Intraoperative 96% ethanol as an adjuvant in Pterygium (Pt) surgery

Abstract

AbstractPurposeThe aim of the study is to present how we use ethanol on the cornea next to the pterygium head to remove the corneal epithelium and create a dissection plane to remove the fibrovascular tissue in a more controlled way leaving a more regular corneal surface.MethodsTopical tetracaine + oxybuprocaine as topical anaesthetic, povidone iodine 5% is instilled and mepivacaine 2% is injected under the body of the pterygium. A cellulose sponge soaked in 96% ethanol is placed over the corneal surface 1‐2 mm around the head of the fibrovascular tissue for 10 seconds, then washed. Blunt lifting of the epithelium towards the head of the pterygium allows identification of the surgical plane for dissection of the underlying corneal adhesions. Excision of the corneal encroaching tissue, tennon's capsule over the bare sclera and under the conjunctival wound was followed by conjunctival autograft sealed with fibrin (tisseel).ResultsA retrospective review of all pterygium procedures performed at our institution from January 2017 to January 2020 was performed to find out if there were any intra‐ or post‐surgical complications related to the use of 96% ethanol. All patients had completed epithelialisation within 1 week and none had limbal deficiency. The recurrence rate was very low.ConclusionsIntrasurgical application of 96% ethanol on the cornea next to the pterygium head for 10 seconds just before surgical removal of the pterygium is an inexpensive, safe and effective adjuvant to the procedure. It may even be of more interest in recurrent pterygium where firm adhesions need to be addressed and creating a new smooth surface may prevent recurrences.BibliographyKaufman 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 Jan;120(1):201‐8. https://doi.org/10.1016/j.ophtha.2012.06.066. Epub 2012 Oct 11. PMID: 23062647.Chen KH, Hsu WM. Intraoperative ethanol treatment as an adjuvant therapy of pterygium excision. Int J Biomed Sci. 2006 Dec;2(4):414‐21. PMID: 23675010; PMCID: PMC3614651.Tsumi E, Levy J, Pitchkhadze A, Baidousi A, Lifshitz T. New approach for pterygium removal using 20 % ethanol. Int Ophthalmol. 2012 Oct;32(5):443‐8. https://doi.org/10.1007/s10792‐012‐9597‐2. Epub 2012 Jun 21. PMID: 22717949.