Research Article

Outcome of Excision of Primary Pterygium with Bare Sclera Technique: A Study of 80 Eyes in Malaysia

Subash Govindasamy
Armed Forces Hospital, Malaysia
Sagili Chandrasekhara Reddy Chandrasekhar
National Defence University of Malaysia, Malaysia
* Corresponding author
DOI icon 10.24018/ejmed.2022.4.4.1379

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Submitted 2022-05-30
Published 2022-07-25

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Article Main Content

In this retrospective study of 166 patients with Pterygium, it was more predominant in males (66.9%) and in 31-40 years age group (69.9%). Irritation was the most common symptom (29.5%), while 13.8% were asymptomatic. Seventy four patients (44.6%) were armed forces personnel and the rest were civilian patients in this study A total of 248 pterygia (146 mild, 94 moderate and 8 advanced) were noted in this study. Standard procedure of excision of the growth with bare sclera technique was performed in 80 eyes wherever indicated (nasal or temporal in 66 eyes, both nasal and temporal in7 eyes). During the follow up period two complications (granuloma of conjunctiva and recurrence of pterygium) were noted. Small (5 mm size) granuloma occurred during the early postoperative period in 10 out of 80 eyes (12.5%), which healed completely with medical treatment without any need of surgical intervention. The recurrence of pterygium occurred in 19 out of 80 eyes (23.7%). The mean duration of recurrence was 5.5 months with a range varying from 2 to 12 months period. Recurrence of pterygium was observed to be higher in armed forces personnel (11 out of 19 eyes, (57.9%)) than in civilian patients (8 out of 19 eyes, 42.1%). There was early recurrence of pterygium in armed forces personnel (mean duration 5.1 months) than in civilian patients (mean duration 6.6 months). The modified technique of this with addition of intraoperative conjunctival auto graft to reduce the recurrence rate of pterygium is in progress.

Keywords: Bare sclera technique, conjunctival autograft, pterygium excision, recurrence of pterygium

References

  1. Duke Elder S, Leigh AG. Disease of the outer eye. In: System of Ophthalmology. Duke-Elder S (ed)., London: Henry Kimpton Publ, 1965, vol 8, pp 573-585.
     Google Scholar
  2. Liu L, Wu J, Geng J, Huang D. Geographical prevalence and risk factors for pterygium: a systematic review and meta-analysis. BMJ Open. 2013; 3: e003787.
    DOI  |   Google Scholar
  3. Al-Bdour M, Al-Latayfeh M. Risk factors for pterygium in an adult Jordanian population. Acta Ophthalmol Scand. 2004; 82: 64–67.
    DOI  |   Google Scholar
  4. Dushku N, Reid TW. Immunohistochemical evidence thathuman pterygia originate from an invasion of vimentinexpressing altered limbal epithelial basal cells. Curr Eye Res. 1994; 13: 473–481.
    DOI  |   Google Scholar
  5. Li DQ, Lee SB, Gunja-Smith Z, Liu Y, Solomon A, Meller D, et al. Overexpression of collagenase (MMP-1) and stromelysin (MMP-3) by pterygium head fibroblasts. Arch Ophthalmol. 2001; 119: 71–80.
     Google Scholar
  6. Aminlari A, Singh R, Liang D. Ophthalmic pearls- Management of Pterygium. Eyenet 2010; Nov-Dec: 37-38.
     Google Scholar
  7. Murugia L, Chong KL, Lim LT, Alias R. Recurrent pterygium in Bintulu, Sarawak (Malaysian Borneo): determining its risk factors. Malaysian J Ophthalmol. 2021; 1: 9-20.
    DOI  |   Google Scholar
  8. Kaufman SC, Jacobs DS, Lee WB, Deng SX, Rosenblatt MI, Shtein RM. Options and adjuvants in surgery for pterygium: a report by the American Academy of Ophthalmology. Ophthalmology. 2013; 120: 201–208.
    DOI  |   Google Scholar
  9. Kim KW, Kim JC. Current approaches and future directions in the management of pterygium. Int J Ophthalmol. 2018; 11(5): 709–711.
     Google Scholar
  10. Tan DT, Chee SP, Dear KB, Lim AS. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol. 1997; 115(10): 1235–1240.
    DOI  |   Google Scholar
  11. Han SB, Jeon HS, Kim M, Lee SJ, Yang HK, Hwang JM, et al. Risk Factors for Recurrence After Pterygium Surgery: An Image Analysis Study. Cornea. 2016; 35(8): 1097–1103.
    DOI  |   Google Scholar
  12. Fernandes M, Sangwan VS, Bansal AK, Gangopadhyay N, Sridhar MS, Garg P, et al. Outcome of pterygium surgery: analysis over 14 years. Eye. 2005; 19: 1182–1190.
    DOI  |   Google Scholar
  13. Khan N, Ahmad M, Baseer A, Kundi NK. To Compare the Recurrence Rate of Pterygium Excision with Bare-sclera, Free Conjunctival Auto Graft and Amniotic Membrane Grafts. Pak J Ophthalmol. 2010; 26(3): 138-142.
     Google Scholar
  14. Ramalingam M, Joshi N, Nair J, Ali NAM. Outcome of surgical management of pterygium in Brunei Darussalam. Brunei Int Med J. 2011; 7 (1): 8-14.
     Google Scholar
  15. Alsagoff Z, Tan DTH, Chee S-P. Necrotising scleritis after bare sclera excision of Pterygium. Br J Ophthalmol. 2000; 84: 1050–1052.
    DOI  |   Google Scholar
  16. Phathanthurarux S, Chantaren P. A Survey of Surgical Techniques in Pterygium, Thailand 2016. Asia Pac J Ophthalmol (Phila). 2019; 8: 476–480.
    DOI  |   Google Scholar
  17. Nuzzi R, Tridico F. How to minimize pterygium recurrence rates: clinical perspectives (Review). Clinical Ophthalmology. 2018; 12: 2347–2362.
    DOI  |   Google Scholar
  18. Sarkar P, Tripathy K. Pterygium. In: StatPearls. Treasure Island (FL): StatPearls Publishing. [Internet]. 2022 [updated 2022 Feb 21; cited 2022 May 6]. Available from: https://www.ncbi. nlm.nih.gov/books/NBK558907/
     Google Scholar