Surgery to remove a pterygium
A pterygium is a benign growth of conjunctival tissue, the thin mucous membrane. It looks like a raised triangular thickening caused by excessive growth of the conjunctiva extending across the eye's surface. In many cases, patients who develop a pterygium have substantial exposure to sunlight, sand, dust and wind without eye protection. The exact cause is unknown, but the environmental factors mentioned, particularly UV radiation from the sun, are associated with a higher incidence of pterygium. More cases are indeed seen in sunny countries and among surfers, hence "surfer's eye."
In many cases, no treatment is required if there are no symptoms. However, removal is necessary when the pterygium causes irritation, does not respond to eye drops or causes vision problems that interfere with the patient's daily activities and lifestyle. Another reason for removal is cosmetic, if the patient wishes.
During pterygium removal surgery, the abnormal tissue is removed from the sclera and cornea. The new, advanced technologies currently available can achieve much higher success rates than traditional pterygium surgery. Traditional removal leaves the sclera, the white of the eye, exposed. Healing takes 2-4 weeks and may involve mild to moderate discomfort. As noted, this surgery has a high rate of recurrence and regrowth, which may occur in up to about 50% of cases. The recurrent pterygium may be larger and more damaging than the one originally removed. This recurrence led ophthalmologists to develop various techniques, including radiation or antimetabolites, chemicals that prevent tissue growth. Each technique naturally carries a risk of damage to the eye, such as epithelial defects (an ulcer on the corneal surface) or corneal melting.
Most doctors performing pterygium surgery today use an autograft, a graft taken from the patient's own tissue beneath the eyelid, which less frequently produces a graft rejection response. This procedure requires greater skill than traditional surgery but, as noted, significantly reduces recurrence risk by filling the exposed area with tissue that prevents abnormal cells from multiplying and filling the space left by removal. Conventional graft surgery uses stitches to secure the graft, and these may cause discomfort for several weeks before dissolving or being removed by the surgeon at a postoperative follow-up appointment. The desire for faster, easier, pain-free recovery led to the development of graft surgery without stitches, allowing most patients to return to work and their daily routine within one or two days, without increased recurrence compared with surgery using stitches.
The stitch-free technique is performed under sedation and local anesthesia, so the eye itself is immobilized and there is no discomfort or pain during surgery. The abnormal corneal tissue is removed and replaced with a thin graft of normal tissue taken from beneath the eyelid and attached with tissue glue. Made from clotting proteins from human blood, this glue allows the surgeon to secure the tissue more quickly and without discomfort, and dissolves within about a week.
Recovery from pterygium surgery
After the procedure, the doctor will instruct you to wear an eye patch temporarily to minimize residual bleeding. It will be removed the next day at a follow-up appointment. During recovery, patients may experience eye irritation, blurred vision and redness around the eye. Normal activities such as driving and work can usually resume within the first few days, depending, of course, on individual healing and how the patient feels. Full recovery may take several weeks to a month. During recovery, the patient will be instructed to use antibiotic and steroid eye drops for 1-2 months to prevent infection, reduce inflammation and lower recurrence risk.
Like any procedure, pterygium removal has potential risks and complications. Some redness, discomfort and occasionally even mildly blurred vision are normal after surgery. Complications such as infection are rare, but it is important to be aware of them, attend follow-up appointments regularly to detect any complications early and monitor healing, and follow the medication regimen and treating doctor's instructions. As noted, recurrence remains possible even when techniques that reduce this risk are used, in which case the risk drops to just 5-10%, compared with 50%. A recurrent pterygium that meets indications for removal is likewise treated with a similar surgical intervention.
