1. What is a pterygium?
2. What causes pterygium?
3. What is the treatment for pterygium?
4. Pterygium surgery: The Facts
5. What to expect after the surgery?
6. What are the side-effects of pterygium surgery?
7. How important is the skill of the surgeon in preventing recurrence?
A pterygium is a fleshy piece of tissue that grows towards the cornea (the clear front covering of the eye). It grows very slowly, and may remain small, but it may also grow large enough to cause problems with vision. It commonly occurs in the inner corner of the eye, but can appear on the outer corner or both.
The exact cause is not well understood, and is thought to be multifactorial, but with ultraviolet (UV) light exposure being the triggering factor. Hence it occurs more frequently in sunny climates, and in people who spend a great deal of time outdoors. Long-term exposure to sunlight, chronic eye irritation from dry, dusty, smoky conditions are believed to play a causal role. Protecting the eyes from excessive UV light with proper sunglasses and avoiding dry, dusty, smoky conditions may help in preventing pterygium from occurring. Other factors involved include viruses (human papilloma virus) and genetic factors.
Generally, small pterygia can be left alone, especially if the patient has no other symptoms. When the pterygium becomes red and irritated, moisturizing eyedrops or ointments may be used to reduce inflammation and soothe the eye. If the pterygium gets larger, causing significant irritation, visual blurring or is cosmetically unacceptable, it should be removed surgically.
A video showing removal of a pterygium that had recurred shortly after surgery by another ophthalmologist. In this case, following surgical excision of the pterygium, conjunctival autografting is performed using fibrin glue. No stitches (sutures) are required to anchor the conjunctival graft in place. This technique, when well performed, results in reduced recurrence rates and excellent cosmetic outcomes.
Ptergyium surgery involves removing the pterygium tissue by cutting it away, and then covering the bare area of the eye with normal, healthy tissue (the conjunctiva) from the area under the upper eyelid. This procedure is called conjunctival autografting. The conjunctival autograft is made to adhere to the underlying tissue either with sutures (stitches) or with a special biological glue (‘fibrin glue’).
This procedure takes about 20- 30 minutes to perform and is done as a Day Surgery Procedure under local anaesthesia.
Occasionally, in more advanced cases, additional or adjunctive methods may be required, and this include the use of amniotic membrane transplantation and or the use of special chemicals called ant-metabolites like mitomycin-C.
The eye may be red and swollen for several weeks after surgery, and there may be discomfort for a few days.
You will be prescribed antibiotic and steroid eyedrops to be instilled for about four weeks.
Recurrence of the pterygium (growing back again) can occur in some cases, and this depends on the severity of the pterygium and the technique and skill of the surgeon performing the surgery. Recurrence usually occurs between one to nine months after the surgery.
Other side-effects include bleeding, inflammation, swelling, graft retraction (the conjunctival graft does not stick adequately to the underlying tissues) and rise in eye pressure (from steroid eyedrops given after surgery)
The surgical technique used and the skill of the surgeon are crucial in determining the rate of recurrence of the pterygium. Pterygium excision with conjunctival autografting has been proven to give one of the lowest recurrence rates and the best cosmetic outcomes. This procedure is technically demanding, and is best done by an experienced surgeon, usually a cornea subspecialist. Once the pterygium recurs, subsequent surgeries have higher risk of recurrence, so the initial surgery is critical. Pterygium surgery should never be performed by just simple excision or removal (the bare sclera technique), as the recurrence rate if this technique is used is more than 90%.