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ARTICLES
Year : 1971  |  Volume : 19  |  Issue : 2  |  Page : 82-84

Role of Hyaluronidase (Hyalase) in management of pterygium


Kanpur Eye Hospital, Kanpur, India

Correspondence Address:
Rajendra Rohatgi
Kanpur Eye Hospital, Kanpur
India
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Source of Support: None, Conflict of Interest: None


PMID: 15744976

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How to cite this article:
Rohatgi R, Rohatgi R, Trivedi L K. Role of Hyaluronidase (Hyalase) in management of pterygium. Indian J Ophthalmol 1971;19:82-4

How to cite this URL:
Rohatgi R, Rohatgi R, Trivedi L K. Role of Hyaluronidase (Hyalase) in management of pterygium. Indian J Ophthalmol [serial online] 1971 [cited 2020 Apr 2];19:82-4. Available from: http://www.ijo.in/text.asp?1971/19/2/82/34985

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Pterygium is very common in the tropics. This seems to be so because of improper nutrition in the poorer classes of people and prevalence of local irritating fac­tors to the eye such as tropical sun, dusty dry season and occupa­tion in the open fields. Since pterygium and its recurrence are the constant problems in the tro­pics and there is acute shortage of hospital beds and technical man power in a country like ours it was felt that development of non surgical treatment should be of value in the management of this condition. Carriker[1] and others have observed beneficial effect of Hyaluronidase (Hyalase) in early cases of pterygium.

Meyer and Palmer[3] were the first to isolate the main intercellu­lar substance, Hyaluronic acid. Duphie and Chain [2] demonstrated that the enzyme Hyaluronidase liquified the tissue cementing sub­stance, Hyaluronic acid. This occurs by the depolymerisation of Hyaluronidase through hydrolysis of the linkages with the decrease in the viscosity of the polysaccha­ride, Hyaluronic acid, allowing more rapid spread of fluds through the connective tissue.

The action of Hyaluronidase is reversible with complete restora­tion of the intercemeting substance in 24 hours. The enzyme presents no toxicity and in our experience no allergic manifesta­tions have been noted.

Stimulated from the publica­tions and encouraged with initial personal observations it was de­cided to conduct a systemetic study with Hyalase in pterygium at Kanpur Eye Hospital. Annu­ally 50,000 patients are treated in the out door and 2,000 in the in­door with various disorders of the eye. Pterygium is commonly met in these patients in this part of the country. The purpose of this communication is to state our ob­servations with this product.


  Method and Material Top


Cases of pterygium were collec­ted from the outpatient depart­ment and examined thoroughly by oblique illumination and slit lamp examination and vision tested. Special note was made of the occupation, age, sex and dura­tion of symptoms. The cases were grouped in the following five groups:

Group 1 - Small fleshy vascular growth (Early pterygium).

Group 2 - Fleshy and vascular growth extending on to the cornea (Progressive ptery­gium).

Group 3 - Dense fibrous growth (Non-progressive pterygium).

Group 4 - Rapid fleshy vascular growth extending on to the cornea (Malignant ptery­gium).

Group 5 - Recurrent pterygium 30 cases of each group were studied.

Method:

1 ampoule of Hyalase was dis­solved in 2 cc of distilled water. 0.25 cc of this solution was taken with 0.1 cc of 1 % Novocaine in the syringe and subconjunctival injection given at the neck of pterygium twice a week with 25 gauge needle pointing away from the limbus with subsequent balooning of the pterygium away from the sclera.

6 injections were given in each case.

Results:

In our series males comprised of more than 2/3rd of the total number of patients studied (107 males to 43 females). 70% of the patients were in the age group of 21 to 50 years [Table - 2]. Inte­restingly 81% were in the occupa­tion which exposed them to re­current local irritation [Table - 3]. This was consistent with the the­sis that pterygium is more com­mon in people exposed to outdoor dusty work.

[Table - 4] narrates the outcome of the 5 groups of pterygium after use of Hyalase.


  Discussion Top


In tropical countries where pterygium is more common in poorer class of people, various methods have been applied while operating mainly to avoid recur­rence. Its recurrence is a problem both for patients and surgeons.

We have found use of Hyalase by the above technique useful in early cases of pterygium. In 80 of such cases the growth comple­tely disappeared and the conjun­ctiva returned to normal. In progressive pterygium also the pterygium became pale and vessels got reduced in size in 60% cases. In 70% cases with malig­nant pterygium we observed change in the growth and reduc­tion in the flesh and vascularisa­tion, but the drug was ineffective in dense and fibrous pterygiums.

We did not encounter any mor­bidity or adverse effects in any of these patients.


  Summary Top


150 cases of pterygium were studied after use of Hyaluronidase (Hyalase). Six bi-weekly injec­tions of 0.25 cc of Hyaluronidase with 0.1 cc of 1% Novocaine solu­tion were given at the neck of the pterygium. The drug was found to be of definite value in early cases of pterygium with disappea­rance of growth in 80% of the cases. Progressive and malignant pterygiums showed diminution in size and vascularisation in 60 and 70 67o cases respectively.


  Acknowledgment Top


We are grateful to Dr. S. Agar­wala of Tata Fison Industries Limited for providing the finan­cial assistance and drugs for this study.

 
  References Top

1.
CARRICKER, F. R.: "The Use of Hyaluronidase in Ophthalmology" Amer. J. of Ophthal. (1952) 35, 1765.  Back to cited text no. 1
    
2.
DUTHIE. S., CHAIN, E.: "A muco lityc enzyme in testis extracts" Nathure (1939) 9th Dec. p. 977.  Back to cited text no. 2
    
3.
MEYER, K. AND PALMER, J.: "The Polysacccharide of the vitre­ous humour J. Biol. Chem. (1934), 629, 107.  Back to cited text no. 3
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]



 

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