A review of outcome of pterygium excision at lions sight first eye hospital
OBJECTIVES This study was conducted to review the outcome of pterygium, indications for excision, the pattern of complication in relation to surgical technique, the recurrence rate within the first six months post operatively and to compare recurrence amongst vanous races. STUDY DESIGN: Retrospective case series done in which medical records of all patients who had pterygium excision at LSFEH between the year 2005 and 2007 were retrieved from the hospital registry and reviewed. A structured questionnaire was used to collect data which was entered into the computer and analyzed using statistical package for social scientist (SPSS). RESULTS: In total, 185 eyes of 175 patients had pterygium excision. There were more females than males with a ratio of 0.8: 1, the range was 17-86 years. Kenyan Africans accounted for 85.9% and Asians 14.1%.No European eye was operated. The most common reason for excision was cosmetic, accounting for 73%. The most common surgical technique was bare sclera with or without MMC. 50.5% of the patients were lost to follow up within the first one month post operatively. The most common complication was recurrence (14.1% within. the first six months post operatively). Astigmatism which is an indication and a complication of pterygium excision was not accounted for in this study because pre and postoperative refraction was not done. Bare sclera with or without MMC was noted to have the highest number of complications. There was no significant association between recurrence, sex, age, race and indication for surgery. Those who underwent previous pterygium excision in the same eye were six times more likely to have recurrence and the difference was statistically significant (p=O.004). Pyogenic granuloma was more likely to occur in patients who under-went surgery by simple closure and the difference was statistically significant (p<O.OO1). CONCLUSION The commonest presenting complaint for pterygium excision was whitish growth in the eye accounting for 73%.The most common complication was recurrence with a rate of 14.1% within the first six months and there was no statistically significant association between recurrence, surgical technique, age, sex, race and indication. The use of anti-metabolites and conjunctival flap was shown to be more likely to reduce recurrence although the difference was not significant compared to bare sclera only. RECOMMENDA nONS Health education should entail proper counseling on the risk of recurrence and as such the need for compliance with follow-up post operatively. All patients undergoing pterygium excision should have the grading of the pterygium documented as it has been shown to influence recurrence. The use of antimetabolites be encouraged in order to reduce the recurrence rates. Refraction before and after surgery is also recommended to assess the astigmatism and visual acuity.