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Removal of pterygium:

General information:

Pterygium is a disorder of the surface of the eyeball consisting of abnormal triangular tissue growth on the cornea of the eye. This disorder occurs in people excessively exposed to UV light, dust, dry environments, for long periods of time. Micro traumas also contribute to the development of this disorder. If left untreated, it can lead to poor vision and in worst cases – to blindness.

Pterygium consists of a head (through which it invades the cornea), connected to the main body of the pterygium by the neck, with a triangular shape typically starting on the cornea near the nose.

Pterygium evolves in 3 stages: the first is the incipient invasion of 1-2mm on the cornea; the second stage is most common, when the pterygium spreads on 3-4mm at the edge of the pupil; the most advanced stage is when the pterygium reaches and even overlays the edge of the pupil, entering the visual axis.

Diagnostics

It is easy to diagnose pterygium for its visual aspect. Usually, it is a triangular translucent membrane formed on the eyeball in the area near the nose. The base of the membrane is spread towards the inner angle of the eyelids, and its peak usually reaches the edge of the cornea or event spreading on a portion of the cornea.

Pterygium is twice more likely to occur in men than women. The condition becomes more common with age in people of over 40 years old, but it seems that in most cases it occurs between the ages of 20 and 40 years old. There aren’t any cases of pterygium in people before the age of 20. Many patients complain of the unaesthetic formation growing on the transparent part of the eye, inflammation and redness of the formation, itchy eyes, burning sensation, foreign body sensation and last, but not least, fogginess of the vision or its worsening (in advanced cases). Pterygium can develop in one or both eyes.

Causes

The causes of this disorder are associated with excessive exposure to UV light, so people working in sunlight for long periods are at risk; sweat, exposure to high temperatures (blacksmith’s shops, glassware companies), toxic environments with different chemical vapors and substances, dust, extreme cold are also factors contributing to the formation of pterygium, as well as genetic predisposition.

There aren’t any known prevention measures.

Doctors recommend seeing a specialist when noticing any ocular modifications. It is extremely important to perform the surgery as quickly as possible, in useful time. The sooner the surgery is performed, the better the results.

Treatment

“Oculus Prim” provides different treatments, depending on the stage of the illness. In the incipient stages, the clinic’s specialists use subconjunctival corticosteroid injection. Surgery is recommended for larger lesions, where grafts or lamellar or penetrating keratoplasty is performed.

The surgical intervention is easily tolerated by the patient and it is performed with local anesthesia. There is no need for hospitalization. For advanced cases, relapses or recurrences, intra and post-surgical treatment with Avastin is indicated. The procedure is short and painless. After the surgery, the eyes are treated with antibiotics, anti-inflammatory medication and artificial tears.

 Pterygium in the 3rd stage

Surgery in pterygium cases is recommended for the following reasons:

  • Aesthetic and functional (the illness can reduce the movement of the eyes);
  • The illness can weaken the vision in the second and third stages;
  • It can get infected and contribute to corneal infections.

Surgical interventions are different and depend on the stage of the pterygium. At all stages, complications might occur due to relapses, this is why the procedures were improved over time.

   

In the beginning of the surgery the head and the main body of the pterygium are removed from the cornea. Subsequently, the main body is sectioned and the surface of the sclera is cleaned from the pathological tissue. There are many ways to finish the surgery:

  • The sclera is left uncovered;
  • The proximal conjunctiva is covered (only in cases of small pterygia due to increased risk of relapse);
  • Using conjunctival auto-grafting from underneath the eyelid (the intervention lasts longer if the relapse is reduced), which sutures and covers the entire defect; in young patients or in severe cases, a substance is applied on the sclera for 5 minutes, which inhibits the development of pathologic tissue, increasingly reducing relapses;
  • In cases of extensive pterygium and for some relapses, lamellar corneal transplantation and amniotic membrane transplantation is performed in order to cover the conjunctiva.
  •  Pterygium in the 1st stage Pterygium in the 2nd stage
   
   
Postoperative evolution:

Within the first days after the surgery the eye is red; it can be watery and it can hurt. These effects gradually disappear after the corneal surface where the pterygium was removed from and the place where the graft was taken heal. It is possible for the patient to wear an eye patch or a therapeutic contact lens for a few days after the surgery. Usually, between the second and the third week after the surgery, an edema forms on the transplanted graft – this disappears after the treatment.

Post-surgery complications are rare and can be associated with corneal infections, rupture of the grafts sutures, corneal astigmatism.
The patient is informed that in pterygium cases with significant corneal invasion, the intervention takes longer time and the patient must come for consultations and evaluations daily and then weekly in order to remove the stitches from the conjunctiva. Also, ocular instillations are recommended, which are used until the surface of the eyeball is healed. During the first 3 weeks after the surgery, it is recommended to avoid dusty and windy places, and extreme temperatures