New approach for pterygium removal using 20 % ethanol

The Role of 20% Ethanol in Enhancing Pterygium Surgery Outcomes: A Clinical Study

Introduction Pterygium is an ocular surface disorder characterized by a hyperplastic growth of conjunctiva encroaching over the cornea. It causes redness, watering, and foreign body sensation. Surgical excision is the preferred mode of treatment when there is encroachment over the visual axis, chronic irritation, restricted ocular motility, and cosmetic concerns. Various surgical methods have been adopted for the treatment and to prevent recurrences. This study assessed the effectiveness and safety of 20% ethanol as an adjuvant in pterygium excision with conjunctival autograft implantation, evaluating surgical outcomes. Methods A prospective hospital-based interventional study was conducted among 30 patients with pterygium from August 2022 to December 2023. Patients were evaluated preoperatively for anterior segment, posterior segment, visual acuity, and corneal astigmatism. Pterygium was excised using 20% ethanol as an adjuvant, and conjunctival autograft was placed over the bare sclera without sutures. Patients were evaluated on postoperative days 1, 8, 30, and 90 for graft condition, visual acuity, corneal astigmatism, and associated complications. Results After three months of follow-up, the mean visual acuity improved to LogMAR 0.46±0.35 (p=0.001), which was statistically significant, and the average corneal astigmatism decreased from 3.36±2.87 to 0.87±0.57 (p=0.0001). No recurrence was noted among the participants. Conclusion This study has shown that using 20% ethanol as an adjuvant for pterygium excision facilitated clean dissection of a pterygium from the underlying cornea and the pterygium-induced corneal astigmatism has significantly decreased, which led to progress in vision.

Evaluation of the effects of ethanol and mitomycin on survival of rat limbal stem cells: an in vitro study

PURPOSE

Ethanol and mitomycin C (MMC) are clinically used to treat corneal diseases such as LASEK and LASIK surgery. In this study, we investigated the effects of time-dependent alcohol and MMC in cultured rat limbal stem cells (LSCs) to determine the appropriate time for the use of this compound in the clinical setting.

METHODS

LSCs (N = 10 eyes) isolated from male Wistar rats were cultured and characterized; then, isolates were divided into three groups. One group was exposed to a 20% concentration of ethanol for 5, 10, 15, 20, 25, and 30 s, and cell viability was assessed one, three, and five days following ethanol exposure using an MTT assay. To investigate the effect of MMC, cells in the second group were treated with 0.02% MMC in various periods (i.e., 15 s, 30 s, 60 s, 90 s, and 120 s) and time-dependent responses of cultured LSCs were recorded. Cells in the third group were co-treated with ethanol and MMC; then, dose and time dependency was evaluated.

RESULTS

In comparison with the viable cells in the control group, ethanol markedly decreased the viability of cells in a time-dependent manner in days one and three. On day five, the viability of LSCs was improved significantly (p < 0.05) in comparison with day one. The number of viable progenitor cells was significantly decreased after MMC treatment in a time-dependent manner, as determined by the MTT assay (p < 0.001). The use of mitomycin, along with alcohol, decreased cell viability in all groups treated with ethanol + MMC compared to the control on days one, three, and five (p < 0.0001).

CONCLUSIONS

Our findings suggest that ethanol and MMC reduced cell viability in cultured LSCs in a time-dependent manner. In addition, when LSCs were exposed to alcohol alone, they had a better recovery process within 5 days in comparison to when exposed to mitomycin alone or mitomycin + alcohol.

Ocular chemical burn associated with gel type alcohol-based hand sanitizer: A case report

INTRODUCTION

Alcohol-based hand sanitizers (ABHS) are widely used for hand hygiene due to the coronavirus disease pandemic. However, risk awareness regarding its adverse effects is lacking. We aim to report a case of ocular chemical burn that showed severe clinical presentation associated with ABHS.

PATIENT CONCERNS

A 5-year-old girl presented with severe left eye pain after 62% gel-type ABHS splashed into her eye.

DIAGNOSIS

On slit lamp examination, a near total corneal and conjunctival epithelial defect with limbal pale on the lower half of the cornea was noted. Severe ocular burn by ABHS was prominent with suspected limbal stem cell damage.

INTERVENTIONS

She was hospitalized and was prescribed topical medications including antibiotics, steroid eye drops with preservative-free artificial tears, and oral nonsteroidal anti-inflammatory drugs.

OUTCOMES

Despite intensive medical treatments, the corneal and conjunctival epithelial defects showed no improvement up to the 4th hospital day. After additional instillation of autoserum eye drops to promote epithelial healing, the corneal epithelium barely recovered from the temporal limbus. On the third week of admission, the epithelial defect was completely resolved without corneal opacity, although with minimal symblepharon in the lower fornix.

CONCLUSIONS

Gel-type ABHS can cause severe form of ocular chemical burn such as delayed ocular surface healing. In clinical setting, immediate and thorough rinsing of alcohol-based gel and early intensive treatment are crucial.

Impact of conjunctival autograft on pterygium treatment: evaluation of related symptoms and patients' satisfaction after surgery

Purpose

Pterygium is a fibrovascular condition of the ocular surface that can cause a broad range of irritative and visual symptoms. Controversy exists regarding pterygium mechanisms, management, surgical techniques, adjuvant approaches and impact on patients’ quality of life. We performed a retrospective survey focused on the impact of pterygium-related symptoms before surgery and patients’ satisfaction after excision surgery followed by conjunctival autograft transplantation with fibrin glue, based on patients’ subjective reporting.

Methods

All patients underwent surgery consisting of the extensive removal of the pterygium fibrovascular tissue, followed by autologous conjunctival graft fixed with fibrin glue to cover the bare scleral area. A total of 500 patients were contacted by phone call and invited to participate in the study answering a brief two-question survey. First, to grade overall intensity of symptoms related to pterygium before surgical intervention, such as pain, irritation, tearing, red eye, photophobia, burning and foreign body sensation, using a scale from 0 to 10 (0 asymptomatic and 10 very severe symptoms). Results were categorized as mild (0–3), moderate (4–7) and severe (8–10). Then, patients were asked about their satisfaction with the surgery outcome, also using a scale from 0 to 10 (ranging from dissatisfied to fully satisfied).

Results

Patients’ mean age was 41.5±12.31 (min 18/max 83) years old and the mean of days after surgery was 1,493±552.7 (min 711/max 2,702). Symptoms were referred to as severe (70.2%), moderate (25.2%) and mild (4.6%). After surgery, most patients were fully satisfied and the mean grade was 9.6; 1% (0–3), 2.4% (4–7) and 96.6% (8–10). Women presented a higher score of symptoms compared to men (P<0.01) but similar satisfaction rates.

Conclusions

The present study shows that pterygium greatly impacts on patients’ quality of life and that excision surgery using conjunctival autograft transplantation and fibrin glue improved symptoms with high rates of satisfaction.

Molecular Basis of Pterygium Development

Pterygium pathogenesis is mainly related to UV light exposure. However, the exact mechanisms by which it is formed have not been elucidated. Clinical advances in surgical treatment use conjunctival autografts and amniotic membranes in combination with adjuvant therapies, including mitomycin C, β-radiation, and 5-fluoroacil, to reduce recurrence. Several studies aim to unveil the molecular mechanisms underlying pterygium growth and proliferation. They demonstrate the role of different factors, such as viruses, oxidative stress, DNA methylation, apoptotic and oncogenic proteins, loss of heterozygosity, microsatellite instability, inflammatory mediators, extracellular matrix modulators, lymphangiogenesis, cell epithelial-mesenchymal transition, and alterations in cholesterol metabolism in pterygium development. Understanding the molecular basis of pterygium provides new potential therapeutic targets for its prevention and elimination. This review focuses on providing a broad overview of what is currently known regarding molecular mechanisms of pterygium pathogenesis.