Pterygium Surgery: An overview

Pterygium is popularly known as surfer’s eye. It primarily involves the conjunctiva and can be benignly extended to the cornea. Though completely benign, it can progress to cause discomforts, cosmetic concerns and visual disability requiring surgical intervention. The present document is meant to cover all aspects of pterygium surgery-from different types to post-operative management.

Types of Pterygium Surgery

1. Bare Sclera Technique- this bare sclera technique is traditional. Pterygium is excised, leaving the sclera exposed. It is very quick but has a higher rate of recurrence.

2. Conjunctival Autograft: The most popular technique at present, whereby an excised part of conjunctiva is grafted onto the conjunctiva of another part of the eye-doing elimination of recurrences.

3. Amniotic Membrane Transplantation: When conjunctival grafting cannot be used, amniotic membrane is transplanted for covering excised site to enhance healing and reduce inflammation.

4. Fibrin Glue Technique: Works in association with autografts or amniotic membranes wherein fibrin glue reduces usage of sutures in the cases of such.

Symptoms of Pterygium

• Redness and inflammation

• Wedge shaped growth on your eye

• Dryness, irritation, or gritty feeling

• Blurred vision if the growth grows onto the cornea

• Sensitivity to light (photophobia)

Diagnosis

It can be diagnosed usually by a normal routine eye examination. It includes

• Visual Inspection: Using a slit lamp to examine the surface of the eye.

• Corneal Topography: Mapping the surface curvature of the cornea to detect pterygium-caused distortions.

• Photography: Serial photographs can be taken to monitor changes over time.

Causes in Pterygium

• Excessive UV Exposure: Long-time exposure to external sources of ultraviolet light, especially during high-sun, high-altitude areas.

• Endless irritation by wind and dust: Environments affected.

• Genetic Factors: These increase a person’s chance of having pterygium.

• Dry Eye: This aspect, with chronic dryness and irritation, feeds the growth mechanism.

Risks and Complications

Pterygium surgery is relatively safe, but it carries potential risk, including:

• Recurrence: Recurrence is the most common complication, especially in the case of bare sclera technique.

• Infection: Though rare, infective complications can occur after surgery.

• Scarring: Might impair vision if it involve cornea.

• Graft Dislocation: Graft may shift or fail to adhere properly.

• Astigmatism: Changes in the corneal shape can cause visual distortion.

Preparation

1. Preoperative consultation: Eye examination and history.

2. Drug History: Patients will report any medications they have or are taking.

3. Discontinuation of some medications: Stopping anti-inflammatory medications and blood thinners has to be done.

4. Transportation: Have someone to drive you home, as your eyesight is likely to be blurry afterward.

Procedure

• Anesthesia: The doctor anesthetizes your eye, numbing it. The regional anesthesia differs only in effect.

• Excision: This involves the proper cutting of the pterygium.

• Grafting: The patient has a choice of conjunctival autograft or amniotic membrane, depending on the technique.

• Securing the Graft: This means the graft is fixated by sutures or fibrin glue and thereafter proper bandaging.

• Bandaging: At first, the eye should need protection regarding soft bedsheets, light, and pressure.

Recovery

• Healing: Initially, there's redness, irritation, and some discomfort and this will fade over the first couple of days postop.

• Medications: You are prescribed antibiotic and anti-inflammatory eye drops.

• Regular Follow-Ups: These will keep the doctor informed of how healing is going so far and of any possible recurrence.

• Activity Restrictions: Things to avoid include swimming, dusty environments, and anything marginally strenuous for a few weeks.

• Three-Week Full Recovery: Usually is generally there at around week four or six.

Clinical Trials

The research being conducted right now is primarily aimed at improving both the success of the pterygium surgery and lowering the chance of the pterygium growing back. A good number of the recent developments are as follows:

• Anti-VEGF Injections: This is the type of injectable that has as its goal inhibiting the blood vessel growth and, accordingly, helps reduce the chances of recurrence.

• New Grafting Materials: Research studies are on for new biomaterials and synthetic grafts.

• Minimal Invasive Techniques: These are procedures that do not traumatize the tissues so much and shorten the healing time.

Side Effects

• Temporary Blurred Vision: Can occur during the healing period or in response to the use of medications.

• Dryness and Irritation: Lasts during the phase of healing.

• Redness: The redness may last for weeks.

• Foreign Body Sensation: As a result of the presence of sutures or graft materials.

Success Rate of Treatment

• Conjunctival Autograft: This has a success rate of over 90%, with very few recurrences occurring.

• Amniotic Membrane Transplantation: This has a slightly lower success rate, but is very effective.

• Bare Sclera Technique: Has been reported to have recurrence rates anywhere up to 80% in some cases.

Diet to follow after Treatment

• Water Intake: Good hydration helps in good overall eye health.

• Omega-3 Fatty Acids: Found in fish and flaxseeds, they also help in the reduction of inflammation.

• Vitamin A: It's helpful for the eyes, found in sweet potatoes, carrots, and spinach.

• Avoidance of Irritants: Foods like spicy and highly processed foods that are likely to cause too much inflammation will be avoided.

Cost of Pterygium Surgery in India

The cost of a pterygium operation in India will vary with the technique used, the facility, and city. Few estimates are outlined herein:

• Plain Surgery (Bare Sclera) costs around 10,000 - 20,000 INR

• Conjunctival Autograft charges fetch between 15,000 - 35,000 INR

• Very expensive surgery like amniotic membrane transplantation costs between 25,000 - 50,000 INR

Conclusion

Pterygium surgery is a very good option for many suffering from discomfort or decreased vision due to pterygium. More with modern techniques like autograft conjunctiva and AMT is its healing time and percentage of recurrence falling considerably. Proper postoperative care is important for eye health maintenance and avoidance of recurrence.