A One-Year Prospective Study To Evaluate The Efficacy Of Intraoperative Application Of 20% Ethanol As An Adjuvant In Pterygium Excision With Conjunctival Autograft

Abstract

BACKGROUND Pterygium is a common ocular surface disorder. It is a slow growing, wing shaped proliferation of fibrovascular tissue, araising from the subconjunctival tissue and encroaching over the cornea.[1] It is more common on the nasal side. It causes foreign body sensation, redness, visual impairment, and diplopia. Surgical excision is the treatment of choice for pterygium. Conjunctival autografting has been used frequently following pterygium excision. Recurrence is one of the most common complication of pterygium. Several methods like amniotic membrane implantation, use of adjuvants such as beta- irradiation, thiotepa, 5-Fluorouracil, mitomycin C were used for the treatment of pterygium surgery. Ethanol is an alternate adjuvant which can be used in the pterygium excision. Ethanol causes rapid denaturation of proteins, including cytokines, enzymes, and growth factors involved in pterygium formation and recurrence after excision. Application of ethanol at a concentration 20% less than the 60s on the cornea appears to be safe. It helps to identify the plane between the pterygium and underlying cornea during surgery. Only a few studies have been conducted regarding the use of ethanol in pterygium excision.

AIM AND OBJECTIVE OF THE STUDY To study the efficacy and safety of 20% ethanol as an adjuvant in pterygium excision with conjunctival autograft implantation and to evaluate the surgical outcomes of using 20% ethanol as an adjuvant in pterygium surgery.

METHODS This is a prospective interventional study conducted among 30 patients with primary pterygium August 2022 to December 2023. Patient were evaluated preoperatively for anterior segment, posterior segment, visual acuity and corneal astigmatism Pterygium is excised using 20% ethanol as an adjuvant and conjunctival autograft was placed over bare sclera withoutsuture. Patients were evaluated postoperatively on day 1, day 8, day 30 and day 90 for condition of graft, visual acuity, corneal astigmatism, and associated complications.

RESULT After 3 months of follow up, the mean visual acuity improved to Logmar 0.46 ±0.35 (p=0.001) which was statistically significant and corneal astigmatism improved from 3.36 ± 2.87 to 0.87±0.57 (p=0.001). No recurrence noted within 3 months of follow up.

CONCLUSION This study has shown that using 20% ethanol as an adjuvant for pterygium excision helps in easy and clean dissection of pterygium head from underlying cornea and the pterygium induced corneal astigmatism has significantly reduced which was associated with improvement in visual acuity.