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Pterygium Treatment & Management

  • Author: Jerome P Fisher, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Apr 07, 2015
 

Medical Care

Patients with pterygia can be observed unless the lesions exhibit growth toward the center of the cornea or the patient exhibits symptoms of significant redness, discomfort, or alterations in visual function. Pterygia can be removed for cosmetic reasons, as well as for functional abnormalities of vision or discomfort.[16]

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Surgical Care

Surgery for excision of pterygia is usually performed in an outpatient setting under local or topical anesthesia with sedation, if necessary.

A prospective, randomized, interventional study by Kheirkhah et al assessed 56 patients who underwent pterygium excision with MMC application and an amniotic graft.[17] Of those 56 patients, 28 received MMC on the perilimbal bare sclera from 1-5 minutes, whereas 28 other patients received MMC under the conjunctiva. Endothelial cell studies revealed loss of 3.4% of cells in the bare sclera group compared with 4.8% in the subconjunctival group at 6 months. No complications were observed in either group; however, the study was small.

A prospective, nonrandomized study by Bahar et al examined the risk of endothelial cell loss in 43 subjects following pterygium surgery with MMC and conjunctival autograft.[18] The study included a control group who had a primary pterygium excision without MMC. Although the number of patients in each group was small, the patients who received MMC experienced a 4% reduction in endothelial cells at 3 months, compared with no loss in the control group. This suggests that MMC can affect the endothelial cell counts in patients undergoing pterygium excision.

Despite the relatively small sample sizes, both studies reported statistically significant decreases in corneal endothelial cell counts (P values ≤0.05) as long as 3 months after surgery. The authors note that placement of MMC at the limbus can be a risk factor for scleral melts. Thus, the authors advise placement of MMC only in the area of the fibrovascular conjunctival tissue.

Hirst initiated a prospective nonrandomized study of an evolution of previous pterygium surgical techniques involving extensive excision of overlying conjunctiva and underlying Tenon fascia in the vicinity of the pterygium, combined with a large, limbal-sparing autograft harvested from the superior conjunctival surface.[19] Hirst subsequently published his longer-term results after more than 1000 surgeries, including 806 primary pterygia and 194 recurrent pterygia. The author had a follow-up of longer than 1 year in 99% of those patients, with a mean follow-up of 616 days. The author reported only one recurrence among those 1000 patients, significantly lower than has been previously reported for both primary and secondary pterygium surgeries.[20]

This technique did not require the use of antimetabolites and it spared limbal stem cells at the site of conjunctival autograft harvesting. In addition to a reduction in expected recurrences, Hirst also reported a lower rate of postoperative complications with fewer than expected postoperative granulomas and fewer than expected conjunctival inclusion cysts.

Postoperatively, the eye is generally patched overnight, and it is treated subsequently with topical antibiotics and anti-inflammatory drops and/or ointments.

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Contributor Information and Disclosures
Author

Jerome P Fisher, MD, FACS Volunteer Associate Professor, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Leonard M Miller School of Medicine

Jerome P Fisher, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, Florida Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

William B Trattler, MD Ophthalmologist, The Center for Excellence in Eye Care; Volunteer Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute

William B Trattler, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery

Disclosure: Received consulting fee from Allergan for consulting; Received consulting fee from Alcon for consulting; Received consulting fee from Bausch & Lomb for consulting; Received consulting fee from Abbott Medical Optics for consulting; Received consulting fee from CXLUSA for none; Received consulting fee from LensAR for none.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Fernando H Murillo-Lopez, MD Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

References
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