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Advances in Pterygium Surgery

Today, the ophthalmological community lacks consensus about the ideal way to treat and surgically manage pterygia. When the disease is discovered early in the process, it’s recommended that patients use protective eyewear to limit UV radiation that can worsen the condition.  

Pterygiums larger than 3 mm may induce astigmatism, larger than 3.5 mm, will likely cause blurring of uncorrected vision and may be associated with more than 1D of astigmatism.

If you observe growth in the lesion, it’s time to recommend that patient to Dr. Cohen. If you see aggressive growth, it is especially important to send that patient for a surgical consultation.  

Surgery

Pterygium is a challenging surgical procedure because of the risk of recurrence. Depending on which ophthalmologist you speak with, you may hear different preferences for surgical procedures. None are universally accepted because recurrence rates are variable. Dr. Cohen is familiar with multiple procedures and will choose a method that works best for your specific patient after evaluation.

Bare Sclera: Involves excising the head and body of the pterygium while allowing the bare scleral bed to re-epithelialize. This procedure typically has high recurrence rates ranging from 24% and 89% in various reports.

Conjunctival autograft: Involves obtaining an autograft and suturing the graft over the exposed scleral bed after excision of the pterygium. The autograft is usually obtained from the superotemporal bulbar conjunctiva. The process is popular as complications are infrequent. What makes this surgery challenging to master is the careful dissection of Tenon’s capsule from the conjunctival graft and recipient bed. Australian surgeon, Lawrence W. Hirst, MBBS, recommends using a large incision for pterygium excision and a massive graft and has reported a very low recurrence rate with this technique.

Amniotic membrane grafting: We don’t know precisely why it works, but the process has been shown to prevent pterygium recurrence. Studies are widely varied, though, with recurrence falling between 2.6% and 10.7% for primary pterygia and as high as 37.5% for recurrent cases. This method holds a distinct advantage in that it preserves the bulbar conjunctiva.  

Limbal stem cell autograft: You may not be familiar with this process, that’s because our own Dr. Ilan Cohen invented it. While not dramatically different than existing procedures, it has demonstrated faster surgical times and lower recurrence rates than current procedures. It’s a combination of a few of the most modern techniques into a custom process used here at Cohen Eye Institute.

Every patient is different, but Dr. Cohen’s deep expertise allows us to treat yours with a level of precision unavailable at other practices. If you see the early warning signs of pterygium in your patients, make sure the entire team knows that Cohen Eye Institute is your #1 choice for surgery.





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