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ARTICLES
Year : 1973  |  Volume : 21  |  Issue : 2  |  Page : 78-79

Sudden amblyopia following hyaluronidase (hyalase) in a case of early pterygium. A case report


Department of Ophthalmology, Medical College, Aurangabad, India

Correspondence Address:
D L Maria
Department of Ophthalmology, Medical College, Aurangabad
India
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Source of Support: None, Conflict of Interest: None


PMID: 4789116

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How to cite this article:
Maria D L, Panse A D. Sudden amblyopia following hyaluronidase (hyalase) in a case of early pterygium. A case report. Indian J Ophthalmol 1973;21:78-9

How to cite this URL:
Maria D L, Panse A D. Sudden amblyopia following hyaluronidase (hyalase) in a case of early pterygium. A case report. Indian J Ophthalmol [serial online] 1973 [cited 2020 May 28];21:78-9. Available from: http://www.ijo.in/text.asp?1973/21/2/78/31406

The treatment of pterygium has always been a problem because of high rate of recurrence even after second or third excision. Beta-rays applica­tion is being used in the ones that recur. There has been a growing need and desire on the part of the surgeons to tackle it by some medicinal approach because of high rate of failure after surgery.

Thiotepa an antimitotic agent has been used extensively but without encouraging results. Some people like CARRIKER, [1] SHUKLA [4] and ROHATGI et al [3] have claimed beneficial effects by the injection of Hyaluronidase (Hyalase) in early pterygium, though Sir Duke Elder [2] has said that these claims are founded on hopes than on fact with reference to Carriker' [1] report.

The main action of Hyalase is its spreading effect by hydrolysing and depolymerising hyaluronic acid.

After constant propaganda by Tata Fison regarding its utility in pterygium and with reference to the work of the above mentioned authors, I decided to try this in early pterygium but a severe side effect was observed in the very first case hence this is being reported.


  Case Report Top


A young doctor aged 26 years came to the hospital on 10th April 1972 for the treatment of early pterygium in the right eye on the medical side of the cornea in the palpeberal fissure. The examination revealed everything normal in both eyes except a very small pterygium just touching the limbus. The vision was 6/5 in both the eyes. The fundus was normal. It was decided to inject 0.3 ml. of Hyalase dissolved in I cc of 2% xylocain, in the apex of the pterygium. The injection was given on 11th April 1972 and pad and bandage was applied for four hours. On the same evening the patient visited the department with painful movements of the eyeball and misty vision. He had himself taken novalgin already. There was a slight conjunctival congestion due to the injection.

The patient was called next day for detailed examination. The vision had gone down to 6 / 1'60 and the fundus showed slight hyperaemia of the disc with retinal oedema localized to macular region. It was decided to watch the progress for one or two days more. On 14th April 1972 the vision was the same but oedema of the retina had increased in extent.

Now the patient was put on prednisolone 40 mg a day with an antihistaminic, (Foristal) one tablet twice a day and cortisone drops locally. The prednisolone was taper­ed every 6th day by 10 mg. On 5 th May 72, his vision improved to 6/9 and on 8th May 72, the vision was restored to 6/6 with fundus completely normal. Surprisingly the pterygium also disappeared more or less completely.


  Discussion Top


Pterygium being a problem for treatment, people have been trying to find out some medicinal treatment. Drugs like Thioepa in the form of drops and hyalase in the form of sub­conjunctival injections have been tried with variable results. ROHATGI [3] et al and SHUKLA [4] et al tried in 50 cases with good results in early pterygium but without a single side effect. In this case with the first injection retinal oedema with slight hyperaemia of the disc took place, which may be due to impuritis in the enzyme, but the pterygium disappear­ed more or less completely even with one injection.


  Summary Top


A young patient with early ptery­gium who was given hyalase 0.3 ml dissolved in 1 ml of 2% xylocain developed retinal oedema with hyperaemia of the disc, with marked diminution of vision, but complete recovery took place with corticosteriod and antihistaminic therapy.

 
  References Top

1.
Carriker F. R.: Quoted by Sir Duke Elder in 2, 1962.  Back to cited text no. 1
    
2.
Sir Duke Elder: System of Ophth. Vol. VII page 718-19. Henry Kimpton London. (1962).  Back to cited text no. 2
    
3.
Rohatgi et al: Role of Hyaluronidase (Hyalase) in the management of pterygium, Indian Journal of Ophthalmology, 19: 82-84, (1971).   Back to cited text no. 3
    
4.
Shukla and Raizada: Orient Arch. of Ophthalmology 160-61, 1964.  Back to cited text no. 4
    




 

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