Outcome of surgical management of pterygium in Brunei Darussalam

Introduction A pterygium is an elevated, superficial, external ocular mass that usually forms over the peri-limbal conjunctiva and extends onto the corneal surface. It is more common in the tropics secondary to higher exposure to ultraviolet light. This study compares the various techniques of pterygium surgery including bare sclera, conjunctival autograft, and conjunctival mini-graft (with or without intraoperative Mitomycin C application) in terms of surgical outcome and recurrence rate and to identify the risk factors for recurrence and complications. Materials and Methods 959 patients operated for pterygium were retrospectively studied to determine the complications and recurrence rate after pterygium excision using the above mentioned surgical techniques. 625 (65.7%) were males. The mean age was 44 ± 12 years. Risk factors for recurrence were also studied. Results The recurrence rate of pterygium was 17.4%. There was no significant difference between the three surgical techniques in terms of recurrence rate (p = 0.28). Younger age was associated with higher recurrence rate (p = 0.001); There was no significant correlation between gender and recurrence of pterygium (p = 0.48). The bare sclera recurrence developed after a longer period of time compared to conjunctival grafts (p = 0.002). The commonest complication was granuloma (3.9%), followed by scleral thinning and/or melting (1.4%). Conclusion The study showed no statistically significant difference in terms of recurrence rate between the three pterygium surgical procedures studied. However, among cases of recurrence, those following bare sclera technique showed delayed recurrence compared to conjunctival autografts and conjunctival minigraft. The use of Mitomycin C adjunctive therapy was associated with significant reduction in recurrence rate. On the other hand, younger age group was associated with significantly higher recurrence rate.

Sudden onset of unilateral blindness (Answers)

(Refer to page 131) Answer: Left Non-arteritic Anterior Ischaemic Optic Neuropathy (AION) Panel A shows a normal right fundus with a normal optic disc and retina, and the left fundus (Panel B) showing sectoral optic disc swelling with corresponding flame-shape haemorrhage.

Sudden onset of unilateral blindness

A 63-year-old gentleman presented with a two-day history of sudden, painless blurring of vision in the left eye, immediately after waking up in the morning. He is known to have had diabetes mellitus and hypertension for seven years, and a recent attack of angina pectoris. There was no history of trauma and no associated neurological abnormalities. Visual acuity was 6/6 in the right eye and ‘Counting Fingers' in the left eye. Ocular examination was normal in the right eye (Panel A). Pupil examination of the left eye (Panel B) showed the presence of a relative afferent pupillary defect (RAPD), in addition to the above shown abnormality in the fundus. What is the diagnosis? Answer: refer to page 153