Intraoperative ethanol treatment as an adjuvant therapy of pterygium excision

Abstract

Recurrence of pterygium is the main concern for ophthalmic surgeons after the excision of pterygium. To evaluate the efficacy and safety of ethanol treatment during pterygium excision in preventing the recurrence of pterygia. A prospective randomized study was performed of 78 eyes in primary pterygium patients treated by excision. Primary pterygium patients were randomly assigned to ethanol group (38 eyes given intraoperative ethanol) or mitomycin-c (MMC) group (40 eyes given intraoperative MMC). Ethanol (20%) was applied for 60 seconds to the pterygial and its adjacent corneal surfaces before pterygium excision. After excision, the excised site of sclera was soaked with 20% Ethanol for 60 seconds. In group 2, MMC (0.25 mg/ml) was applied for 60 seconds to the bare sclera after pterygium excision. The outcomes were followed for more than one year. Pterygium recurred in 2 (5.3%) of 38 eyes in ethanol group and 4 (10.0%) of 40 eyes in MMC group. Final appearance of the pterygium excision area was satisfactory in 73.6% of group1 and 67.5% of group 4. No patients experienced severe complications postoperatively. In comparison with MMC treatment, intraoperative ethanol is more efficacious in preventing recurrence of pterygium and causes fewer complications. It suggests this regimen as an alternative for the treatment of pterygium, especially for those patients of high risk group for MMC treatment complications.

Keywords: eecurrence; ethanol; excision; mitomycin; pterygium.

Figure 1

Classification system for pterygia grading. Circle represents cornea; 1, 2, and 3 represent grades of pterygia as they encroach onto cornea beyond the limbus.

Figure 2

Technique for pterygium excision with intraoperative application of ethanol as an adjuvant. (A). Application of 20% ethanol in a ring marker. (B). Removal of the marker after absorbing the ethanol with a cellulose sponge. (C). Lifting the margin of epithelial flap with two cellulose sponges. (D). Dissecting the adherence of the pterygium body and separating with a Beaver 64 surgical blade. (E). Circumcising completely the conjunctival part of pterygium using a Westcott scissors along the mark. (F) A bare sclera after complete removal of residual pterygium tissue.

Figure 3

Determination of the adequate size of the optical zone marker. A optical zone marker (model E9011 3.0:storz. St. Louis, MO) of adequate size was used to delineate the area for corneal epithelium/pterygium removal. The size of the optical zone marker was determined by three points: point A and B, the pterium margins at limbus, and a third point, C, located 1 mm (in the case of primary pterygium) or 2 mm (in the case of recurrent pterygium) central to the head of pterygium.