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Year : 1972  |  Volume : 20  |  Issue : 4  |  Page : 171-172

Recurrence of pterygium. Review of 135 cases-excision technique


Department of Ophthalmology, Christian Medical College, Vellore-2, India

Correspondence Address:
M S Quraishy
Department of Ophthalmology, Christian Medical College, Vellore-2
India
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Source of Support: None, Conflict of Interest: None


PMID: 4671309

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How to cite this article:
Quraishy M S, Ebenezer R. Recurrence of pterygium. Review of 135 cases-excision technique. Indian J Ophthalmol 1972;20:171-2

How to cite this URL:
Quraishy M S, Ebenezer R. Recurrence of pterygium. Review of 135 cases-excision technique. Indian J Ophthalmol [serial online] 1972 [cited 2021 Jun 21];20:171-2. Available from: https://www.ijo.in/text.asp?1972/20/4/171/34642

Table 1

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Table 1

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  Introduction Top


Pterygium - essentially a triangular encroachment of bulbar conjunctiva on the cornea is a hyperplastic and degenerative process which starts in the subconjunctival tissue.

It is found more commonly in sunny, hot and dusty regions of the world such as India, Australia and Egypt. The age of onset is 20 years to 29 years and rises sharply upto 60 years and then declines FRANKEN AND MEHRA[2]. Males predominate in its incidence and 70% cases are unilateral and nasal.

Pterygium, though it has been known since very early days, has so far defied satisfactory treatment. Not being uncommon in India and because of its recurrences in spite of the several operation techniques devised for its removal, its pathology and pathogenesis deserve better attention than what it has been receiving by Indian ophthalmologists on an average.

The object of this study was to eva­luate the operation technique of ex­cision of pterygium and to determine the incidence of recurrences after ope­ration.


  Material and Method Top


For this assessment and evaluation we have taken all the cases of pterygium which were operated from 1964-1968 and could be followed for more than a year. Those patients who did not report have not been included. The total number of such cases was 135.

Technique After the usual instil­lations of Zylocaine 27c with adrenalin, 0.5 cc Zylocaine 2% solution with adrenaline 1:1000 is injected under the pterygium for complete local anaesthesia.

The neck of the pterygium is held with h fixation forceps and the pterygium is carefully shaved off the cornea including the superificial layer of the cornea and upto its entire extent with Burr's knife, the episcleral tissue is thoroughly cleaned and scraped. Bleeding points are cauterised when­ever necessary. The whole of the pterygium is dissected well from the episcleral area and excised by two converging incisions.

The conjunctiva is mobilised on the two sides; one or two No. 50 black thread sutures are applied to approxi­mate the edges, leaving a bare area around the limbus, semilunar in shape, so as to allow the corneal epithelium to grow first (photograph 1). Neosporin ointment and a pad and bandage are applied, and the patient is allowed to go home. Daily dressing is done. The pad and bandage and the sutures are removed on the 7th day.

Histopothology

(a) Primary Pterygium:- shows tissue covered by stratified squamous epithelium. There are areas of atrophy. The subepithelial tissue contains numerous vascular spaces and chronic inflammatory cells. There are areas of hyalinisation and basophilic degenera­tion just beneath the epithelium.

(b) Recurrent Pterygium: shows collagenous fibrous tissue covered by stratified squamous epithelium. There is homogenisation of the collagen in one part of the lesion. A few dilated vascular channels are present. The covering stratified squamous epithe­lium shows pongiosis. There is a scanty superficial lymphocytic infiltrate beneath the epithelium.


  Discussion Top


DUKE ELDER [1] has given a recur­rence rate of pterygium after various operations as between 30% and 50%. D'OMBRAIN with his technique, has reported no recurrence in a period of seven years.

Recurrence rate in our study was only 6.6%. [Table - 1] It was observed that almost all the cases that had re­currence had them more than once. One case recurred upto 4 times and finally the patient, a female, between 40-50 years stopped coming to the Hospital.

It is obvious from the assessment that recurrence is more common in the 51-70 years age group. A longer ob­servation period, say at least 5 years is necessary to determine these recur­rences in the younger age group of 15­40 years since they are more exposed to heat glare and dust than the older age group.

Histopathology shows little differ­ences between primary pterygium and recurrent pterygium and the histologi­cal structure is consistent with that described by HOGAN AND ZIMMER­MAN [3] for pterygium.


  Summary Top


A simple technique of pterygium operation has been described with as­sessment of 135 operated cases; the rate of recurrence was found to be 6.6 per cent[4].

 
  References Top

1.
Duke Elder, S . , (1965) : System of Ophthalmology. V, VII, Part I pages 573-582, Henry Kimpton, London.  Back to cited text no. 1
    
2.
Franken, S., Mehra, K. R.: (1968): A survey to determine Ophthalmic Morbidity.  Back to cited text no. 2
    
3.
Hogan, M. J . , and Zimmerman, L. E.: Ophthalmic Pathology-an atlas and Textbook, pages 253-254 W. B. Saunders Co., Philadelphia (1966).  Back to cited text no. 3
    
4.
Stallard, H. B.: Eye Surgery page 385-390 John Wright and Sons Ltd., Bristol (1966).  Back to cited text no. 4
    


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    Tables

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Introduction
Material and Method
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Summary
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