Pterygium and Pterygium Surgery
A pterygium is a growth that covers at least part of the cornea which is the clear window over the eye. As shown in this image, a progressive pterygium can cause blurred vision. However, it also can often cause irritation, unsightly redness, and even tearing. The best way to avoid these growths is to wear sunglasses and avoid ultraviolet light exposure to the eye. Besides sun exposure, there may also be other factors such as wind, and dryness that may contribute. The decision to remove these growths is an active one between the patient and the surgeon. When I discuss removing the growth, I will definitely recommend removal for progressive growth of the lesion because this may cause vision loss. I will also recommend removal if there is already vision loss, or irritation that cannot be easily controlled. They can also be removed for cosmetic reasons, but that is usually not covered by insurance. However, since the eyes are one of the first things people notice, it is often a real consideration.
There are several ways to remove these growths. Each way of removal has its positives and its negatives. I feel strongly that the pterygium should be removed and replaced with what is called a conjunctival autograft. The autograft is the patient's own tissue taken from underneath the upper eyelid. I do a sutureless technique and use tiseel glue to attach the autograft (which is a piece of conjunctiva) to the area where the pteryigum is removed. In my hands, this has resulted in a recurrence rate of around 1%. The surgery only takes about 15 minutes, and it is an outpatient procedure. The eye will be red and irritated after surgery. The redness may persist for a month or even slightly longer, but most of the irritation usually resolves in the first few days after surgery. Although not guaranteed, usually the cosmetic outcome is excellent.
There are other techniques of removing this growth. These include excision with amniotic membrane (a piece of the human placenta) combined with the use of mitomycin C (a chemotherapy chemical). Other surgeons will remove the graft without using any of the above. This results in a 50 to 80% recurrence rate. Most people quote the rate of recurrence with mitomycin C and amniotic membrane around 5 to 15%. Mitomycin C can also have long term complications such as melting of the eye, and chronic irritation. For these reasons, and the lower recurrence rate, I feel that ptergyium with conjunctival autograft is the preferred technique. As a cornea specialist, I have performed hundreds of these surgeries, and done extensive training above and beyond with my fellowship at Washinton University in St. Louis. If you have a pterygium and would like an evaluation, please call our office at 512-686-1272. We serve the greater Austin area and have a main office in Georgetown with a satellite location in Waco, TX.