Pterygium (pronounced "tur-RIDGE-ium") is a benign thickening of the outer coating (conjunctiva) of the eye that grows onto the cornea. As a pterygium grows, it may become red and irritated. Eventually, it may cause visual disturbances by disrupting the normally smooth surface of the cornea. In severe cases, a pterygium can block a patient's vision altogether.
Pterygium surgery can be performed under local anaesthesia(awake) or general anaesthesia (asleep). The choice is based on the anticipated length and difficulty of the operation, your suitability for different sorts of anaesthesia, your own preferences and your surgeon's advice.
A routine pterygium operation would be expected to last about 45 minutes and can usually be performed comfortably under local anaesthetic. Conversely, a recurrent pterygium (that has re-grown after a previous operation) usually needs more extensive surgery and a general anaesthetic is recommended. You will usually be able to go home on the day of your operation, but you may be asked to return for an eye check on the following day.
Pterygiums are usually caused by extended exposure to sunlight. They may remain stable after appearing, or they may grow and affect vision. Treatments include eye drops for irritation and redness, protection from sunlight and dust to prevent the pterygium from worsening, and occasionally steroids to lessen inflammation. If the pterygium grows into the central cornea, surgical removal is recommended. This prevents the pterygium from altering the cornea's shape and affecting vision.
In surgery, the pterygium is removed and a small piece of the conjunctiva, which is the thin transparent skin that covers the white of the eye, is placed into this site from under the upper lid. The surgery is performed under local anaesthetic. There should be no pain during the surgery, which takes approximately half an hour. Following the procedure, a prescription is given for eye ointment or eye drops and analgesic tablets. For approximately 1-2 weeks following surgery, getting water, dust or dirt in the eye should be avoided.
Re-growth may occur
In traditional "bare sclera" pterygium removal, the underlying white of the eye (sclera) is left exposed. Healing occurs over two to four weeks with mild to moderate discomfort. Unfortunately, the pterygium may grow back, sometimes larger than its original size.Our specialists have solution to stop this recurrence.
A] Conjunctival Autograft with Stitches
Our cornea specialists perform pterygium surgery with a conjunctival autograft because of a reduced risk of recurrence.
Procedure : - Here the pterygium is removed, and the cornea regains clarity. However, the gap in the mucous membrane (conjunctiva) tissue, where the pterygium was removed, is filled with a transplant of tissue that has been painlessly removed from underneath the upper eyelid. Although the procedure requires more surgical skill than traditional surgery, this "auto-graft" (self-transplant) helps prevent re-growth of the pterygium by filling the space where abnormal tissue would have re-grown.
The autograft is held in place with tiny stitches that may dissolve after a few weeks or can be removed in the surgeon's office. Stitches on the eye frequently cause discomfort, however, after pterygium/autograft surgery. The desire for a quicker, more painless recovery has led to the development of no-stitch pterygium/autograft surgery.
B] No-stitch Pterygium/Autograft Surgery
No-stitch pterygium/autograft surgery allows most patients to return to work within one or two days of surgery. A major advantage found, patients undergoing no-stitch surgery had significantly less pain after surgery than those having traditional surgery. The no-stitch technique also reduced surgery time from an average of 21 minutes to 14 minutes. No pterygium recurrences were found in any patients in the study.
Procedure : - Here the patient is lightly sedated to ensure comfort, and the eye is completely numbed, so there is no way to see the surgery occurring and no sensation of discomfort. The abnormal corneal tissue is removed and replaced with a thin graft of normal tissue. Over the next 2-3 weeks, the eye gradually returns to a normal appearance.
No-stitch surgery is made possible by the use of modern tissue adhesive. Composed of clotting proteins normally found in human blood, tissue adhesive allows the surgeon to secure a conjunctival autograft in seconds rather than minutes. After about one week the tissue adhesive dissolves with no residue, leaving the eye to heal comfortably. Although tissue adhesive is derived from human blood products, no cases of blood borne infection have ever been reported among millions of patients treated with this material in heart and lung surgery.
The main reason for removing a pterygium is to prevent future loss of eyesight by stopping the pterygium from growing over
the central area of the cornea. Other symptoms such as redness or discomfort are not as easily treated by surgery and are best treated, where the possible by more simple methods, such as the use of lubricant eye drops.
Complications during the operation
As the operation only involves the outer layers of the eye, pterygium surgery is relatively safe compared to many
types of eye surgery.One of the eye muscles lies partly underneath the operation site. It is possible, though unlikely, that this muscle could be damaged during the operation, causing double vision and requiring further surgery.
This particular complication is more of a concern when removing a pterygium that has re-grown after a previous operation, when there is much more scarring and the muscle may be difficult to identify. Very rarely, the internal structures of the eye could be damaged, causing loss of eyesight. This is more of a concern when operating on an eye that has already had surgery or where the eye has been damaged by previousinjury or by other eye diseases.
Complications and side-effects after the operation Pain or discomfort
Some pain is very common in the first 24 to 48 hours aftersurgery. This is because the corneal surface previously
covered by the pterygium is left bare (see surgical diagram)and takes 24 to 48 hours to heal and simple painkillers such
as paracetamol are available to overcome it.The frequent use of eye lubricants may also help. Dissolving stitches may cause a gritty sensation for several weeks. The inflammation caused by surgery may take several weeks or sometimes months to settle fully, in which case the eye may still appear slightly red and the eye may feel mildly dry or gritty.
After corneal surgery the eye surface is often slightly bumpy. The tear film, which keeps the eye moist, tends to dry out on the surface of the bumps. If the drying is severe, the eye can be prone to infection or ulceration. Lubricant eye drops are often needed in the first few months after surgery and possibly long-term in some cases.
After the operation the corneal surface previously covered by the pterygium is often slightly bumpy and also scarred. This means that in cases where the pterygium has grown over the central cornea, the vision may remain poor, even when the pterygium has been removed.
Recurrence of the pterygium
The chance of a pterygium recurring after the first operation isbetween 1:6 and 1:20 approximately. Corneal ulceration or infection
Severe problems such as corneal ulceration or infection arerare but may require intensive treatment such as antibioticsand can lead to scarring and opacity of the cornea or, very rarely, perforation of the eye. If the ulceration is severe a corneal transplant may be needed, sometimes as an emergency.
Further surgery is unlikely, but patients who require further surgery, including surgery for recurrent pterygium may also have complications arising from the additional surgery or treatments required.
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