Year : 1971 | Volume
: 19 | Issue : 2 | Page : 82--84
Role of Hyaluronidase (Hyalase) in management of pterygium
Rajendra Rohatgi, Ramesh Rohatgi, LK Trivedi
Kanpur Eye Hospital, Kanpur, India
Kanpur Eye Hospital, Kanpur
|How to cite this article:|
Rohatgi R, Rohatgi R, Trivedi L K. Role of Hyaluronidase (Hyalase) in management of pterygium.Indian J Ophthalmol 1971;19:82-84
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Rohatgi R, Rohatgi R, Trivedi L K. Role of Hyaluronidase (Hyalase) in management of pterygium. Indian J Ophthalmol [serial online] 1971 [cited 2021 Jun 16 ];19:82-84
Available from: https://www.ijo.in/text.asp?1971/19/2/82/34985
Pterygium is very common in the tropics. This seems to be so because of improper nutrition in the poorer classes of people and prevalence of local irritating factors to the eye such as tropical sun, dusty dry season and occupation in the open fields. Since pterygium and its recurrence are the constant problems in the tropics and there is acute shortage of hospital beds and technical man power in a country like ours it was felt that development of non surgical treatment should be of value in the management of this condition. Carriker and others have observed beneficial effect of Hyaluronidase (Hyalase) in early cases of pterygium.
Meyer and Palmer were the first to isolate the main intercellular substance, Hyaluronic acid. Duphie and Chain  demonstrated that the enzyme Hyaluronidase liquified the tissue cementing substance, Hyaluronic acid. This occurs by the depolymerisation of Hyaluronidase through hydrolysis of the linkages with the decrease in the viscosity of the polysaccharide, Hyaluronic acid, allowing more rapid spread of fluds through the connective tissue.
The action of Hyaluronidase is reversible with complete restoration of the intercemeting substance in 24 hours. The enzyme presents no toxicity and in our experience no allergic manifestations have been noted.
Stimulated from the publications and encouraged with initial personal observations it was decided to conduct a systemetic study with Hyalase in pterygium at Kanpur Eye Hospital. Annually 50,000 patients are treated in the out door and 2,000 in the indoor with various disorders of the eye. Pterygium is commonly met in these patients in this part of the country. The purpose of this communication is to state our observations with this product.
Method and Material
Cases of pterygium were collected from the outpatient department and examined thoroughly by oblique illumination and slit lamp examination and vision tested. Special note was made of the occupation, age, sex and duration of symptoms. The cases were grouped in the following five groups:
Group 1 - Small fleshy vascular growth (Early pterygium).
Group 2 - Fleshy and vascular growth extending on to the cornea (Progressive pterygium).
Group 3 - Dense fibrous growth (Non-progressive pterygium).
Group 4 - Rapid fleshy vascular growth extending on to the cornea (Malignant pterygium).
Group 5 - Recurrent pterygium 30 cases of each group were studied.
1 ampoule of Hyalase was dissolved in 2 cc of distilled water. 0.25 cc of this solution was taken with 0.1 cc of 1 % Novocaine in the syringe and subconjunctival injection given at the neck of pterygium twice a week with 25 gauge needle pointing away from the limbus with subsequent balooning of the pterygium away from the sclera.
6 injections were given in each case.
In our series males comprised of more than 2/3rd of the total number of patients studied (107 males to 43 females). 70% of the patients were in the age group of 21 to 50 years [Table 2]. Interestingly 81% were in the occupation which exposed them to recurrent local irritation [Table 3]. This was consistent with the thesis that pterygium is more common in people exposed to outdoor dusty work.
[Table 4] narrates the outcome of the 5 groups of pterygium after use of Hyalase.
In tropical countries where pterygium is more common in poorer class of people, various methods have been applied while operating mainly to avoid recurrence. Its recurrence is a problem both for patients and surgeons.
We have found use of Hyalase by the above technique useful in early cases of pterygium. In 80 of such cases the growth completely disappeared and the conjunctiva returned to normal. In progressive pterygium also the pterygium became pale and vessels got reduced in size in 60% cases. In 70% cases with malignant pterygium we observed change in the growth and reduction in the flesh and vascularisation, but the drug was ineffective in dense and fibrous pterygiums.
We did not encounter any morbidity or adverse effects in any of these patients.
150 cases of pterygium were studied after use of Hyaluronidase (Hyalase). Six bi-weekly injections of 0.25 cc of Hyaluronidase with 0.1 cc of 1% Novocaine solution were given at the neck of the pterygium. The drug was found to be of definite value in early cases of pterygium with disappearance of growth in 80% of the cases. Progressive and malignant pterygiums showed diminution in size and vascularisation in 60 and 70 67o cases respectively.
We are grateful to Dr. S. Agarwala of Tata Fison Industries Limited for providing the financial assistance and drugs for this study.
|1||CARRICKER, F. R.: "The Use of Hyaluronidase in Ophthalmology" Amer. J. of Ophthal. (1952) 35, 1765.|
|2||DUTHIE. S., CHAIN, E.: "A muco lityc enzyme in testis extracts" Nathure (1939) 9th Dec. p. 977.|
|3||MEYER, K. AND PALMER, J.: "The Polysacccharide of the vitreous humour J. Biol. Chem. (1934), 629, 107.|