|Year : 1957 | Volume
| Issue : 1 | Page : 11-14
Results of beta ray therapy
Department of Ophthalmology, Eye Infirmary, Medical College, Calcutta, India
|Date of Web Publication||9-May-2008|
Department of Ophthalmology, Eye Infirmary, Medical College, Calcutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sengupta M. Results of beta ray therapy. Indian J Ophthalmol 1957;5:11-4
Radioactive substances emit alpha, beta and gamma rays and of them gamma rays have the highest penetrating power. Beta rays have low penetration and so their ionising effect is best marked in the superficial tissues. For therapeutic purposes beta rays are therefore suitable for superficial diseases of the eye as they do not penetrate deeper to damage the intraocular structures particularly the lens. Due to greater penetration gamma rays have limited use in ocular diseases. Beta irradiations have been reported (Sen, 1954) to produce good results in vernal conjunctivitis, recurent pterygium, phlyctenular keratitis, rosacea keratitis, nodular episcleritis, corneal vascularisation particularly after lime and other chemical burns and papilloma and haemangioma of the conjunctiva or skin of the lid. In some other eye conditions like resistant chronic corneal ulcers (Mooren's ulcer, herpetic ulcer), sclerokeratitis, Bowen's disease, vascularised leucoma etc. beta therapy has been found to have some therapeutic action.
In ophthalmology beta irradiation is done by contact therapy from a surface applicator and the usual source for such a medical applicator is Strontium 90.
In the Eye Infirmary, Medical College. Calcutta, Strontium 90 Beta ray applicator is being used since 1954. The applicator has an output of 42 rep per second and the diameter of the contact surface is about 12.7 m.m. The applicator is kept clean in its box and before use its contact surface is soaked in rectified spirit and wiped with sterile gauze to dry its surface. The patients' eyes are anaesthetised with one or two drops of amethocain solution and where necessary a speculum is inserted to retract the eye lids. Each course of therapy consists of exposures of 10 to 20 seconds twice per week till the required dosages are given. Upto December 1956 altogether 85 eyes were treated with beta irradiation for various types of ocular diseases and their results are given below:
| Assessment of Clinical Results|| |
Out of 85 eyes treated 55 eyes had vernal conjunctivitis, 15 treated for palpebral condition and 40 for bulbar condition. Vernal conjunctivitis responds well with beta therapy and of the two types the bulbar type has better results. Symptoms disappear in 2 to 3 months time but the proliferative growths take some time to disappear. The palberal type is more refractile and may require two or more exposures before complete disappearance.
Seven out of 8 cases of recurrent pterygium following operation had good results with beta therapy. In the other case the progress of pterygium appeared to be checked in the short period of follow up.
Beta irradiation was also found to have beneficial effect in rosacea keratitis and phlyctenular keratitis with marked vascularisation though the number of cases so treated was small. Beta ray therapy did not have any effect on 8 cases of Mooren's ulcer. It could neither check the progress of the ulcer nor alter the course of the disease. In corneal vascularisation beta therapy was effective in 2 out of 8 cases. In 4 cases of long standing vascularisation of dense leucoma (corneal scar) beta therapy failed to obliterate the vessels. In 1 case of vascularised keratitis Mantaux in which the reaction was positive in l in 1,00,000, beta irradiation not only failed but produced complications. In 3 cases of haemangioma of bulbar conjunctiva and in 1 case of h emangioma of skin of the lid, the effect of beta therapy could not be assessed as the follow up period is too short.
| Complication of Beta Irradiation|| |
Sixty-two out of 85 cases had total dosage varying between 3200-4800 rep., twenty-two cases had 6000-8000 rep. and 1 case had 19,200 rep. Maximum period of follow up is 21 years. Therefore in this series the average dosage in a large number of cases was not high and the follow up period was not long enough to evaluate the late effects of beta irradiation. However one case of corneal vascularisation with keratitis (where Mantaux test was strongly positive) requires special mention. After exposure with total dosage of 3200 rep. as the condition did not show any improvement within 4 months locally cortisone drops 0.5% drop was used for I week followed by a second course of beta radiation of 3200 rep. Immediately following the irradiation an acute punctate corneal ulcer appeared in the central part of the cornea followed later on by the formation of a keratocele. With the usual treatment the keratocele healed up but the corneal vascularisation never disappeared. On the other hand limbal vessels showed telengiectic dilatation. The only case which had total dosage of 19,200 rep. was the palpebral type of vernal conjunctivitis. After irradiation there was scarring of the palpebral conjunctiva but even with such a high dosage all the follicles did not disappear.
| Discussion|| |
Results of beta radiation in vernal conjunctivitis, recurrent pterygium, rosacea keratitis, phlyctenular keratitis in the present series of cases confirm the good results already obtained by other workers. Mooren's ulcer and vascularised old leucoma failed to show any therapeutic effect though favourable results have been reported by Lederman (1956). Complications of irradiation like telengiectasis, keratinization of the conjunctiva, superficial punctate keratitis, corneal scarring. atrophy of the sclera, atrophy of the ciliary body with hypotony, iritis, iris atrophy, secondary glaucoma, radiational cataract etc. as described as late effects of beta radiation (Merriam 1955) did not occur (excepting in 1 case), but the dosage used was not high and the period of follow up is not yet 5 years.
I take this opportunity to thank Mrs. Watumull of Watumull Foundation, Honolulu. Hawaii, for presenting the Strontium 90 Beta Ray Applicator to the Eye Infirmary, Medical College, Calcutta and Dr. John Holmes (Honolulu), through whose efforts the application was presented.
| Summary|| |
Results of beta ray therapy on 85 eyes are described. Of them 55 eyes had vernal conjunctivitis. 8 recurrent pterygium, 8 Mooren's ulcer, 8 corneal vascularisation. 3 haemangioma of conjunctiva, 1 haemangioma of skin of the lid, 1 rosacea keratitis and 1 phlyctenular keratitis. One case got a corneal ulcer after beta radiation.
| References|| |
Lederman, M. (1956). Brit. J. Radiol. 29, 1-13.
Merriam, George R. (1955), Arch. Ophthal., 53, 708.
Sen. K. L. (1954), J. of I.M.A., 23, 396-398.
[Table - 1]