strontium-radioisotopes and Pterygium

Pterygium is a benign conjunctival neoformation usually treated by surgical excision, but recurrences may affect 30% to 89% of cases, so that adjunctive therapies like conjunctival autografting, antimitotic drugs and beta-irradiation (β-irradiation) are often used to improve the rate of local control. Our essay has reviewed relevant studies addressing the role of postoperative irradiation in the treatment of pterygium in the last 30 years through an Internet-based search and hand search in libraries. Sixteen studies on β-irradiation and one on soft X-ray irradiation were accessible. They covered more than 6000 lesions treated by surgical excision and postoperative β-irradiation using strontium-90 ((90)Sr) applicators at doses varying from 10 to 60 Gy/1-6 fractions/1-6 weeks starting within 3 days postoperatively. The rates of local recurrence were in general lower than 15% and major complications such as scleral thinning, ulceration, infections, or radiation-induced cataract were rarely encountered. Early postoperative β-irradiation at a dose of 30 Gy/three fractions/2-3 weeks starting within 24h from surgical excision is an effective and safe procedure with local control rates comparable to chemotherapeutic agents and conjunctival autografting and superior to simple excision alone.

Topics: Humans; Postoperative Care; Pterygium; Radiotherapy Dosage; Randomized Controlled Trials as Topic; Retrospective Studies; Strontium Radioisotopes

To affirm the effectiveness and complication rate of postoperative single-dose beta-irradiation (RT) with (90)Sr in the case of primary pterygium in a clinical trial. Pterygium is a benign disease of the supporting orbital tissue that can cause impairment of visual function. Depending on the technique used for surgery, recurrence is described in up to 70% of cases-a reason to combine the initial treatment with radiotherapy or chemotherapy.. This trial was designed as a prospective, randomized, multicenter, double-blind study. Surgery was performed in all cases according to the bare sclera technique. Ninety-one patients with 96 pterygia were postoperatively randomized to either beta-RT or sham RT. In the case of beta-RT, a (90)Sr eye applicator was used to deliver 2500 cGy to the sclera surface at a dose rate of between 200 and 250 cGy/min. Sham RT was given using the same type of applicator without the (90)Sr layer. After treatment, both an ophthalmologist and a radiation oncologist performed the follow-up examinations. The accumulated data were analyzed using a group sequential test.. Between February 1998 and September 2002, 96 eyes with primary pterygium were operated on according to the trial protocol. Additional treatment was performed within 24 hours postoperatively. Ten patients were lost to follow-up, resulting in 86 patients who could be analyzed. In the 44 eyes randomized to receive beta-RT, 3 relapses occurred compared with 28 recurrences in the 42 eyes that received sham RT, for a crude control rate of 93.2% vs. 33.3%, respectively. At a mean follow-up of 18 months, major treatment complications had not been observed.. Single-dose beta-RT after bare sclera surgery is a simple, effective, and safe treatment that reduces the risk of primary pterygium recurrence.

Topics: Adult; Aged; Combined Modality Therapy; Double-Blind Method; Female; Humans; Male; Middle Aged; Prospective Studies; Pterygium; Secondary Prevention; Strontium Radioisotopes

Beta radiation has a long history as a treatment modality in ophthalmology. It is a convenient and practical method of applying radiation and has the advantage of minimal tissue penetration. There has been a recent resurgence in the use of beta radiation in other areas in medicine, such as the prevention of restenosis after coronary artery stenting. Beta radiation has been shown in vitro and in vivo to inhibit proliferation of human Tenon's fibroblasts, which enter a period of growth arrest but do not die. Effects on the cell cycle controller p53 have been shown to be important in this process. In ophthalmology, beta radiation has been used widely for the treatment of pterygium and is under evaluation for treatment of age-related macular degeneration and for controlling wound healing after glaucoma drainage surgery. In this latter role, beta radiation may be particularly appropriate for use in developing countries to improve the results of trabeculectomy while potentially avoiding some of the side effects of other antimetabolites.

Topics: Aged; Beta Particles; Brachytherapy; Cicatrix; Glaucoma; Humans; Lens, Crystalline; Macular Degeneration; Middle Aged; Pterygium; Strontium Radioisotopes; Wound Healing

Pterygium are triangular growths of fibrovascular tissue of the bulbar conjunctiva that ultimately cause visual disturbances. Surgical removal is the initial treatment of choice for pterygium, but the recurrence rate after excision alone is 20-40%. The purpose of this paper is to reaffirm the effectiveness of postoperative irradiation with a 90Sr eye applicator.. From 1993 to 1996, 361 patients (393 lesions) were treated with 90Sr postoperative radiation therapy. Forty-five lesions were recurrent cases. All cases had been excised using the "bare sclera" method. Postoperative radiation performed within 48 h after surgery received radiation doses of 30 Gy, the others received doses of 35 Gy, using the 90Sr eye applicator.. Thirty-four (8.6%) of the 393 lesions recurred. The overall 1-year local control rate was 93.7%. Seventy-one percent of the recurrent cases were noticed within 1.5 years after treatment. The multivariate analysis for total cases demonstrated that sex, age, prior treatment, and duration of pterygium affected the overall local control rate. No complications from this treatment have been observed.. It was reconfirmed that postoperative irradiation was effective in preventing local recurrence after surgical removal of pterygium.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Multivariate Analysis; Pterygium; Radiopharmaceuticals; Recurrence; Strontium Radioisotopes

Although complications associated with the use of beta radiation after pterygium surgery can occur, the author has found the use of beta radiation to be beneficial in preventing recurrences when used with pterygium surgery. An effective surgical regime of pterygium surgery is presented. A procedure made up of steps that tend to prevent revascularization of the operative site after pterygium surgery will decrease the recurrence rate. The use of strontium 90 and the mechanism of action of beta ray therapy in treatment of the pterygium is discussed. Few complications have occurred in > 200 surgically treated cases of pterygium with postoperative beta radiation administered with a strontium 90 applicator. No cases of radiation cataract have been observed.

Topics: Beta Particles; Combined Modality Therapy; Conjunctiva; Humans; Postoperative Care; Pterygium; Recurrence; Strontium Radioisotopes

To compare our results in the management of pterygium using a higher total dose with other reported results.. Between 1971 and 1991, 690 patients were treated with complete surgical excision followed by beta irradiation for primary or recurrent pterygium. Of these patients, 129 had two or more areas involving both eyes for a total of 825 lesions treated. Only 17 patients (2%) had temporal lesions with the rest of the patients having nasal pterygia. All patients underwent complete surgical resection of the pterygium before undergoing radiation therapy. One hundred forty-nine patients had undergone previous surgical resection alone but developed recurrence. After surgical excision, all patients were treated with Strontium-90 applicators starting immediately within 24 hr of surgery. Our standard policy was six weekly applications, each delivering a surface dose of 1000 cGy. The total dose delivered was 6000 cGy. Minimum follow-up was 1 year with a median of greater than 8 years.. There were only fourteen recurrences (1.7%) out of a total of 825 lesions treated. Nine of the fourteen patients received suboptimal therapy undergoing less than five applications of Strontium-90. There were no major complications.. The combination of surgical excision followed by adequate Strontium-90 applications is highly effective in the management of pterygium. The optimal total dose appears to be in the range of 2000 cGy to 6000 cGy.

Topics: Adult; Aged; Aged, 80 and over; Brachytherapy; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Pterygium; Strontium Radioisotopes

A pterygium is a benign, usually progressive fibrovascular overgrowth of the conjunctiva usually arising at the inner canthus of the eye which may cause local symptoms, particularly if large and impinging on the cornea. The treatment of choice for symptomatic pterygia is surgical excision, but early proliferation of fibroblasts and vascular buds leads to recurrence in a large proportion of cases. We review the published results of adjuvant postoperative beta irradiation using an ophthalmic applicator containing strontium-90 which is effective at reducing recurrence to an acceptable level. This treatment is well tolerated in the short term, and although a number of late sequelae are recognized, these are extremely uncommon in everyday clinical practice.

Topics: Combined Modality Therapy; Humans; Pterygium; Strontium Radioisotopes

Postoperative adjuvant treatment using β-radiotherapy (RT) is a proven technique for reducing the recurrence of pterygium. A randomized trial was conducted to determine whether a low fractionation dose of 2 Gy within 10 fractions would provide local control similar to that after a high fractionation dose of 5 Gy within 7 fractions for surgically resected pterygium.. A randomized trial was conducted in 200 patients (216 pterygia) between February 2006 and July 2007. Only patients with fresh pterygium resected using a bare sclera method and given RT within 3 days were included. Postoperative RT was delivered using a strontium-90 eye applicator. The pterygia were randomly treated using either 5 Gy within 7 fractions (Group 1) or 2 Gy within 10 fractions (Group 2). The local control rate was calculated from the date of surgery.. Of the 216 pterygia included, 112 were allocated to Group 1 and 104 to Group 2. The 3-year local control rate for Groups 1 and 2 was 93.8% and 92.3%, respectively (p = .616). A statistically significant difference for cosmetic effect (p = .034), photophobia (p = .02), irritation (p = .001), and scleromalacia (p = .017) was noted in favor of Group 2.. No better local control rate for postoperative pterygium was obtained using high-dose fractionation vs. low-dose fractionation. However, a low-dose fractionation schedule produced better cosmetic effects and resulted in fewer symptoms than high-dose fractionation. Moreover, pterygia can be safely treated in terms of local recurrence using RT schedules with a biologic effective dose of 24-52.5 Gy(10.).

Topics: Adult; Aged, 80 and over; Algorithms; Beta Particles; Dose Fractionation, Radiation; Eye Diseases; Female; Granuloma; Humans; Male; Middle Aged; Photophobia; Prospective Studies; Pterygium; Radiotherapy; Recurrence; Sclera; Strontium Radioisotopes; Treatment Outcome; Young Adult

To evaluate the effectiveness and safety of postoperative low single-dose of beta-irradiation (β-RT) in pterygium comparing conjunctival autograft (CAG) surgery with CAG plus adjuvant β-RT in a randomized clinical trial.. This trial was designed as a prospective, randomized, single-center study. Surgery was performed in all cases according to the CAG technique. One hundred and eight pterygia were postoperatively randomized to CAG + β-RT or CAG alone. In the case of β-RT, a (90) Sr eye applicator was used to deliver 10 Gy to the sclera surface at a dose rate of between 200 and 250 cGy/min. After treatment, both an ophthalmologist and a radiation oncologist performed the follow-up examinations. The accumulated data were analyzed using a group sequential test.. Between February 2008 and September 2008, 116 eyes with primary pterygium were operated on according to the trial protocol. Adjuvant treatment was performed within 24 h postoperatively. Eight patients were lost to follow-up, resulting in 108 patients who could be analyzed. At a mean follow-up of 18 months (range, 8-33), in the 54 eyes randomized to receive CAG + β-RT, 5 relapses occurred compared with 12 recurrences in the 54 eyes in CAG, for a crude control rate of 90.8 % vs. 78%; p = 0.032, respectively. The treatment complications as hyperemia, total dehiscence of the autograft and dellen were significantly more frequent in the CAG (p < 0.05). The arm of β-RT resulted in better cosmetic results and improves of symptoms than CAG.. A low single-dose of β-RT of 10 Gy after CAG surgery was a simple, effective, and safe treatment that reduced the risk of primary pterygium recurrence, improved symptoms after surgery, resulting in a better cosmetic effect than only CAG.

Topics: Adult; Aged; Aged, 80 and over; Conjunctiva; Female; Follow-Up Studies; Humans; Hyperemia; Male; Middle Aged; Prospective Studies; Pterygium; Radiotherapy Dosage; Radiotherapy, Adjuvant; Recurrence; Strontium Radioisotopes; Surgical Wound Dehiscence; Treatment Outcome; Young Adult

Postoperative adjuvant treatment with strontium-90 radiation therapy (RT) is a proven technique for reducing the recurrence of pterygium. This randomized trial was conducted to evaluate whether a total dose of 40 Gy provides a better local control rate than a total dose of 30 Gy for surgically resected pterygia.. A single institutional randomized trial was conducted. Between 1999 and 2003, 74 pterygia in 71 patients were randomly allocated to 30 Gy/3 fractions/15 days (arm A) or to 40 Gy/4 fractions/22 days (arm B). Only primary pterygia for which RT could be started within 3 days of surgical resection were included. Postoperative RT was given by a strontium-90 eye applicator, and a dose of 10 Gy per fraction was delivered in weekly fractions (day 1, 8, 15, 22).. Of the 74 pterygia treated, 73 in 70 patients were analyzed. Of the 73 pterygia, 41 were allocated to arm A, and the remaining 32 to arm B. The 2-year local control rates for arm A and arm B were 85% and 75%, respectively, without significant difference. No serious acute and late complications were noted in either arm.. Our new standard fractionation for postoperative RT for pterygia is 30 Gy/3 fractions.

Topics: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Dose Fractionation, Radiation; Dose-Response Relationship, Radiation; Female; Humans; Male; Middle Aged; Pterygium; Radiotherapy, Adjuvant; Strontium Radioisotopes

To evaluate the long-term safety, effectiveness, and prognostic factors of fractionated postoperative beta-irradiation.. Between 1993 and 2005, 623 patients with 737 pterygium lesions were treated with a strontium-90 eye applicator after surgical excision. The median follow-up period was 60 months (range, 6.7-139.5). Of the 737 lesions, 644 were primary and 93 were recurrences after surgical removal alone. Fractionated radiotherapy (RT) to a total dose of 35 Gy in five to seven fractions was used.. A total of 73 local pterygium recurrences (9.9%) were noted. Of the recurrent cases, 80% were noted within 3 years after treatment. The 5- and 10-year probability of local control was 90% and 88%, respectively. The multivariate analysis for all cases demonstrated that gender, age, total radiation dose, recurrent pterygia, and interval between surgery and RT affected the overall local control rate. Late toxicities that might have been associated with strontium-90 RT included scleromalacia (scleral thinning) in nine eyes, adhesion of the eyelids in eight, cataracts in six, and scleral ulcer in five eyes.. Fractionated strontium-90 RT to a total dose of approximately 35 Gy in five to seven fractions results in a similar local control rate as higher doses in other series, with an acceptable complication rate.

Topics: Adult; Aged; Aged, 80 and over; Brazil; Comorbidity; Dose Fractionation, Radiation; Female; Humans; Incidence; Longitudinal Studies; Male; Middle Aged; Prognosis; Pterygium; Radiation Injuries; Radiopharmaceuticals; Risk Assessment; Risk Factors; Strontium Radioisotopes; Treatment Outcome

To evaluate long term results and to demonstrate safety and efficacy of non-surgical, exclusive strontium-/yttrium-90 beta irradiation of non-operated pterygia.. Between March 1977 and April 1999, 43 patients with 54 primary pterygia were treated with an exclusive strontium-/yttrium-90 beta-irradiation up to a total dose of 50 Gy divided in four fractions with one week apart. All patients were referred from the same ophthalmologist. The average follow-up were 112(+/-88 months (range, 12-321 months), median 96 months.. The patients were referred with early symptomatic manifestations of pterygia with a mean horizontal diameter of 1.6+/-0.7 mm (range, 0.5-4.5 mm), which shrank to a mean diameter of 0.9+/-0.6 mm (range, 0-2.5 mm) after irradiation (P<0.005). There was a reduction of size in every pterygium, none of the 54 pterygia developed a recurrent growth and there were no patient with any late side effect. Following the strontium-/yttrium-90 application the process came up with an obliteration of the vessels, which resulted in a grey, thin and avascular pannus.. Strontium-/yttrium-90 beta-irradiation as an exclusive, non-surgical treatment for early pterygia provides a significant reduction of the size of the irradiated pterygia, is a safe and effective therapy to prevent a recurrence and can be performed without late side effects.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pterygium; Radiation Injuries; Strontium Radioisotopes; Treatment Outcome; Yttrium Radioisotopes

To affirm the effectiveness and complication rate of postoperative single-dose beta-irradiation (RT) with (90)Sr in the case of primary pterygium in a clinical trial. Pterygium is a benign disease of the supporting orbital tissue that can cause impairment of visual function. Depending on the technique used for surgery, recurrence is described in up to 70% of cases-a reason to combine the initial treatment with radiotherapy or chemotherapy.. This trial was designed as a prospective, randomized, multicenter, double-blind study. Surgery was performed in all cases according to the bare sclera technique. Ninety-one patients with 96 pterygia were postoperatively randomized to either beta-RT or sham RT. In the case of beta-RT, a (90)Sr eye applicator was used to deliver 2500 cGy to the sclera surface at a dose rate of between 200 and 250 cGy/min. Sham RT was given using the same type of applicator without the (90)Sr layer. After treatment, both an ophthalmologist and a radiation oncologist performed the follow-up examinations. The accumulated data were analyzed using a group sequential test.. Between February 1998 and September 2002, 96 eyes with primary pterygium were operated on according to the trial protocol. Additional treatment was performed within 24 hours postoperatively. Ten patients were lost to follow-up, resulting in 86 patients who could be analyzed. In the 44 eyes randomized to receive beta-RT, 3 relapses occurred compared with 28 recurrences in the 42 eyes that received sham RT, for a crude control rate of 93.2% vs. 33.3%, respectively. At a mean follow-up of 18 months, major treatment complications had not been observed.. Single-dose beta-RT after bare sclera surgery is a simple, effective, and safe treatment that reduces the risk of primary pterygium recurrence.

Topics: Adult; Aged; Combined Modality Therapy; Double-Blind Method; Female; Humans; Male; Middle Aged; Prospective Studies; Pterygium; Secondary Prevention; Strontium Radioisotopes

The long-term safety and effectiveness of fractionated strontium-90 radiation therapy (RT) for pterygium were reviewed retrospectively.. Between 1984 and 1996, 399 patients with 490 pterygia were treated with a strontium-90 eye applicator following surgical removal of the pterygium. The median follow-up period was 61 months (range 2-178). Of the 490 pterygia, 452 were fresh, 17 were recurrences after surgical removal alone, and 21 were recurrences after surgical removal plus postoperative RT. Fractionated RT of 31-42 Gy/4-5 fractions/22-29 days was given for 95.1% of the pterygia.. In total, 58 (11.8%) local recurrences of pterygia were noted. The median time of local recurrences was 10 months, ranging from 2 to 93 months, and 16 recurrences (28%) were noted later than 24 months after treatment. The interval between surgery and the start of RT (1-3 days vs. >3 days) and recurrent pterygia were significant variables for local control in the multivariate analysis, while total RT dose (7-29 Gy vs. 31-50 Gy) was a marginally significant variable. Late toxicities that may be associated with strontium-90 RT were scleromalacia (scleral thinning) in 4 eyes, adhesion of eyelids in 3 eyes, and scleral ulcer in 2 eyes.. Fractionated strontium-90 RT of approximately 40 Gy/4-5 fractions was safe and effective for preventing recurrence of pterygia, when RT was started within 3 days of surgery.

Topics: Adult; Aged; Aged, 80 and over; Dose Fractionation, Radiation; Female; Humans; Male; Middle Aged; Multivariate Analysis; Pterygium; Retrospective Studies; Strontium Radioisotopes; Time Factors; Treatment Outcome

To compare our results in the management of pterygium using a higher total dose with other reported results.. Between 1971 and 1991, 690 patients were treated with complete surgical excision followed by beta irradiation for primary or recurrent pterygium. Of these patients, 129 had two or more areas involving both eyes for a total of 825 lesions treated. Only 17 patients (2%) had temporal lesions with the rest of the patients having nasal pterygia. All patients underwent complete surgical resection of the pterygium before undergoing radiation therapy. One hundred forty-nine patients had undergone previous surgical resection alone but developed recurrence. After surgical excision, all patients were treated with Strontium-90 applicators starting immediately within 24 hr of surgery. Our standard policy was six weekly applications, each delivering a surface dose of 1000 cGy. The total dose delivered was 6000 cGy. Minimum follow-up was 1 year with a median of greater than 8 years.. There were only fourteen recurrences (1.7%) out of a total of 825 lesions treated. Nine of the fourteen patients received suboptimal therapy undergoing less than five applications of Strontium-90. There were no major complications.. The combination of surgical excision followed by adequate Strontium-90 applications is highly effective in the management of pterygium. The optimal total dose appears to be in the range of 2000 cGy to 6000 cGy.

Topics: Adult; Aged; Aged, 80 and over; Brachytherapy; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Pterygium; Strontium Radioisotopes

A retrospective study was done of 338 patients with pterygia treated between October 1974 and May 1990. These patients resided in the desert of the southwestern United States, where the hot, dry, dusty climate is thought to predispose to pterygium formation and subsequent recurrence. The pterygia were excised, and the administration of beta irradiation was initiated within 24 hr of surgery. Sixteen percent of the pterygia were recurrent. Ninety-five percent of the beta irradiation prescriptions consisted of 3 weekly 800 cGy fractions. For patients with a minimum of 6 months follow-up, the crude local control rate was 225/258 (88%). The Kaplan-Meier estimate of the 5-year local control rate was 84% (95% confidence interval: 79-89%). Ten of 33 recurrences were diagnosed within 6 months, and 32/33 recurrences were diagnosed within 5 years of treatment. Previously untreated pterygia were controlled more easily than were recurrent pterygia (p = 0.005). In 86% of the cases, patients judged the cosmetic results to be satisfactory. No severe complications developed. This study and others, when compared with studies involving excision alone, suggest that postoperative beta irradiation reduces the likelihood for pterygium recurrence. When the beta irradiation is fractionated, satisfactory cosmetic results can be achieved with low morbidity.

Topics: Adult; Aged; Beta Particles; Cataract; Combined Modality Therapy; Humans; Middle Aged; Pterygium; Radiotherapy Dosage; Recurrence; Strontium Radioisotopes

It is known that pterygia above a certain size cause astigmatism and other aberrations of the human cornea and thus impair the quality of vision. Exclusive Sr-/Ytt-90 beta irradiation is a highly effective treatment for primary pterygia. The aim of this retrospective study is to determine the extent to which higher order corneal aberrations are affected by this treatment.. Evaluation of corneal topographies and wavefront aberration data of 20 primary pterygia patients generated before and at different points in time in the first year after irradiation. Additionally, the size of the pterygium was measured.. The study showed a significant increase in coma and triple leaf aberrations in pterygia with a horizontal length of 2 mm and more. It was also found that a pterygium size greater than 2 mm significantly induces astigmatism. Both phenomena reduce visual quality. In none of the patients could a pterygium recurrence be detected after irradiation.. If the pterygium size is less than 2 mm, early exclusive Sr/Ytt-90 beta irradiation can be recommended. If the size is more than 2 mm, a pterygium excision 6 months after beta irradiation can be discussed.

Topics: Adult; Aged; Biosensing Techniques; Cornea; Female; Humans; Male; Middle Aged; Pterygium; Retrospective Studies; Strontium Radioisotopes; Yttrium Radioisotopes

Topics: Female; Humans; Male; Pterygium; Strontium Radioisotopes

To study the long-term effects of low-dosage strontium-90 (Sr90) irradiation on the recurrence of pterygium.. One hundred twenty eyes from 104 patients with primary or recurrent pterygia were treated with surgery followed by Sr90 irradiation. In brief, starting on the sixth day after surgery, patients were treated with irradiation three times every other day at a total combined dosage of 2000 cGy to 3000 cGy. Corneal topography was used to evaluate ocular surface regularity before and after treatment. Patient follow-up was performed 2 days, 5 days, 2 weeks, 1 month, 3 months, 1 year, 5 years, and 10 years after surgery. Recurrence of pterygium was not observed in any of the patients in this study. Obvious cataract progression was observed in 6 eyes, which may be due to aging. During follow-up studies, only one eye was reported with dryness and foreign-body sensation. Significant pterygium-induced astigmatism was observed in corneal topography, which decreased after surgery.. Sr90 irradiation is effective in preventing the recurrence of primary and recurrent pterygia. We recommend delivering a total combined dosage of 2000 cGy to 3000 cGy of Sr90 irradiation administered in three batches every other day starting from the sixth day after surgery. Surgery is important in the rapid recovery of the cornea from pterygium-induced astigmatism.

Topics: Adult; Aged; Astigmatism; Cataract; Cornea; Corneal Topography; Humans; Middle Aged; Ophthalmology; Pterygium; Radiotherapy; Recurrence; Strontium Radioisotopes; Time Factors; Treatment Outcome

Scleromalacia is a rare but serious complication following excision of an atypical pterygium and postoperative radiation which needs immediate action and treatment. In this case report we describe a successful method for treating this condition with amniotic membrane transplantation. Despite severe blepharoconjunctivitis the patient is now free of recurrence of pterygium for 3 years supporting the use of amnion membranes for covering scleromalacia in inflammatory conditions.

Topics: Aged, 80 and over; Biological Dressings; Conjunctiva; Conjunctival Diseases; Humans; Male; Postoperative Complications; Pterygium; Radiation Injuries; Radiotherapy, Adjuvant; Reoperation; Sclera; Scleral Diseases; Strontium Radioisotopes; Ulcer

To evaluate the consecutive treatment results regarding pterygium recurrence and the efficacy of exclusive strontium-/yttrium-90 beta-irradiation for primary and recurrent pterygia and to analyze the functional outcome.. Between October 1974 and December 2005, 58 primary and 21 recurrent pterygia were exclusively treated with strontium-/yttrium-90 beta-irradiation with doses ranging from 3,600 to 5,500 cGy. The follow-up time was 46.6 +/- 26.7 months, with a median of 46.5 months.. The treatment led to a size reduction in all pterygia (p < 0.0001). Neither recurrences nor side effects were observed during therapy and follow-up in this study. Best-corrected visual acuity increased (p = 0.0064). Corneal astigmatism was reduced in recurrent pterygia (p = 0.009).. Exclusive strontium-/yttrium-90 beta-irradiation of pterygia is a very efficient and well-tolerated treatment, with remarkable aesthetic and rehabilitative results in comparison to conventional treatments, especially for recurrent lesions which have undergone prior surgical excision.

Topics: Adult; Aged; Aged, 80 and over; Astigmatism; Beta Particles; Brachytherapy; Esthetics; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pterygium; Radiotherapy Dosage; Recurrence; Retreatment; Strontium Radioisotopes; Visual Acuity; Yttrium Radioisotopes

Irradiation of ocular pterygium is considered a valuable treatment supplementation after surgical therapy. Since prospective randomized trials are scare and only limited patient data are available, the aim of this study was to evaluate the patient population treated with fractioned 90Sr irradiation after surgical pterygium resection.. Between September 1993 and March 2001, 1,147 patients with pterygium lesions (1,320 lesions) were treated surgically and with 90Sr postoperative beta-irradiation. A total dose of 30 Gy was used for patients treated within 48 h after surgery, while those treated>48 h postoperatively received a total dose of 35 Gy. A minimum follow-up period of 3 months was required for inclusion in the analysis, and 1,253 lesions were ultimately analyzed.. Recurrence of the pterygium after postoperative 90Sr irradiation was observed in 97 of 1,253 cases (7.7%). Statistical analysis (uni- and multivariate) revealed, that male gender, younger age (<40 years), prior treatment (surgery and radiotherapy) and immediate irradiation (<2 h after surgery) were negative predictors for local recurrence. Temporary radiotherapy-induced side effects were observed in 15.2% of patients, including moderate conjunctivitis, local pain, visual disturbance and photophobia or an increase in tear flow. However, no long-term serious side effects were documented.. 90Sr irradiation of pterygium after surgery represents a safe and effective treatment option to prevent disease recurrence. The data obtained in this study indicate that a certain interval after surgery might improve therapy outcome.

Topics: Adult; Beta Particles; Combined Modality Therapy; Data Interpretation, Statistical; Dose Fractionation, Radiation; Female; Follow-Up Studies; Hospitals, University; Humans; Japan; Male; Middle Aged; Postoperative Care; Pterygium; Radiotherapy; Radiotherapy Dosage; Recurrence; Retrospective Studies; Strontium Radioisotopes; Time Factors

Topics: Combined Modality Therapy; Humans; Pterygium; Randomized Controlled Trials as Topic; Secondary Prevention; Strontium Radioisotopes

The aim of this study was to compare 5-fluorouracil (5-FU) with beta-irradiation in the prevention of pterygium recurrence. A retrospective non-randomised review of cases of fleshy pterygium treated with bare scleral excision and adjuvant 5-FU were compared with similar morphologically appearing pterygia, matched for age and sex, treated with bare scleral excision and adjuvant beta-irradiation. All surgeries were carried out at the university college hospital and Ojulowo eye hospital, Ibadan, Nigeria. Twenty-seven eyes of 24 patients who had pterygium excision with adjuvant treatment with 5-FU were compared with 31 eyes of 24 patients who were treated with excision and beta-irradiation. The mean age for the 5-FU group was 46.1 years while that for the beta-irradiation group was 46.9 years. Both sexes were equally represented, 12 males and 12 females. There were seven (25.9%) initial recurrences in the 5-FU group but four of these became atrophic, and therefore, cosmetically acceptable leaving three eyes (11%) with unacceptable recurrent pterygia. The beta-irradiation group, however, had seven (22.5) initial recurrence but five of these became atrophic and fell short of the cornea, leaving two (6.5%) with clinically unacceptable recurrence. The difference was, however, not statistically significant (Zc = 0.74 and p > 0.1). The associated complications were mostly mild in both groups and included cornea opacity of 10 (37%) complications, conjunctivitis of three (11%) complications, sclera granuloma of three (11%) complications and conjunctiva necrosis of one (3.7%) complication for the 5-FU group, and while the beta-irradiation group had corneal opacity of one (3.7%) complication and conjunctivitis of three (11%) complications. The non-statistical significance of a lower-pterigium recurrence rate with use of beta-irradiation for the treatment of fleshy pterygium compared with 5-FU may have been partly due to the small number of patients studied. A randomised-controlled study using a larger sample size is therefore proposed. However, the fact that over half of those with initial recurrence in the 5-FU group became atrophic (and therefore cosmetically acceptable) over time as well as less cost implication in the purchase of 5-FU relative to Strontium-90 association with few and mild complications makes it a desirable adjuvant therapy in depressed economies. However, beta-irradiation still has a place when cost issue is not an inhibiting factor in view of its

Topics: Antimetabolites; Beta Particles; Combined Modality Therapy; Female; Fluorouracil; Humans; Male; Middle Aged; Pterygium; Retrospective Studies; Secondary Prevention; Strontium Radioisotopes; Treatment Outcome

A retrospective review of cases of pterygium excision using the bare sclera method followed by application of 2500-3500 rads of Sr 90 beta-radiation carried out between 1994 and the year 2000 at Ojulowo Eye clinic Ibadan and St Mary's Catholic Specialist Eye Hospital Ago-Iwoye, Nigeria. Follow up period was between six months and six years. A total of 124 eyes from 95 patients were operated. 58 (61.1%) were males and 37 (38.9%) were females. The youngest patient was 10 years old while the oldest was 89 years mean 46.1 +/- 2 STD of 13.5. Most pterygia were unilateral and nasal in location. Improvement in visual acuity of between 2-6 lines on snellen chart occurred in 6 (4.8%) of operated eyes. Recurrence necessitating repeat surgery and additional radiation occurred in 8 eyes (6.9%). The complications of surgery and beta radiation consisted of conjunctiva inflammation 10 (8.6%), cornea opacities 4 (3.2%), gritty sensation 3 (2.6), cataract 1 (0.8%). No case of sclera necroses was observed. Post-operative beta-radiation is safe and effective in preventing recurrence of pterygium.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Beta Particles; Child; Female; Humans; Male; Middle Aged; Occupational Exposure; Occupations; Postoperative Care; Pterygium; Radiotherapy, Adjuvant; Recurrence; Retrospective Studies; Strontium Radioisotopes; Sunlight; Treatment Outcome; Visual Acuity; Yttrium Radioisotopes

[corrected] In the Institute of Radio-Oncology in Lucerne we reviewed the records of 75 patients with 97 pterygia in a retrospective study. All patients had the same number of fractions (4), the same single fraction dose (1250cGy) and the same total dose (5000cGy). The operation technique used was the bare sclera technique. Patients were treated following three different concepts. The first group was treated prior to the operation, 1 fraction weekly, at least 2 months before operation. The second group was treated postoperatively, also one fraction weekly, immediately after operation. The third group received 2 fractions prior to and 2 fractions following operation.. We observed only 2 out of 97 (2%) recurrences in the second group. Because of their clinically inactive behavior these two cases required no further treatment. Three patients showed teleangiectasia as a moderate reaction. As a severe complication we observed one ulcus corneae, which was successfully treated with a lamellar keratoplasty, for a complication rate of 1%.. Beta irradiation has proved to prevent pterygium recurrence. Severe late complications after excision and B-irradiation may partly be caused by other factors than irradiation alone. But it seems unequivocal that there is a relation with the high single-dose procedure of more than 2200cGy or re-irradiation. Fractionation must therefore be used.

Topics: Combined Modality Therapy; Dose Fractionation, Radiation; Female; Humans; Male; Pterygium; Radiotherapy Dosage; Retrospective Studies; Strontium Radioisotopes; Yttrium Radioisotopes

The purpose of this retrospective analysis is to assess the effectiveness of postoperative irradiation with a strontium 90 (Sr-90) contact applicator in the prevention of recurrence of resected pterygia.. Thirty five patients were treated with Sr-90 postoperative radiation therapy performed immediately after surgery. The dose of irradiation was 2500 cGy in five fractions using a standard Sr-90 applicator.. The local control rate was 94.6% in the first year after surgery. Pterygia eventually recurred in 5.8% of the 52 eyes treated. In our study primarily treated patients remained recurrence free, but recurrences developed in three eyes irradiated after multiple previous excisions. No patient developed conjunctival ulceration, damage to cornea, eye pain, cataract or any other serious complications.. Postoperative irradiation was effective in preventing local recurrence after surgical removal of pterygium. In our experience, acute and late morbidity up to three years is nil. A very satisfactory dose/time/fractionation appears to be of 2500 cGy in 5 fractions starting immediately after surgical excision.

Topics: Brachytherapy; Female; Humans; Male; Middle Aged; Postoperative Care; Pterygium; Retrospective Studies; Secondary Prevention; Strontium Radioisotopes; Treatment Outcome

Analysis of effectiveness of perioperative 20 kV soft X-ray irradiation in recurrent pterygium as an alternative to postoperative 90Sr beta irradiation.. Between 1987 and 2000 a total of 65 patients with 81 pterygia were treated with 20 kV X-ray therapy in the course of surgical treatment of recurrent pterygium. Until 1995 simple excision (bare sclera technique) followed by postoperative irradiation (generally four fractions of 5 Gy) was applied, with radiation starting on mean 4 days following surgery (34 cases, mean follow-up 52 months). Since 1995 we have changed our policy to a perioperative regimen starting with a single dose of 7 Gy prior to microsurgical excision with conjunctival autograft and proceeding within 24 hours with 5 Gy single dose to the surgical bed and then every other day to a total dose of 27 Gy (47 cases, mean follow-up 31 months). Recurrence rate was calculated by Kaplan Meier method. A multivariate Cox regression analysis of prognostic factors for recurrence was performed.. A total of 19 recurrences were observed, 15 in the historical postoperative group and four in the perioperative group. Actuarial 2- and 5-year recurrence rate is 9% in the "new treatment group" compared to 34% and 56% in the historical group (p = 0.001). Only one of the four recurrences among the pre- and postoperatively irradiated group required a new surgical procedure. In this case radiation had been terminated at 17 Gy. Actuarial rate of surgical reintervention was only 2% at 2 and 5 years compared to 28% and 36% in the historical group. In multivariate Cox regression analysis only the new treatment strategy was found to influence control rate significantly. Until now no case of severe side effects like scleral necrosis or thinning, symble-pharon, radiation-induced cataract or glaucoma were observed in both groups.. The combination of pre- and postoperative 20 kV X-ray therapy and microsurgical excision combined with conjunctival autograft is a highly effective treatment to prevent recurrence in the high-risk group of recurrent pterygia and can be recommended as an alternative to postoperative 90Sr beta irradiation.

Topics: Actuarial Analysis; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pterygium; Radiotherapy Dosage; Recurrence; Strontium Radioisotopes

To evaluate the efficacy of postoperative beta irradiation and to analyze treatment sequelae in patients with primary and recurrent pterygium.. From June 1986 to June 1998, 94 patients corresponding to 100 eyes received postoperative beta irradiation. Two groups of patients were treated: 37 eyes with primary pterygium (Group I) and 63 eyes with recurrent pterygium (Group II). Terson technique surgery was used in the majority of patients. Time between surgery and beta irradiation ranged from 2 to 48 h. Radiation doses and fractionation consisted of 30 Gy/3 fractions/5 days in 17 cases, 60 Gy/6 fractions/6 weeks in 80 cases, and 20 Gy/1 fraction in 3 patients.. Fourteen of the 100 cases (14%) treated with surgery and adjuvant irradiation recurred. The overall crude local recurrence rates were 5.4% for Group I and 19% for Group II patients. The 5-year probability of local tumor control was 83.5% for the whole group of patients, 94% for Group I, and 76.9% for Group II (p = 0.04). The early sequelae related to surgery or irradiation were self limited and disappeared by 6 months after the end of the treatment: ocular irritation (14 cases), scleral atrophy (5 cases), and neovascularization (7 cases). A greater incidence of sequelae was observed in Group II patients, but the difference between the groups was not statistically significant (p = 0.15). No significant correlation between treatment sequelae and treatment dose was noted: 29% sequelae with 30 Gy vs. 18.7% sequelae with 60 Gy (p = 0.32). No late complications have been observed.. Adjuvant beta irradiation provides effective therapy for primary pterygium, is somewhate less effective in patients with recurrent pterygium, and is associated with a moderate rate of early and transient sequelae.

Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Period; Pterygium; Radiotherapy, Adjuvant; Recurrence; Strontium Radioisotopes

Topics: Adult; Aged; Beta Particles; Brachytherapy; Disease-Free Survival; Dose-Response Relationship, Radiation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pterygium; Recurrence; Retrospective Studies; Strontium Radioisotopes; Surgical Flaps

Aim of the study was the evaluation of the role of adjuvant radiation therapy in the prevention of recurrence after excision.. Between July 1, 1985 and April 1, 1993, 64 patients (43 male, 21 female) were referred to radiation therapy after excision of a nasal pterygium. Radiation therapy was done with a strontium-90 eye applicator and a total dose of 30 Gy, fractionated in 6 fractions of 5 Gy each, 3 times a week. Forty-nine patients were treated primarily, 15 patients underwent radiation therapy for the first time in case of recurrent pterygium after multiple re-excisions. All patients had a following of 1 to 9 years with a median of 5.5 years.. In 8 of 64 irradiated patients recurrent pterygium was detected (12.5%). Differentiated into the 2 groups 4 of the primarily treated patients had recurrent pterygium (8.16%), the other 4 were in the group with multiple former re-excisions (26.7%). With regard to the initiation of the irradiation after surgery pterygium did not recur in any of the primarily treated patients who were irradiated in between 3 days after surgery. In contrary 3 of 7 primarily treated patients (42.9%) who started radiation therapy between 7 and 10 days after surgery had recurrent pterygium. For the patients with primarily recurrent pterygium no dependence of the initiation of radiation therapy after surgery could be detected.. Adjuvant radiation therapy after excision of pterygium lowers the rate of recurrence from about 40% to 12.5%, in a primarily adjuvant situation to 8.16%. In these patients radiation therapy should be initiated within 3 days after surgery. Patients with primarily recurrent pterygium have an elevated risk of recurrence independently of the initiation of radiation therapy.

Topics: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Postoperative Care; Pterygium; Radiotherapy Dosage; Recurrence; Strontium Radioisotopes; Time Factors

The aim of the present study was the evaluation of the role of adjuvant radiation therapy in the prevention of recurrence after excision. Between July 1, 1985, and April 1, 1993, 64 patients (43 men, 21 women) were referred for radiation therapy after excision of a nasal pterygium. All patients were followed for 1-9 years (median 5.5 years). Radiation therapy was done with a strontium 90 eye applicator at a total dose of 30 Gy fractionated into six fractions of 5 Gy each. In all, 49 patients were treated after their first excision and 15 patients had undergone multiple prior excisions. In 8 of 64 irradiated patients, recurrent pterygium was detected (12.5%); 4 recurrences developed after first excision and adjuvant radiation therapy (8.16%) and the other 4, following multiple former reexcisions and radiotherapy (26.7%). Pterygium did not recur in any of the primarily treated patients who were irradiated within 3 days of surgery. In contrast, 3 of 7 accordingly treated patients (42.9%) who started radiation therapy at between 7 and 10 days after surgery developed recurrent pterygium. Adjuvant radiation therapy after excision of pterygium lowers the overall rate of recurrence to 12.5%. In an adjuvant situation after first excision, radiation therapy should be initiated within 3 days of surgery, the result being freedom from recurrence.

Topics: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pterygium; Radiotherapy, Adjuvant; Recurrence; Retrospective Studies; Strontium Radioisotopes; Treatment Outcome

Topics: Aged; Female; Humans; Male; Middle Aged; Postoperative Care; Pterygium; Radiation Injuries; Strontium Radioisotopes

Beta-radiation has been used since 1950 as a postoperative measure to reduce the recurrence of pterygia. Scleral necrosis has been a major complication after radiotherapy that has led to perforation of the globe, endophthalmitis, and visual loss in some cases.. A patient is presented in whom scleral necrosis developed 25 days after a pterygiectomy with bare sclera technique followed by 3000 cGy in 3 weekly, divided doses of strontium 90. After a conjunctival graft failure, the patient was treated with hyperbaric oxygen therapy.. The sclera revascularized and returned to nearly normal thickness after 14 sessions of hyperbaric oxygen therapy.. Hyperbaric oxygen therapy may be an effective treatment for acute scleral necrosis after postoperative beta-radiation.

Topics: Adult; Humans; Hyperbaric Oxygenation; Male; Necrosis; Pterygium; Radiation Injuries; Radiotherapy, Adjuvant; Sclera; Strontium Radioisotopes

Postoperative adjuvant strontium-90 beta-ray therapy is a proven technique for reducing the recurrence rate of pterygium. A wide variety of doses and fractionation schemes have been used in the application of the radiation. There have been recent reports of significant rates of late-occurring complications after single-fractioned treatment. Compared with a single-dose application, fractionation would only offer a therapeutic benefit if recurrence prevention were an early-responding tissue phenomenon, in contrast to late-responding sequellae. We investigate this point with a view to elucidating better treatment protocols for postoperative beta-ray therapy for pterygium.. We use the linear-quadratic formalism to analyze published nonrecurrence rates, as a function of dose and fraction number, to obtain a value for the parameter alpha/beta, which is an indicator of whether nonrecurrence is an early or late-responding phenomenon.. The estimated value of the linear-quadratic parameter, alpha/beta, is 25 Gy, with 90% confidence limits of +/- 9 Gy. This large value unequivocally suggests that nonrecurrence is an early responding phenomenon, implying that fractionation should give an increased therapeutic ratio between nonrecurrence and late sequellae.. Compared with a single-fractioned treatment, an improved therapeutic ratio (nonrecurrence vs. complications) would be expected from fractionated application of the beta-ray therapy. Given the parameters obtained from fitting literature data, we calculate guidelines for the dose/fraction schemes that should give equivalent disease control to different single-fraction applications, but should reduce the incidence of late-occurring sequellae.

Topics: Combined Modality Therapy; Humans; Pterygium; Radiotherapy Dosage; Recurrence; Strontium Radioisotopes

Beta irradiation with strontium 90 has been associated with significant iatrogenic disease, causing such complications as ptosis, symblepharon, iridic and scleral atrophy, cataracts, and endophthalmitis. We studied 171 eyes in 140 patients treated and followed up during a 17-year period from 1973 to 1990. We sought to show that a single small dose of radiation administered immediately after surgical excision not only prevents decrease recurrence, but also avoids significant complication. Pterygia recurred in 14 (8%) of the 171 eyes treated. Six of these recurrences were corneal and eight were conjunctival. Complications were seen in five (3%) of the 171 eyes treated. All were minor except for one case of scleral thinning in a diabetic patient. Optimal radiation dosage to avoid significant recurrence in this adult population is a single dose of 2,000 rads using a bare sclera technique that vaults the limbus.

Topics: Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Pterygium; Radiotherapy; Recurrence; Strontium Radioisotopes; Treatment Outcome

Although postoperative beta irradiation for prevention of pterygium recurrence is widely used, its complication rate has not been widely appreciated. Thirty-six patients underwent pterygium excision followed by irradiation with 90Sr to between 1600 and 5300 cGy (median 2400) in two to four fractions over 7 to 27 days. A median of three fields were used in each treatment course (range two to 10). Most patients had undergone previous treatment for their pterygia, including surgery alone (25 patients), or both surgery and irradiation (5 patients). Overall, recurrences developed in 10 eyes (28%). Recurrence occurred in one eye after re-irradiation (20%), compared to 9 of 31 (29%) previously non-irradiated eyes (p greater than 0.1). There was no association with number of excisions and recurrences, although all but 6 patients had undergone more than one excision. Thirteen patients (36%) developed complications including: epithelial defect or corneal thinning (3), symblepharon (5), cataract (4) and corneal ulceration (1). Complications developed in 4 of the 5 (80%) re-irradiated eyes compared to 9 of 31 (29%) previously non-irradiated eyes (p less than 0.05). The power of the statistical analysis was limited by sample size, but no significant association was observed between the development of complications or recurrences and total dose, number of abutting fields, number of previous surgical excisions or patient age, even when re-irradiated patients were excluded. Recently described calibration uncertainties with the 90Sr applicator may explain in part these complications. Alternatively, technical factors such as the number of fields or volume treated may play a role. Excessive complications and recurrences with the use of postoperative beta irradiation in this series emphasize the danger of re-treatment and the need for alternative safe and effective therapies.

Topics: Adolescent; Adult; Aged; Beta Particles; Child; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pterygium; Radiotherapy; Recurrence; Retrospective Studies; Strontium Radioisotopes

A retrospective evaluation was performed with records of 128 patients with 146 eyes that underwent applications of strontium-90 after pterygium excisions performed between 1982 and 1988. With a median follow-up of 13 months, 135 eyes were evaluable. Most pterygia (127 of 135) were treated with a single postoperative application of Sr-90 that delivered 3,000 cGy of beta radiation in one fraction. The actuarial freedom from relapse was 87%; all recurrences occurred within the first 18 months, and 46% of these within the first 3 months. Of the 13 recurrences, 10 have been re-treated with surgery and a second course of beta irradiation with excellent results. All eight eyes for which follow-up was available had no evidence of disease. The ultimate control rate was 96.3% for the series. Correlation of various treatment parameters, including age, bilaterality, prior recurrence, and interval from surgery to irradiation, was performed, and no statistically significant difference was seen. No serious complications have developed. Transient conjunctivitis and photophobia were almost universally seen, with five cases lasting beyond 5 months. The authors conclude that a single application of Sr-90 after surgery is effective and safe in managing pterygia.

Topics: Adult; Aged; Combined Modality Therapy; Humans; Middle Aged; Pterygium; Radiotherapy Dosage; Recurrence; Retrospective Studies; Strontium Radioisotopes

Recurrent pterygia in 42 patients (48 eyes) were treated locally with strontium-90 irradiation from May 1967 to May 1988. The 31 male patients had an average age of 52 years; the 11 female patients, 46 years. All patients underwent surgical resection of the recurrent pterygia with use of the bare-sclera technique. During the immediate postoperative period the surgical site was treated with an Sr-90 applicator (beta irradiation). Doses ranged from 10 to 70 Gy (average, 50 Gy). Follow-up times ranged from 8 to 136 months (median, 14 months). The local control rate was 89%. Four of the five recurrences were in patients treated with doses of 1,000-1,500 cGy (P less than .0002). None of the patients developed cataracts or any other serious complications.

Topics: Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Care; Pterygium; Radiotherapy Dosage; Recurrence; Retrospective Studies; Sclera; Strontium Radioisotopes

Topics: Adult; Aged; Combined Modality Therapy; Evaluation Studies as Topic; Female; Humans; Intraoperative Period; Male; Middle Aged; Pterygium; Radioisotope Teletherapy; Recurrence; Strontium Radioisotopes

Details of the Strontium-90 Eye Application including equipment, irradiation technique, radiation safety and data are presented.

Topics: Brachytherapy; Humans; Pterygium; Strontium Radioisotopes

Topics: Calibration; Humans; Pterygium; Strontium Radioisotopes

Topics: Brachytherapy; Humans; Pterygium; Retrospective Studies; Strontium Radioisotopes

Results of 483 cases of pterygia treated with surgery and prophylactic postoperatory beta therapy are discussed. Distribution by age and sex show the predominant age range to be between 20 to 50 years with an almost equal proportion of males and females. The postoperative dose administrated was 2800 rads in four to five days overall time, with a recurrence rate of 4.32%. Of this group of recurrent cases, only one patient received the first irradiation treatment immediately after surgery; the rest were treated 24 hours after being operated. We have found no undesirable side effects or damage produced by beta radiation.

Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Postoperative Care; Pterygium; Radiotherapy Dosage; Recurrence; Strontium Radioisotopes

Out of 107 patients 123 pterygia were surgically removed: 24 pterygia of the progressive Type I, 49 of the semi progressive Type II and 50 of the regressive Type III. After surgical removal of the pterygia Type I and Type II followed a treatment with strontium 90 beta radiation with 2700 rep: 900 rep at the 2nd, 8th and 15th day after surgery. The recurrence rate was high in Type I (62%) and Type II (16%), but lower than it is reported in these groups operated without following radiation. More often pterygia of Type I and II are seen in people of the highlands.

Topics: Adult; Female; Humans; Male; Middle Aged; Pterygium; Recurrence; Strontium Radioisotopes; Yttrium Radioisotopes

The results of a study of 975 pterygia treated surgically and immediately with Strontium 90 are presented. The recurrence rate (quiescent) was 6%. The actual recurrence requiring surgery was 0.82%. Technique of removal involves simple wide excision and immediate treatment with Strontium 90 over the entire area. Three thousand RADS is the maximum dosage. In most instances more than 3000 RADS is cataractogenic. Two methods of Strontium 90 production are discussed. Strontium 90 has a half life of 19.9 plus or minus .3 years. It decomposes to Yttrium 90 which has a half life of 62 hours. Tissue penetration is estimated by the use of polystyrene absorber which is considered to be a tissue equivalent. Age and sex occurrence is given from a survey of 832 patients. Newer developments that might replace Strontium 90 are briefly discussed.

Topics: Adult; Age Factors; Brachytherapy; Cataract; Female; Humans; Male; Pterygium; Recurrence; Sex Factors; Strontium Radioisotopes

A rationale for the management of pterygium, based on theory and clinical experience, is presented in this review. Pterygium is classified as primary, secondary (recurrent), or pseudopterygium. Empirical data and proposed theories of pterygium pathogenesis and recurrence are discussed. The treatment of pterygium based on this information is divided into four phases: diagnosis, medical therapy, surgery, and postoperative adjunctive measures. The indications, techniques, results, and complications of the postoperative adjunctive measures used to lower recurrence are considered. Guidelines for the treatment of pterygium are recommended.

Topics: Administration, Topical; Anti-Inflammatory Agents; Glucocorticoids; Humans; Postoperative Complications; Pterygium; Radiotherapy; Recurrence; Strontium Radioisotopes; Thiotepa

During a ten-year period, 211 patients with a diagnosis of pterygium were treated in the University of Texas Medical Branch by a combined effort using a strontium 90 beta ray applicator immediately after surgical excision. Only one patient developed recurrence. No complications were observed during the first year of follow-up.

Topics: Humans; Postoperative Complications; Pterygium; Recurrence; Strontium Radioisotopes

Topics: Beta Particles; Humans; Pterygium; Strontium; Strontium Radioisotopes

Topics: Humans; Pterygium; Strontium; Strontium Radioisotopes

Topics: Humans; Pterygium; Strontium; Strontium Radioisotopes