A clinical study of tear functions in patients with pinguecula and its management

Abstract

Introduction: Pinguecula is a common conjunctival degenerative disorder. Its origin came from the Latin word "pinguis," which means fat or lipid. It is a round, elevated, yellowish fleshy mass located in the interpalpebral fissure at the limbus (usually at 3
o’ clock or 9 o’clock position).
Material and methods: This interventional and prospective study included 100 patients with pinguecula [random eyes; 39 males and 31 females, 17 to 70 years of age (mean ± SD: 46.52 ± 16.31 years) for medical management and 14 males and 16 females, 26 to 69 years of age (mean ± SD: 50.9±12.20 years) for surgical management]. Thereafter they were categorised as grade P (0), P (1) and P (2) by slit lamp bio-microscopy.
Results: On the basis of statistical analysis applying unpaired -t test, for each test parameter in P (0) grade of pinguecula patients, the p- values for Schirmer-1 test and Tear film breakup time were 0.93, 0.46, 0.03 and 0.22, 0.002 and <0.0001, For P (1) grade of pinguecula 0.81, 0.08, 0.0002 and 0.31, <0.0001 and <0.0001, Before medical management vs After medical management at 1m, 3m and 6m respectively. These p – values showed that there were no significant changes in ST-1 at 1m and 3m follow-up after medical management. For TFBUT p - values showed there were no significant changes at 1m of follow-up but extremely significant at 3m and 6 m of follow-up. For P (1) grade there were no significant changes in ST-1 and TFBUT at 1m follow-up after medical management, while extremely significant changes at 3m and 6 m of follow-up were found in ST-1 as well as TFBUT both. For surgical
management in P (2) grade of pinguecula patients, the p- values for Schirmer-1 test and TFBUT were < 0.0001 for pre-op vs post-op at 1m, 3m and 6m respectively. These p – values showed that there were extremely significant changes in ST-1 as well as TFBUT at 1m, 3m and 6 m follow-up.
Conclusion: The alteration in schirmer-1 test and TFBUT after medical management with e/d Carboxy methyl cellulose 0.5% and/or eye drop Fluorometholone 0.1% showed improvement in tear film production and tear film stability after 6 months of
follow-up.Vascularised pinguecula excision resulted in both vascular regression and cosmetic improvement without serious or permanent complications. Tear film parameters after 6 months of follow-up improved more in surgical management group
(ST-1 by 8.87mm and TFBUT by 5.57 secs) as compared to medical management group (ST-1 by 4.14mm and TFBUT by 2.62 secs).