hope that it can initiate meaningful risk-benefit discussions between providers and physicians.

First introduced in 2008 as a surgical treatment of chronic conjunctival injection, cosmetic eye whitening became popularized in South Korea1 and has been performed in more than 1800 patients in the United States.1-3 Individuals with healthy eyes who elect to undergo this procedure often present with concerns of hyperemia, undesirable ocular pigmentation, or pingueculas. An initial report from Kim4 described 571 patients who underwent regional conjunctivectomy for persistent irreversible hyperemic conjunctiva with a 94.6% postoperative satisfaction rate. In contrast, over the last 5 years, various reported permanent complications raised concerns of the risk-benefit ratio of this cosmetic procedure.

The procedure involves performing a localized conjunctivectomy with or without removal of the Tenon capsule.4 Brimonidine tartrate is given for vascular constriction. When conjunctivectomy is performed in the right eye, the medial conjunctiva is incised from the 2-o’clock to 5-o’clock positions and the lateral conjunctiva is incised from the 10-o’clock to 7-o’clock positions. After the conjunctiva and Tenon capsule are excised, hemostasis is achieved with electrocauterization. Postoperative management may consist of topical mitomycin C (MMC) 0.02% 4 times daily for 2 to 5 days along with topical steroids. The addition of bevacizumab 1.25 mg/mL also has been described.5

In this report, we provide a comprehensive review of the complications of cosmetic eye whitening based on a review of the literature. Clinicians in both aesthetic practice and ophthalmology should be aware of the potential complications to accurately educate their patients about the possible risks and benefits of this procedure.

Methods

A review of PubMed articles indexed for MEDLINE (January 2009 to July 2017) using the search terms cosmetic eye whitening, cosmetic wide conjunctivectomy, I-Brite, and chronic hyperemic conjuctiva was conducted to evaluate the number of reports of complications from cosmetic eye whitening. A total of 10 articles were included in the study based on a review of abstracts. Non–English-language abstracts were not reviewed.

Results

Based on a review of 10 articles commenting on the complications of cosmetic eye whitening, a total of 2400 patients had undergone a cosmetic conjunctivectomy with various postoperative complications and recurrences (Table).4-13 The most commonly recurring complications based on the reported frequencies in the articles included chronic conjunctival epithelial defects, scleral thinning, calcific plaques, dry eye syndrome, diplopia (sometimes requiring strabismus surgery), and elevated intraocular pressure.

Kim4 was the first to report this surgical technique for irreversible hyperemic conjunctiva (N=1815). The reported success rate in South Korea was overwhelmingly high at 94.6%. In a mean (SD) follow-up time of 12.9 (7.8) months (range, 2–27 months), less than 20% of patients required surgical revision. During this time, the most common postoperative complications included elevation in intraocular pressure (17.2%), conjunctival granuloma (8.4%), transient vision decrease (7.5%), pigment deposition (5.3%), scleral calcifications (3.9%), and diplopia secondary to conjunctival adhesions (1.6%). No permanent defects were reported, and complications improved with surgical and medical management.4

Contrary to the findings of Kim,4 a large number of complications were seen; thus, on March 4, 2011, the Korean Ministry of Health & Welfare issued a declaration to discontinue the procedure under Article 49 of the Medical Service Act. Medical records from the single clinic in Korea from November 2007 to May 2010 were reviewed.5 One of the largest reviews of cosmetic eye whitening complications reviewed 1713 patients who underwent conjunctivectomy plus topical MMC with or without bevacizumab injection. Pterygium and chronic conjunctival hyperemia were the most common diagnoses that prompted patients to undergo treatment. Over an average follow-up period of 10.9 months, the overall complication rate was 82.9%, with severe complications being fibrovascular conjunctival proliferation (43.8%), recurrent hyperemic conjunctiva (28.1%), intraocular pressure (13.1%), scleral thinning with calcified plaques (6.2%), scleral thinning (4.4%), and diplopia (3.6%). A total of 56.9% of patients reported being satisfied with the cosmetic outcome of the surgery.5

In some of the smaller case series and case reports we reviewed, more vision-threatening complications have been described. Infectious endophthalmitis, infectious scleritis, and necrotizing scleritis have all been reported as complications of cosmetic eye whitening.8,10

 

 

Comment

The pathophysiology of the complications of cosmetic eye whitening stem from the disruption of the normal conjunctiva, destruction of the vascularization to the sclera, and loss of limbal stem cells. Mitomycin C is a topical antimetabolite antibiotic agent that inhibits DNA synthesis. This relatively safe and inexpensive product has decreased the recurrence rate in pterygium surgery as early as 1963.14,15 Complications of MMC in pterygium surgery include infectious scleritis, necrotizing scleritis, calcium formation, and even scleromalacia, occurring at incidence rates as low as 1.4%.16 These risks are balanced against the medical necessity of using MMC. Given the elective nature of cosmetic eye whitening, these complications in a cosmetic setting may not be justified.

The debate of the use of this procedure continues to occur in ophthalmologic societies. Both the Korean Ministry of Health & Welfare and the American Society of Cataract Refractive Surgery do not condone the use of regional conjunctivectomy for cosmetic eye whitening.5,17 Evidence shows that complications from cosmetic conjunctivectomy can be devastating and unnecessary given its elective nature. Although some complications (eg, dry eye syndrome, pain, discomfort) may be considered mild, the number of potentially serious complications brings the usefulness of the procedure into question.

This review is a launchpad to inform the medical community of the potential downside to conjunctivectomy for cosmetic eye whitening with the hope that it can initiate meaningful risk-benefit discussions between providers and physicians.

References
  1. Kim BH. Cosmetic eye whitening. Poster presented at: American Society of Cataract and Refractive Surgery; April 4-9, 2008; Chicago, IL.
  2. Kim BH. Cosmetic eye whitening by regional conjunctivectomy. Poster presented at: European Society of Cataract & Refractive Surgeons; September 13-17, 2008; Berlin, Germany.
  3. Raiskup F, Solomon A, Landau D, et al. Mitomycin C for pterygium: long term evaluation. Br J Ophthalmol. 2004;88:1425-1428.
  4. Kim BH. Regional conjunctivectomy with postoperative mitomycin C to treat chronic hyperemic conjunctiva. Cornea. 2012;31:236-244.
  5. Lee S, Go J, Rhiu S, et al. Cosmetic regional conjunctivectomy with postoperative mitomycin C application with or without bevacizumab injection [published online April 6, 2013]. Am J Ophthalmol. 2013;156:616-622.
  6. Rhiu S, Shim J, Kim EK, et al. Complications of cosmetic wide conjunctivectomy combined with postsurgical mitomycin C application. Cornea. 2012;31:245-252.
  7. Kwon HJ, Nam SM, Lee SY, et al. Conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy. Cornea. 2013;32:821-825.
  8. Leung TG, Dunn JP, Akpek EK, et al. Necrotizing scleritis as a complication of cosmetic eye whitening procedure. J Ophthalmic Inflamm Infect. 2013;3:39.
  9. Shin HY, Kim MS, Chung SK. The development of scleromalacia after regional conjunctivectomy with the postoperative application of mitomycin C as an adjuvant therapy. Korean J Ophthalmol. 2013;27:208-210.
  10. Vo RC, Stafeeva K, Aldave AJ, et al. Complications related to a cosmetic eye-whitening procedure. Am J Ophthalmol. 2014;158:967-973.
  11. Moshirfar M, McCaughey MV, Fenzl CR, et al. Delayed manifestation of bilateral scleral thinning after I-BRITE® procedure and review of literature for cosmetic eye-whitening procedures. Clin Ophthalmol. 2015;9:445-451.
  12. Jung JW, Kwon KY, Choi DL, et al. Long-term clinical outcomes of conjunctival flap surgery for calcified scleromalacia after periocular surgery. Cornea. 2015;34:308-312.
  13. Saldanha MJ, Yang PT, Chan CC. Scleral thinning after I-BRITE procedure treated with amniotic membrane graft. Can J Ophthalmol. 2016;51:e115-e116.
  14. Seiler T, Schnelle B, Wollensak J. Pterygium excision using 193-nm excimer laser smoothing and topical mitomycin C. Ger J Ophthalmol. 1992;1:429-431.
  15. Singh G, Wilson MR, Foster CS. Long-term follow-up study of mitomycin eye drops as adjunctive treatment of pterygia and its comparison with conjunctival autograft transplantation. Cornea. 1990;9:331-334.
  16. Lam DS, Wong AK, Fan DS, et al. Intraoperative mitomycin C to prevent recurrence of pterygium after excision: a 30-month follow-up study. Ophthalmology. 1998;105:901-904; discussion 904-905.
  17. ASCRS Cornea Clinical Committee. Clinical alert: eye-whitening procedure: regional conjunctivectomy with mitomycin-C application [press release]. Fairfax, VA: American Society of Cataract and Refractive Surgery. http://www.ascrs.org/node/1352. Accessed January 22, 2015.
References
  1. Kim BH. Cosmetic eye whitening. Poster presented at: American Society of Cataract and Refractive Surgery; April 4-9, 2008; Chicago, IL.
  2. Kim BH. Cosmetic eye whitening by regional conjunctivectomy. Poster presented at: European Society of Cataract & Refractive Surgeons; September 13-17, 2008; Berlin, Germany.
  3. Raiskup F, Solomon A, Landau D, et al. Mitomycin C for pterygium: long term evaluation. Br J Ophthalmol. 2004;88:1425-1428.
  4. Kim BH. Regional conjunctivectomy with postoperative mitomycin C to treat chronic hyperemic conjunctiva. Cornea. 2012;31:236-244.
  5. Lee S, Go J, Rhiu S, et al. Cosmetic regional conjunctivectomy with postoperative mitomycin C application with or without bevacizumab injection [published online April 6, 2013]. Am J Ophthalmol. 2013;156:616-622.
  6. Rhiu S, Shim J, Kim EK, et al. Complications of cosmetic wide conjunctivectomy combined with postsurgical mitomycin C application. Cornea. 2012;31:245-252.
  7. Kwon HJ, Nam SM, Lee SY, et al. Conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy. Cornea. 2013;32:821-825.
  8. Leung TG, Dunn JP, Akpek EK, et al. Necrotizing scleritis as a complication of cosmetic eye whitening procedure. J Ophthalmic Inflamm Infect. 2013;3:39.
  9. Shin HY, Kim MS, Chung SK. The development of scleromalacia after regional conjunctivectomy with the postoperative application of mitomycin C as an adjuvant therapy. Korean J Ophthalmol. 2013;27:208-210.
  10. Vo RC, Stafeeva K, Aldave AJ, et al. Complications related to a cosmetic eye-whitening procedure. Am J Ophthalmol. 2014;158:967-973.
  11. Moshirfar M, McCaughey MV, Fenzl CR, et al. Delayed manifestation of bilateral scleral thinning after I-BRITE® procedure and review of literature for cosmetic eye-whitening procedures. Clin Ophthalmol. 2015;9:445-451.
  12. Jung JW, Kwon KY, Choi DL, et al. Long-term clinical outcomes of conjunctival flap surgery for calcified scleromalacia after periocular surgery. Cornea. 2015;34:308-312.
  13. Saldanha MJ, Yang PT, Chan CC. Scleral thinning after I-BRITE procedure treated with amniotic membrane graft. Can J Ophthalmol. 2016;51:e115-e116.
  14. Seiler T, Schnelle B, Wollensak J. Pterygium excision using 193-nm excimer laser smoothing and topical mitomycin C. Ger J Ophthalmol. 1992;1:429-431.
  15. Singh G, Wilson MR, Foster CS. Long-term follow-up study of mitomycin eye drops as adjunctive treatment of pterygia and its comparison with conjunctival autograft transplantation. Cornea. 1990;9:331-334.
  16. Lam DS, Wong AK, Fan DS, et al. Intraoperative mitomycin C to prevent recurrence of pterygium after excision: a 30-month follow-up study. Ophthalmology. 1998;105:901-904; discussion 904-905.
  17. ASCRS Cornea Clinical Committee. Clinical alert: eye-whitening procedure: regional conjunctivectomy with mitomycin-C application [press release]. Fairfax, VA: American Society of Cataract and Refractive Surgery. http://www.ascrs.org/node/1352. Accessed January 22, 2015.
Issue
Cutis - 100(3)
Issue
Cutis - 100(3)
Page Number
E24-E26
Page Number
E24-E26
Publications
Cutis
MDedge Dermatology
Publications
Cutis
MDedge Dermatology
Topics
Aesthetic Dermatology
Article Type
Article
Display Headline
Complications of Cosmetic Eye Whitening
Display Headline
Complications of Cosmetic Eye Whitening
Sections
For Residents
Inside the Article

Resident Pearl

  • Cosmetic eye whitening has severe and vision-threatening complications that should be aware to all cosmetic surgeons.
Disallow All Ads
Content Gating
No Gating (article Unlocked/Free)
Alternative CME
Disqus Comments
Default
Use ProPublica
Teaser Media
Article PDF Media
Subscribe to Catherine Hoeppner, BS