Effect of 2% Hyaluronic Acid on the Rate of Healing of Corneal Epithelial Defect After Pterygium Surgery: A Randomized Controlled Trial

Abstract

Purpose

The study aimed to investigate the effects of 2% hyaluronic acid (HA) on corneal epithelial defect after pterygium surgery in comparison with the control group, measured in terms of the healing rate of corneal epithelial defect and pain score after surgery.

Methods

In this double-blind randomized clinical trial, fifty patients with primary pterygium were randomized into 2 groups: a control group or the group treated with a single topical application of 2% HA. Comprehensive ophthalmological examinations included measuring the area of corneal epithelium defect using ImageJ freeware and the pain score assessment after the operation.

Results

The mean and SD of the area of epithelial defect measured on postoperative Day 0, 1, and 2 were 10.89 ± 1.33 mm², 5.04 ± 0.87mm², and 2.44 ± 0.74 mm² for the HA group, and 11.14 ± 1.11 mm², 7.74 ± 1.17 mm², and 5.31 ± 1.15 mm² for the control group, respectively. While the initial area of the defect on Day 0 was essentially the same for both groups (p = 0.478), the area of the defect in the HA group was significantly smaller on both Day 1 and Day 2 (p < 0.001, p < 0.001), respectively. Similarly, the HA group exhibited a statistically significant higher rate of healing for the cornea epithelial defect over Day 0 and 1 compared to the control group (5.85 ± 0.89 mm²/day vs 3.14 ± 1.28 mm²/day, p < 0.001), respectively. The median (range) pain scores were evaluated at Day 0 was 7 (4–10) in the HA group and 7 (3–10) in the control group (p = 0.953). There was no statistically significant difference between two groups (p > 0.05) for Days 1, 2, and 3.

Conclusion

A single topical application of 2% HA tended to accelerate the healing process of corneal epithelium defect after pterygium surgery without any observable adverse effects during short-term follow-up.

Keywords:

• 2% hyaluronic acid
• corneal epithelial defect
• pterygium surgery

Acknowledgments

The authors thank associate professor Janejit Choovuthayakorn, M.D., PhD., and Miss Kittika Kanjanarattanakorn for kind assistance in statistical analysis and Dr. Robert Paul Batzinger, PhD., for English manuscript revision.

Data Sharing Statement

Datasets collected, used, and analyzed for the study can be obtained from the corresponding author on a reasonable request. Besides the study, no specific data is intended to share. No other study documents will be available.

Ethics Approval and Informed Consent

The study protocol was conducted in accordance with the tenets of the Declaration of Helsinki and approved by the Ethics committee of Faculty of Medicine, Chiang Mai University (Study code: OPT-2560-04526), and Thai Clinical Trial Registry Committee (Study ID 20180822002, https://www.thaiclinicaltrials.org/). Written informed consent was obtained from all participants.

Consent for Publication

All participants provided written informed consent prior to the study.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

This study was supported by the Faculty of Medicine Endowment Fund, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (Grant Number 014/2561).