Recurrent Pterygium Management.
Measure 10 times and operate once – planning is the key
by Rajesh Khanna MD
Recurrent Pterygium may be considered a common side effect of pterygium surgery. If the pterygium is removed but no attention is paid to removing the scaffold of tenon’s capsule, nor adjunctt therapies used – there is up to a 70% chance of recurrence. Recurrent Pterygium management is an art and sequence. We end up helping a lot of these patients who had their primary pterygium surgery elsewhere. Pterygium are like weeds. Either behead them, kill them completely or leave them alone. Never prick, sword or irritate them. For then they attack savagely.
Recurrent Pterygium is worse than the original one because they can spread in all directions and have more fibrosis. It means they are more firmly attached to the muscles and surrounding eye tissue. They are also more vascular. The blood vessels supply it the nutrition in its march to conquer territory it had lost before.
Is your Pterygium back again? The above video tells you important information about what you need to know regarding recurrent Pterygium and Pterygium removal.
Before operating on recurrent pterygium:
- Find out what was done in the original surgical procedure.
- Treat the dryness of the eye on a war footing.
- Plan to repeat surgery in winter or when the UV exposure is going to be a minimum.
- Inject Mitomycin C (avoid in pregnant or breast feeding women) into the Pterygium body. This anticancer drugs kills the cells of the Pterygium including the blood vessel cells. This causes the recurrent Pterygium to shrink in size and its margins to become more defined.
- The surgery may be more painful so attention should be directed to proper numbing of the eye and even oral or iv pain relievers.
During the procedure of recurrent Pterygium:
- Identify the borders and extensions of the recurrent pterygium.
- Identify the muscles like the lateral rectus, medial rectus and the obliques. Avoid trauma to them.
- If conjunctival autograft does not suffice an allograft may be required.
- Attention to good control over bleeding is important
- Avoid using stitches
After surgery for recurrent Pterygium:
- Close follow up is required.
- Treat emerging blood vessels aggressively.
- Taper antiinflammatory drops slowly.
Please don’t worry if you have had a recurrence of Pterygium. If you are out of the Los Angeles area you can skype with us to learn your options. If you send us your insurance card our staff can let you know your insurance coverage.
Above information on Recurrent Pterygium management courtesy of Khanna Vision Institute serving the Thousand Oaks and Los Angeles area,
Pterygium and Lasik eye Surgery
Pterygium, which is a callus, is a result of dry eye. Lasik can further increase the dryness of eyes. Hence, Lasik eye surgery may cause progression of Pterygium. Depending on the decision of the surgeon Lasik eye surgery should be avoided in the presence of Pterygium.
There are several reasons why Lasik may be deemed unsafe if you have Pterygium:
- During the process of making the Lasik flap the head of the Pterygium may get cut. This is a big problem for the patient. For an irritated Pterygium is worse for the eye.
- Second the Pterygium may go grow into the interface causing visual problems. Since the potential space allows it an unimpeded progress it may expand in all directions lifting the flap. This results in irregular astigmatism causing ghosting of images.
- Thirdly the progressive Pterygium may grow over the flap. Removing it may be very difficult, as it may lift the flap.
- Lastly the Pterygium may grow over and under the flap and this will affect the nutrition of the flap leading to the destruction of the edges of the flap.
So what are the options to see better in the presence of Pterygium?
- Superlasik eye surgery is a great option for people suffering with pterygium. It avoids entering into the cornea. It can avoid disturbing the flap.
- Another option is Visian ICL: Implantable collamer lenses inserted away from the pterygium
- The best option is Superlasik eye surgery combined with Pterygium removal. Superlasik as you may recall, uses a highly specialized automated instrument called epikeratome. This separates the top layer of the cornea along a natural cleavage plane. The same plane is required to separate the progressive pterygium.
Therefore combining the two procedures makes a lot of sense. It does require advanced instrumentation and higher skill. But this is likely the best option to tackle two problems at once. Also since both procedures require similar medications it saves time and money for the eye drops. And it will decrease the total number of visits to the lasik eye surgeon.
Rajesh Khanna, MD
Dr. Khanna, of the Khanna Vision Institute, has performed hundreds of vision corrective surgery with patients suffering from pterygium. Located in Beverly Hills and Thousand Oaks, Khanna Vision Institute has helped thousands of individuals achieve the best vision possible after ridding them of pterygium from their eyes.