Treatment. Surgical excision is the only satisfactory
treatment, which may be indicated for: (1) cosmetic
reasons, (2) continued progression threatening to
encroach onto the pupillary area (once the pterygium
has encroached pupillary area, wait till it crosses on
the other side), (3) diplopia due to
interference in
ocular movements.
Recurrence of the pterygium after surgical excision
is the main problem (30-50%). However, it can be
reduced by any of the following measures:
1. Transplantation of pterygium in the lower fornix
(McReynold's operation) is not performed now.
2. Postoperative beta irradiations (not used now).
3. Postoperative use of antimitotic drugs such as
mitomycin-C or thiotepa.
4. Surgical excision with bare sclera.
5. Surgical excision with free conjunctival graft taken
from the same eye or other eye is presently the
preferred technique.
6. In recurrent recalcitrant pterygium, surgical
excision should be coupled with lamellar
keratectomy and lamellar keratoplasty.
Surgical technique of pterygium excision
1. After topical anaesthesia, eye is cleansed, draped and exposed using universal eye speculum.
2. Head of the pterygium is lifted and dissected off the cornea very meticulously (Fig. 1A).
3. The main mass of pterygium is then separated
from the sclera underneath and the conjunctiva
superficially.
4. Pterygium tissue is then excised taking care not
to damage the underlying medial rectus muscle
(Fig. 1B).
5. Haemostasis is achieved and the episcleral tissue
exposed is cauterised thoroughly.
6. Next step differs depending upon the technique
adopted as follows:
i. In simple excision the conjunctiva is sutured back to cover the sclera (Fig. 1C).
ii. In bare sclera technique, some part of conjunctiva is excised and its edges are sutured to the underlying episcleral tissue leaving some bare part of sclera near the limbus (Fig. 1D).
iii. Free conjunctival membrane graft may be used to cover the bare sclera (Fig. 1E).
This procedure is more effective in reducing
recurrence. Free conjunctiva from the same
or opposite eye may be used as a graft.
iv. Limbal conjunctival autograft transplantation
(LLAT) to cover the defet after
pterygium excision is the latest and most
effective technique in the management of
pterygium.
treatment, which may be indicated for: (1) cosmetic
reasons, (2) continued progression threatening to
encroach onto the pupillary area (once the pterygium
has encroached pupillary area, wait till it crosses on
the other side), (3) diplopia due to
interference in
ocular movements.
Recurrence of the pterygium after surgical excision
is the main problem (30-50%). However, it can be
reduced by any of the following measures:
1. Transplantation of pterygium in the lower fornix
(McReynold's operation) is not performed now.
2. Postoperative beta irradiations (not used now).
3. Postoperative use of antimitotic drugs such as
mitomycin-C or thiotepa.
4. Surgical excision with bare sclera.
5. Surgical excision with free conjunctival graft taken
from the same eye or other eye is presently the
preferred technique.
6. In recurrent recalcitrant pterygium, surgical
excision should be coupled with lamellar
keratectomy and lamellar keratoplasty.
1. After topical anaesthesia, eye is cleansed, draped and exposed using universal eye speculum.
2. Head of the pterygium is lifted and dissected off the cornea very meticulously (Fig. 1A).
3. The main mass of pterygium is then separated
from the sclera underneath and the conjunctiva
superficially.
4. Pterygium tissue is then excised taking care not
to damage the underlying medial rectus muscle
(Fig. 1B).
5. Haemostasis is achieved and the episcleral tissue
exposed is cauterised thoroughly.
6. Next step differs depending upon the technique
adopted as follows:
i. In simple excision the conjunctiva is sutured back to cover the sclera (Fig. 1C).
ii. In bare sclera technique, some part of conjunctiva is excised and its edges are sutured to the underlying episcleral tissue leaving some bare part of sclera near the limbus (Fig. 1D).
iii. Free conjunctival membrane graft may be used to cover the bare sclera (Fig. 1E).
This procedure is more effective in reducing
recurrence. Free conjunctiva from the same
or opposite eye may be used as a graft.
iv. Limbal conjunctival autograft transplantation
(LLAT) to cover the defet after
pterygium excision is the latest and most
effective technique in the management of
pterygium.
 |
| Fig. 1. Surgical technique of pterygium excision : A, dissection of head from the cornea; B, excision of pterygium tissue under the conjunctiva; C, direct closure of the conjunctiva after undermining; D, bare sclera technique–suturing the conjunctiva to the episcleral tissue; E, free conjunctival graft after excising the pterygium. |
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