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ARTICLES
Year : 1982  |  Volume : 30  |  Issue : 4  |  Page : 281-284

Evaluation of a new polishing technique in surgery of primary pterygium


Guru Gobind Singh International Eye Centre; New Delhi, India

Correspondence Address:
Gurbax Singh
Guru Gobind Singh international Eye Centre: Bank Street, KarolBagh, New Delhi-110005
India
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Source of Support: None, Conflict of Interest: None


PMID: 7166406

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How to cite this article:
Singh G, Rana R K. Evaluation of a new polishing technique in surgery of primary pterygium. Indian J Ophthalmol 1982;30:281-4

How to cite this URL:
Singh G, Rana R K. Evaluation of a new polishing technique in surgery of primary pterygium. Indian J Ophthalmol [serial online] 1982 [cited 2020 Jun 1];30:281-4. Available from: http://www.ijo.in/text.asp?1982/30/4/281/29450

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Table 1

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Table 1

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Inspite of great advancements in the field of ophthalmic surgery, pterygium is still a challenge to the ophthalmic surgeons. The success in pterygium-surgery is marred by its high rate of recurrence. Though the pterygium has been incised, removed, split, excised transplated coagulated and irradiated but still there is no single operation which is an ideal one. The aim of the present study was to evaluate the standard-surgical techniques of bare-sclera and bare-sclera followed by betaradiations with the new polishing technique modified after Barraquer.[1]


  Materials and methods Top


Seventy-two cases of primary pterygia were selected for the present study. The ocular examination was done with the help of a torch and loupe examination and the findings were confirmed on slit-lamp. All these cases were operated and followed up regularly every fort­night for first 3 months, every month for 3 months and then every 3 months interval till the period of 12 months-15 months. These cases were divided into 3 groups as follows:­

Group - 1 Baresclera technique (D'ombrain's method) - 18 cases.

Group - 2 Baresclera Technique with post operative supplementation of beta­radiations in a single dose of 2000

rads immediately after operation­18 cases.

Group - 3 Polishing technique modified after Barraquer (1965) 18 cases.

Group - 4 Polishing Technique supplemented with Betaravs-18 cases.


  Anaesthesia Top


4% Lignocaine hydrochloride drops were instilled into conjunctive alsac and the facial block was given (O'brian's technique) with 2% Lignocaine hydrochloride. The eye was cleaned, draped and local infiltration of 2% Lignocaine hydrochloride was done into the body of pterygium.


  Steps of polishing technique Top


The head of pterygium was separated from the cornea by Gill's corneal knife starting from the apex. A superficial keratectomy was done with minimal possible trauma to cornea.

The pterygium was lifted and separated from the sclera till the insertion of the medi­al rectus muscle

The subconjuncttval tissue was undermined from the overlying conjunctival -epithelium

back to plica-semilunaris.

The thick triangular piece of subconjuncti val tissue was excised in a larger area than the one occupied by the pterygium. The apex of pterygium was excised and the cut edges of the conjunctive were allowed to retract.

The burr was mounted on the rotor. The instrument was switched on and applied to cornea, bare-area of sclera and limbus, keeping it vertical, so as to rub-off all the remnants attached to these areas. As a result the surfa­ce gets polished and becomes smooth and regular. All the bleeding points were checked with heat-ceutery.

Undermining of the conjunctival edges was done and the cut edge of the conjunctiva was sutured to superficial layers of sclera with the help of three sutures of 0000 virgin-silk. Oxyte­tracycline hydrochloride ophthalmic ointment was put in the conjunctival sac and pad and bandage applied. Post operative treatment in the form of Betamethason 0.1% with Neomycin 0.5% drops four times a day were given to every case for a period of 3 weeks.

The sutures were removed on seventh day and the pad discontinued. These cases were followed up regularly.

Beta radiation was given to the cases upto 2 GOO reps after the completion of polishing technique using strontium 90 as radio active source.

The cases which showed invasion of cornea either by blood vessels or by conjunctive when seen under magnification were labelled as recurrences. However, those cases which showed thickening and vascularisation of con­junctiva in the interpalpebral area without the encroachment of cornea were labelled as con­junctival recurrences[2].


  Observations Top


They are recorded in [Table - 1][Table - 2].


  Discussion Top


The recurrence rate of pterygium with Bare sclera technique was found to be 50% in the present study. A high success rate had been reported by a number of authors[3],[4],[5],[6] Youn­gson[7] reported a 37% recurrence in a series of 100 patients in the first few weeks following surgery. Youngson advocated that no surgery­should be done in cases of pterygium for cosme­tic indication. A recurrence rate of 50-60% has been reported with the have sclea techni­que [2],[8],[9] sub The wide discrepancy in the results of different techniques in the pterygium- surgery perhaps can be explained by varied opinions as to what constitutes a recurrence and the duration of follow up.[2] In the present series, cases which showed invasion of cornea either by subconjunctival tissue were labelled as recurrences. The cases were labelled as successful if there was not corneal encroach­ment after 6 months of operation.

The recurrence rate of bare sclera technique followed by beta radiations was found to be 27.8% in the present series. Low recurrence in the range of 1%-6% had been reported in lite­rature.[10] However these authors used the beta­radiations in the dose 2,500 rads. 5000 rads, and reported various side effects like punctate­keratitis, telengiactasis and keratinisation of conjunctiva, damage of cornea and sclera, lens

opacities and vascularisation of cornea. How­ever authors who have used beta radiations in the range of 1000-2200 rads reported recu­rrence in the range of 16% to 35%[2],[4] Cameron[2] reported 35% conjunctival recurrence in addition to 16% corneal-recurrence.

The recurrence rate of the Polishing techni­que in the present series was found to be 22.2% The results obtained with Polishing technique were better than the other methods on the present series, with no complications.

In the 4th Group where polishing technique was combined with betaradiation at time of operation, a 100% success rate was achieved. This concludes that pterygium should be treated best with polishing and beta-radiations. The surgical principles of the polishing technique are based on Dallen's theory which explains the etiopathogenesis of pterygium[11],[12]. The factors which contribute to the higher success rate are a regular and smooth surface keratectomy, the smooth and regular paralimbal bare area of sclera (c. f. to bare sclera technique in which the deep keratectomy and the bare area of sclera have irregular surface consisting of micro elevations and depressions, leading to the formation of dallens thus triggering of the recurrence) and excisions of thick subconjunctival tissue in a larger area than the one occu­pied by the pterygium. The suturing of conjun­ctive to the superficial layers of sclera results in a firm adhesion of the conjunctiva to the sc­lera and thus preventing the growth of under­lying subconjunctival tissue.

The polishing technique is simple to perform with better results in the therapy of primary pterygium. As it gives better cosmetic appearance and least incidence of recurrences. The application of beta radiation at time of surgery further enhances the success rate as it retard the growth of newly forming cells.


  Summary Top


This study comprised of 72cases of primary pterygium, (bare-sclera-18 cases, bare-sclera with beta-radiations - 18 cases a new polishing technique - 18 cases and polishing technique with beta-ardiation - 18 cases) the cases were followed up for a period of 12-24 months. The success rates were found to be 50% in bare sclera technique, 72.2% in bare-sclera technique with beta-radiations 77.8% in the Polishing technique and 100% with polishing com­bined with beta-radiation. The Period after which recurrence took place is shown in [Table - 1]. The cosmetic appearance with polishing technique was better than other. The post operative complications seen were least with this technique [Table - 2]. The authors recommend this as the best and safe in cases of primary pterygium.

 
  References Top

1.
Barraquer, J. 1. Enrique Ariza, Salomon Reino­so, Angelica Dim-,], Carlos Penarnda, 1965, Archives of Society of American Oftal Optom. 5:99.  Back to cited text no. 1
    
2.
Cameron, M. C., 1965 , 'Pterygium throughout the world' Charles C. Thomas.  Back to cited text no. 2
    
3.
D, Ombrain, 1948 , Brit. J. Ophthalmol. 32:65   Back to cited text no. 3
    
4.
King, J. H. R., 1950 , Arch. Ophthalmol, 44: 854.  Back to cited text no. 4
    
5.
Gibson, W., 1953 , quoted by Cameron, 1965 Pterygium throughout the world.  Back to cited text no. 5
    
6.
Bernstin, M, 1960 , Amer. J. Ophthalmol, 49:1024.  Back to cited text no. 6
    
7.
Youngson, R. M., 1972 ; Brit. J. Ophthalmol, 56 : 120.  Back to cited text no. 7
    
8.
Liddy, B., St. L. Morgan, John F, 1966 , Amer, J. Ophthalmol. 61:888.  Back to cited text no. 8
    
9.
Zauberman, Han, 1967 , Amer. J. Ophthalmol, 63 : 1780.  Back to cited text no. 9
    
10.
Lentino, W. Zaret M., 1959, Amer. J. Roentganology and Radium Therapy and Nuclear Medicine, 81:93.  Back to cited text no. 10
    
11.
Barraquer, M. J. 1., 1965, Ophthalmologics (Basel) 120:111.  Back to cited text no. 11
    
12.
Paton, David, 1975, Trans of Amer. Soc. Ophthalmol. 79:603.  Back to cited text no. 12
    



 
 
    Tables

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  In this article
Materials and me...
Anaesthesia
Steps of polishi...
Observations
Discussion
Summary
References
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