The Role of Using Motorized Diamond Burr Polisher Instrument in Minimizing the Recurrent Rate of Pterygium Excision

Abstract = 438 times | PDF = 301 times

Main Article Content

Sakar Abdulkarim Nidhamalddin


To compare the effects of using motorized diamond burr polisher in pterygium excision versus manual polishing of the corneoscleral bed in reducing the recurrent rate. A prospective, comparative and interventional study of 90 consecutive patients with different grads of primary pterygium, who underwent pterygium excision at Shahid Aso teaching eye hospital in Sulaimani city, between August 2018 till September 2019, which was performed by single surgeon. In group A (45) eyes polishing of the corneoscleral bed done using motorized diamond polishing burr, and in group B (45) eyes using manual crescent blade for polishing. Recurrent rate was evaluated after about (8±2) months postoperatively. Ethical consideration of the risks and the benefits of the procedure was observed for each individual patient. A 90 patients with the mean age of group A (48.84±12.7) years and group B (49.67±12.3) years, complained of different grads of primary pterygium, group A had 31(68.9%) male and 14(31.1%) female, while group B had 22(48.9%) male and 23(51.1%) female. Each individual factors like age, gender, visual acuity, BCVA pre and postoperatively, IOP measurement, dryness of the eye and risk factors like smoking and UV exposure affecting the recurrence were assessed. In both groups the main indication for surgery was sign of irritation. The mean surgical time was calculated and the difference between two groups were significant. After follow-up of average six months the outcomes and recurrent rate were checked, recurrent rate was in group A 1(2.2%) while in group B was 6(13.3%) patients. it significantly decreased. Corneal scar happens in only 1(2.2%) case of group A while in 11(24.4%) cases in group B, Corneal scar was statistically significant. In both groups the change of BCVA was significant but the visual change was more significant in group A in compare to group B. Motorized diamond burr is a safe instrument for polishing the cornea during pterygium excision, it is easy to handle, low price, need lesser operative time, its effect on recurrence postoperatively is significant and beside it leaves lesser corneal scar and early visual recovery postoperatively.   


Pterygium, diamond burr, blade, complications, recurrence, intraoperative time


Download data is not yet available.

Article Details


[1] Ardalan, S. Ravi singh, L. David liang, “Md,management of pterygium,” 2010.
[2] MS. Insler, DR. Caldwell, DH. Leach “Pterygium. In: Brightbill FS, ed. Corneal surgery: Theory, technique and tissue,” 2nd ed. St. Louis: Mosby Year Book, pp. 336–338, 1993.
[3] J. Mauro, CS. Foster, “Pterygia: pathogenesis and the role of subconjunctival bevacizumab in treatment,” Semin Ophthalmol, 24(3), pp.130–134, 2009.
[4] N. Di Girolamo, MT. Coroneo, D. Wakefield, “Active matrilysin (MMP‑7) in human pterygia: Potential role in angiogenesis,” Invest Ophthalmol Vis Sci, 42, pp. 1963-8, 2001.
[5] G. Koranyi, S. Seregard, ED. Kopp, “A no suture, small incision approach to pterygium surgery,” Br J Ophthalmol, 88(7), pp. 911–4, 2004.
[6] LW. Hirst, “The treatment of pterygium” Surv Ophthalmol, 48(2), pp. 145-80, 2003.
[7] M. Fernandes, VS. Sangwan, AK. Bansal, “Outcome of pterygium surgery: analysis over 14 years,” Lond, 19(11), pp. 1182-90, 2005.
[8] SA. Kurna, A. Altun, B. Aksu, R. Kurna, T. Sengor, “Comparing treatment options of pterygium: limbal sliding flap transplantation, primary closing, and amniotic membrane grafting,” Eur J Ophthalmol, 23(4), pp. 480-7, 2013.
[9] C. Pinto, G. Shikha K. Sudarshan, V. Murugesan, D. Tanuj, M. Ravinder, “Corneal Polishing After Pterygium Excision With Motorized Diamond Burr: A Randomized Control Trial,” Eye & Contact Lens, 41, pp. 268–272), 2015.
[10] RC. Hall, AJ. Logan, AP..Wells, “Comparison of fibrin glue with sutures for pterygium excision surgery with conjunctival autografts,” Clin Experiment Ophthalmol, 37, pp. 584–589, 2009.
[11] EB. Ozgurhan, N. Kara, A. Yildirim, “Diamond burr superficial keratectomy with mitomycin C for corneal scarring and high corneal astigmatism after pterygium excision,” Clin Ophthalmol, 7, pp. 951–954, 2013.
[12] M. Ayala, “Results of pterygium surgery using a biologic adhesive,” Cornea, 27, pp. 663–667, 2008.
[13] G. Koranyi, S. Seregard, ED. Kopp, “A no suture, small incision approach to pterygium surgery,” Br J Ophthalmol, 88, pp. 911–914, 2004.
[14] S. Srinivasan, M. Dollin, P. McAllum, “Fibrin glue versus sutures for attaching the conjunctival autograft in pterygium surgery: A prospective observer masked clinical trial.,” Br J Ophthalmol, 93, pp. 215–218, 2009.
[15] R. Castroviejo, “Atlas of keratectomy and keratoplasty,” Philadelphia: WB Saunders, 1966.
[16] T. Simsek, I. Gunlap, H. Atilla, “Comparative efficacy of betairradiation and mitomycin-C in primary and recurrent pterygium,” Eur J Ophthalmol, 11, pp. 126–132, 2001.
[17] DT. Tan, SP. Chee, KB. Dear, AS. Lim, “Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision,” Archives of Ophthalmology, 115(10), pp. 1235-1240, 1997.
[18] V. Huerva, A. March, M. Martinez-Alonso, MJ. Muniesa, C. Sanchez, “Pterygium surgery by means of conjunctival autograft: Long term follow-up,” Arq Bras Ofta lmol, 75, pp. 251-5, 2012.
[19] KR. Kenyon, MD. Wagoner, ME. Hettinger, “Conjunctival autograft transplantation for advanced and recurrent pterygium,” Ophthalmology. 92(11), pp. 1461–1470, 1985.
[20] N. Andamanand, “IslandsInstitution of MedicalScience, Port Blair,Andaman and Nicobar, India, Recurrence‑Free Pterygium Surgery with Special Surgical Techniquey”, 62, pp. 201-255.158, 2020.
[21] K. Kampitak, W. Leelawongtawun, S. Leeamornsiri, W. Suphachearaphan, “Role of artificial tears in reducing the recurrence of pterygium after surgery: a prospective randomized controlled trial,” Acta Ophthalmol, 95(3), pp. e227-e229, 2017.
[22] AP. Adamis, T. Starck, KR. Kenyon, “The management of pterygium,” Ophthalmol Clin North Am, 3, pp. 611–23, 1990.
[23] SK. Kodavoor, NN. Tiwari, D. Ramamurthy, “Concomitant use of conjunctival tissue graft from the pterygium itself without rotation in pterygium surgery: A full circle in conjunctival autografting,” Indian J Ophthalmol, 66(4), pp. 506-510, 2018.
[24] H. Soo, K. Hong, “Analysis of recurrence patterns following pterygium surgery with conjunctival autografts,” Medicine, 94, pp. 4, 2015.
[25] R. GUILLERM, “Techniques in Ophthalmology,” Vision Centre, Brandon Regional Health Centre,Brandon, 1(1), pp. 22–28, 2003.
[26] E. Clearfield, V. Muthappan, X. Wang, IC. Kuo, “Conjunctival autograft for pterygium,” Cochrane Database Syst Rev, 2, pp. CD011349, 2016.
[27] H. Halil, G. Gökçen, M. Alper, K. Yaran, E. Metin, “Non-Recurrence Complications of Fibrin Glue Use in Pterygium Surgery: Prevention and Management”, 2017.
[28] N. guria, S. Ntuli, T. Carmichael, “Young patient’s age determines pterygium recurrence after surgery,” African Health Sciences, 2017.
[29] O. lusanya, O. Ogun, C. Bekibele, A. Ashaye, A. Baiyeroju, O. Fasina, “Risk factors for pterygium recurrence after surgical excision with combined conjunctival autograft (CAG) and intraoperative antimetabolite use,” African journal of medicine and medical sciences, 43, pp. 35-40, 2014.
[30] S. Ha, “Clinical analysis of risk factors contributing to recurrence of pterygium after excision and graft surgery,” International journal of ophthalmology, 8(3), pp. 522-7. 2015.