GETTING RID OF RED EYE
Most common, non-emergent causes of redness of eye commonly encountered by a family physician in every day practice are pterygium and pinguecula.
PINGUECULA (pronounced pin-gu-e-culaa)– Development of thick yellow triangles in the edges of the cornea. Occurs in the elderly.It may sometimes present as abnormally dilated blood vessels giving a constant, embarrassing red look to the eye which creates a cosmetically unacceptable appearance. Lubrication with artificial tears may help. It may be removed for discomfort or cosmetic reasons.
PTERYGIUM (pronounced tur-ij-ee-um)– A triangular patch of hypertrophied bulbar subconjunctival tissue, extending from the inner canthus to the border of cornea or beyond, with apex pointing toward the pupil. This lesion can be varied in its appearance from small and pink to large and angry red with symptoms of dry eye,cosmetically unacceptable appearance and/or affecting vision adversely.
Theories about the etiology of pterygium are diverse and range from hereditary, neurotrophic, angioplastic and immunological causes to ultraviolet light exposure.Regardless of the cause, the result is elastotic degeneration with vesiculation of Bowman’s membrane in the cornea and formation of epithelial islets (Fuchs patches) as cysts around the pterygium.
Pterygium is one of the oldest pathologies known to ophthalmologists.Surgery for this condition can range from simple excision to techniques with exotic detail and meticulous maneuvers with task specific instruments beckoning an area of raised expectations and cosmetic outcomes in the field of ocular surface surgery itself. Traditional pterigium surgery is barbaric and painful (scalpel and stitches),scar tissue often remains, so the eye still looks red and irritated.Today however,there have been major advances in the treatment of pterigium.
Amniotic membrane (human placenta) graft is used. No stitches are involved during the surgery since Tissue Glue (Baxter- USA) is used to stick the graft in position. This concept raises the bar in aesthetically improving " Next Day" post operative appearance and comfort for patients with these pathologies. Patients experience good visual and cosmetic results. Recovery time and chance of recurrence are significantly decreased.
Amniotic membranes,which are composed of a monostratified epithelial surface,a basement membrane and a stromal side,have been used in medicine for about 60 years.
The advantages of commercially available membrane are that there is no immune reaction and it has anti-inflammatory functions, is antiadhesive and antibacterial, encourages epithelial differentiation and growth, and has an antitissue growth factor effect.
Thus far, most treatments,such as copper sulfate,silver nitrate,mitomycin-C,thiotepa and 5-fluorouracil,have been ineffective and associated with major side effects.Argon laser treatment has been used to contract conjunctival tissue and treat blood vessels.Radiation with stronium90 has been used postoperatively,but patients must be followed for years because of the potential side effects such as sclera/corneal melting. Indications for surgery include correction of cosmetic defects;visual effects such as location within the visual axis and induction of astigmatism or dry eye;and recurrence of the pterygium in which patients present with scars and extremely aggressive pterygia.Atrophic pterygia do not require surgery.
Advances in pterygium/ pinguecula surgery involve a Three step protocol
3-STEP SURGERY
1.Complete removal of the Pinguecula/Pterygium from the roots(Gulani Ice Berg Concept)
2.Mitomycin-c drug application
3.Amniotic Membrane Graft covering for the surgical site with Glue (No Stitches)
The cosmetic appeal of this surgical concept with the no stitch,no patch,and no red approach along with absence of visual deficit is raising the bar in patients now seeking this approach for related ocular surface conditions.Recurrence rate is lower.
Additionallythese patients can also avail of vision corrective surgery in the form of Lasik-laser vision surgery and/or cataract surgery very soon in succession because the cornea is basically cleared with excellent globe contour and for temporal/superior incisions. Thus recovering full vision potential for patients along with appearance in order to return to their productive lifestyles.
http://www.gulani.com/Pterygium-cases.html
References
edit1.Gulani,AC. Sutureless Amniotic Surgery for Pterygium:Cosmetic Outcomes for Ocular Surface Surgery. Techniques in Ophthalmology.6(2):41-44,2008.
2.Gulani,AC.Surgical method sets higher standard for managing pterigium. Ocular Surgery news.26(15):45,2008
3.Gulani,AC.Corneoplastique.Techniques in Ophthalmology 5(1):11-20,2007
4.Gulani,AC.Amniotic membrane lowers chance of pterigium recurrence.Ophthalmology Times.Sept 15th,2003
5.Gulani,AC. Corneoplastique. Video Journal of Cataract and Refractive Surgery. Vol22(3),2006
6.Gulani,AC. Simultaneous pterygium and cataract surgery. J Postgrad Med 1995;41:8-11
7.Trelford JD, Trelford-Sauder M The amnion in surgery,past and present. Am J Obstet Gynecol.1979;134:833-845.
8.Kim JC, Tseng SCG.Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea.1995;14:472-484.