|Year : 1982 | Volume
| Issue : 4 | Page : 281-284
Evaluation of a new polishing technique in surgery of primary pterygium
Gurbax Singh, RK Rana
Guru Gobind Singh International Eye Centre; New Delhi, India
Guru Gobind Singh international Eye Centre: Bank Street, KarolBagh, New Delhi-110005
Source of Support: None, Conflict of Interest: None
|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
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.
| Materials and methods|| |
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|| |
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|| |
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.
| Observations|| |
They are recorded in [Table - 1][Table - 2].
| Discussion|| |
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,,, Youngson 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 ,, 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. 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. 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%, Cameron 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,. 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|| |
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|| |
Barraquer, J. 1. Enrique Ariza, Salomon Reinoso, Angelica Dim-,], Carlos Penarnda, 1965, Archives of Society of American Oftal Optom. 5:99.
Cameron, M. C., 1965 , 'Pterygium throughout the world' Charles C. Thomas.
D, Ombrain, 1948 , Brit. J. Ophthalmol. 32:65
King, J. H. R., 1950 , Arch. Ophthalmol, 44: 854.
Gibson, W., 1953 , quoted by Cameron, 1965 Pterygium throughout the world.
Bernstin, M, 1960 , Amer. J. Ophthalmol, 49:1024.
Youngson, R. M., 1972 ; Brit. J. Ophthalmol, 56 : 120.
Liddy, B., St. L. Morgan, John F, 1966 , Amer, J. Ophthalmol. 61:888.
Zauberman, Han, 1967 , Amer. J. Ophthalmol, 63 : 1780.
Lentino, W. Zaret M., 1959, Amer. J. Roentganology and Radium Therapy and Nuclear Medicine, 81:93.
Barraquer, M. J. 1., 1965, Ophthalmologics (Basel) 120:111.
Paton, David, 1975, Trans of Amer. Soc. Ophthalmol. 79:603.
[Table - 1], [Table - 2]