Cosmetic Outcome Pterygium Surgery (COPS)

• Definition
• What to expect; Before, During and After
• Surgery
• Dr.Khanna’ Special Surgical Sauce
• Pterygium Surgeon
• Before and After Pictures
• Prevention of recurrence
• Surgery For Recurrence
• Costs
• Special Situations
• FAQ

Definition

Cosmetic Outcome Pterygium Surgery (COPS) is an outpatient procedure, typically performed under topical anesthesia. The primary goal of the surgery is to remove the pterygium growth, obtain a good cosmetic outcome and prevent its recurrence. The eye should look natural and white.

What To Expect

Before:

We start treatment for Dry eyes and UV prevention before the procedure, if possible.Its normal to feel some apprehension before an eye procedure. Drops or eye ointment will usually be prescribed, to put in the affected eye 1-3 days before.These contain antibiotic or combination of antibiotic and steroid. It is best not to watch too many you tube videos on the subject. They can be scary. We want to remain calm.

When you arrive for your procedure, your name and eye to be operated will be confirmed. Anesthetic drops will be put which numb the eye. This is followed by a special pain preventing eye ointment. Betadine, an antiseptic cleans the eyelids and the eye. A xanax tablet will be given to take the edge off.Its best o not overdose lest you fall asleep or have other side effects.

During

You lie down on a comfortable bed with a neck supporting pillow. Music of your choice will be played. Drapes will be put over your eye. Microscope light will be focussed on your eye. the best part is unlike the you tube videos you may have seen nothing comes directly at your eye. All instruments ar brought in from the periphery. You may feel some pressure or even cold from the drops. Pain is unlikely. If you feel any pain more medicine can be put.

After

At the end of the procedure eye steroid antibiotic eye ointment is put. The eye is patched to protect the conjunctival graft. You may feel some foreign body sensation as if there is sand in your eyes. As the drops wear off you may feel some discomfort. You can apply ice pack over the patch. You may also take a pain killer. Its not common to have severe pain.

Surgery

Indications for Pterygium Surgery:

There are two important considerations to keep in mind when thinking of getting your pterygium removed. If it begins to grow, it needs to be removed before it causes permanent visual changes. Secondly, meticulous surgery by a skilled pterygium surgeon is required to get good cosmetic result and prevent recurrence.

1. Visual:

Causes astigmatism, affecting vision.

Invades the center of the cornea, preventing light to enter the eye.

Restriction of eye movement.

Dry eyes due to interference in the spread of tears.

2. Cosmetic

High schooler or college going person may find social interaction challenging.

At work people often think a person with surfers eye is drunk.

People may not like what they see in the mirror.

It may be a work hazard for actors, newscasters and others who face cameras.

Contraindications:

Being on blood thinners or having an active bleeding disorder.

Differentiate from Pesudopterygium

Psudopterygium is a condition where conjunctiva covers an inflamed portion of cornea. Pterygium can be differentiated from psudopterygium by doing a probe test. In a pterygium, a probe can be passed between the pterygium and the eyeball.

Special Surgical Sauce

1. Accurate marking and removal of the entire pterygium. We use a special pen to mark out the pterygium before numbing medicine is placed below the pterygium. This is important as the medicine swells the conjunctiva blurring its margins. If some pterygium is left behind it can grow back. We grab the head of the growth. This is the part on the Cornea. This is disinserted and the pterygium is removed in one piece if possible.
2. Smoothen the surface of cornea: It/s important to prevent irregularity on the surface of cornea. A smooth surface appears cosmetic. It also decreases chances of growth coming back.
3. Removal of the membrane called tenons: This may be thin in older white patients. It may be thick in younger people especially those of hispanic origin. Many scientists believe the growing pterygium claws on this layer. Therefore it is best to remove it.
4. Heat to close vessels feeding it. Mild bleeding may be good as blood supplies antibacterial and some minerals to the area. Further oozing can prevent the glue to work and displace the graft.
5. Proportionate conjunctival graft: We use a calliper to measure. Small graft can leave bare area of sclera. Large graft can get stuck to cornea.
6. Glue the graft with no stitches: Stiches cause irritation. They can also attract blood vessels.

Pterygium Surgeon Dr.Khanna

• Pterygium surgery experience of over three decades.
• Has been successful with multiple techniques for over 25 years.
• Uses the latest, safest, cosmetic technique with the least chance recurrence happening.
• #1 choice of movie stars, newsreaders and physicians.
• Board Certified by American Board of Ophthalmology.
• Pain-free surgery in operating suite.

Before and After Pictures

Prevention of recurrence

Before operating, measure 10 times and plan carefully! It’s important to know that pterygium surgery can result in recurrent pterygium, which is when the growth comes back. This happens if the tenon’s capsule scaffold is not removed and adjunct therapies are not used. In fact, there’s up to a 70% chance of recurrence! Managing recurrent pterygium is complex, and we often see patients who had their initial surgery done elsewhere. Pterygium are like weeds – remove them completely, or leave them alone. Never irritate them, as this can make them worse. Recurrent pterygium is even worse than the first one because it can spread in all directions and have more fibrosis. This makes it more firmly attached to the muscles and surrounding eye tissue, and more vascular because it’s getting the nutrition it needs to grow.

Surgery For Recurrence

Recurrent Pterygium Management

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.
• Plan to repeat surgery in the 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 anti-cancer 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 and be sure to 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 anti-inflammatory 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 FaceTime, Skype or Zoom with us to learn your options. If you send us your insurance card, our staff can let you know your insurance coverage.

Costs

Special Situations

Pterygium and Lasik Eye Surgery

Pterygium, which is a callus growth on the eye, 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  because an irritated pterygium is worse for the eye.
• The pterygium may 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.
• The progressive pterygium may grow over the flap. Removing it may be very difficult, as it may lift the flap.
• 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.
• Another option is EVO Visian ICL (Implantable Collamer Lenses) inserted the natural lens.
• 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 SuperLasik eye surgeon.

FREQUENTLY ASKED QUESTIONS

1. What is a pterygium Surgery? Pterygium surgery is the removal of the growth on the cornea. It is performed under medical indications when the vision has become blurry our sight is lost.
2. What is Cosmetic pterygium eye surgery? Cosmetic Pterygium eye surgery is the removal of the pterygium growth which is unsightly to the patient and observer. The growth may be small or large, causing irritation or interfering in vision. The focus is to restore a white eye, which has a natural cosmetic appearance even in front of HD cameras.
3. How is pterygium eye surgery performed? Pterygium eye surgery is usually performed as an outpatient procedure under topical anesthesia. Most people can return to normal activities within a few days.
4. What are the risks of pterygium eye surgery? The risks of pterygium eye surgery include infection, bleeding, and recurrence of the pterygium.
5. What are the benefits of pterygium eye surgery? The benefits of pterygium eye surgery include improved vision, cosmesis and comfort.
6. How long does it take to recover from pterygium eye surgery? Most people recover from pterygium eye surgery within a few days. However, it may take several weeks for the full cosmetic effect and eye to return to looking white and shiny.
7. Can I work after pterygium eye surgery? Most people can return to work the next day after pterygium eye surgery. However, if you work in  the sun like in the fields, or surf than you may need to take some time off to rest and shield your eye from the sun.
8. Can I drive after pterygium eye surgery? Yes, you can as long as you have a valid driver’s license. ? Most people can drive after pterygium eye surgery. However, you may need to wear protective eyewear for a few weeks.
9. Can I fly after pterygium eye surgery? You would need to wait 1-3 days to fly after pterygium eye surgery. However, depending on your destination the surgeon may advise a longer time for example if you’re going for mountain climbing or trekking through forests then at least a week or two would be required. But if you’re going to a metropolitan city like San Francisco, you could fly the next day.
10. Can I swim after pterygium eye surgery? You would need to wait at least one to two weeks before swimming or going into spa. The reason is the water pressure could displace the graft. Also the chemicals in a pool or salt in sea water can induce irritation which can cause rubbing and again lead to movement of the graft.
11. Can I wear contact lenses after pterygium eye surgery? Yes after Pterygium has been removed the surface is more smoother to accept a contact lens. Most people can wear contact lenses after pterygium eye surgery. However, you Have to be careful not to dislodge the craft when trying to insert or more importantly remove the contact lens. It may be best to wait at least 2 weeks before wearing contact lenses.
12. Can I take over-the-counter pain medication after pterygium eye surgery? Yes, you can take over-the-counter pain medication after pterygium eye surgery. However, you should avoid taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 48 hours after surgery.
13. Can I use eye drops after pterygium eye surgery? Yes, you can use eye drops after pterygium eye surgery. Ointment are usually more beneficial as they coat the eye giving longer term relief. Your doctor will prescribe eye drops to help prevent infection and promote healing.
14. Will my pterygium grow back after surgery? The risk of recurrence of a pterygium after surgery at our Institution is less than 1%.
15. What should I do if I have questions or concerns after pterygium eye surgery? We give written postop instructions, and also have instructions on our website and YouTube. If you still have questions or concerns after pterygium eye surgery, you should contact your doctor.
16. Is pterygium surgery considered cosmetic? The pterygium surgery is considered cosmetic or elective when the growth is on the white part of the eye or just invades the cornea.
17. What is the success rate of pterygium surgery?
18. For pterygium surgery to be successful cosmetically it should give a normal appearance. It should also not come back again. At Khanna vision institute are decades of experience has resulted in 99% or more success rate.
19. What is the cosmetic outcome of femtosecond laser assisted pterygium surgery? Recently some doctors have started performing femtosecond assisted laser daddy Jim removal. The outcomes are good cosmetically.
20. What are the disadvantages of pterygium surgery?
21. If this surgery is not performed properly it can have disadvantages. The pterygium if it’s just cut off when all the techniques and steps are not followed it can come back viciously.
22. What are the benefits of pterygium removal?
23. Once the growth is removed the dryness of the eye decreases as the lids are able to spread the tears uniformly over the eye. A person can also wear contact lens more comfortably. The contact lens is less likely to fall off. Eyes look normal person is not confused to be drunk. Actors and actresses again give better performances without worrying how their eyes look on the camera.
24. Should I have my pterygium removed?
25. If your surgeon recommends you to have the growth removed it’s a good idea period of course you should discuss with the surgeon thus success rate in their hands and what guarantee they have about recurrence.
26. How much does removal of pterygium cost?
27. The cost of cosmetic outcome pterygium surgery varies From $2000 to $6000 with an average in 2023 being $3600. This variation is based on whether you’re having it done in Los Angeles or a small town in Midwest. The cost of living influences this. Another factor affecting the final cost is what is included in the price. For example at Khanna vision institute we include all the preoperative measurements documentation the surgery the drops ointments required and follow-up exams. We also include a warranty about recurrence.
28. How long does it take to recover from pterygium eye surgery?
29. Cosmetic outcome Pterygium procedure requires an overnight patch. Once the patch is removed and the graft is confirmed to be in place a person can resume normal activities. They still need to wear UV protection glasses and avoid the sun.
30. What should not be done after pterygium surgery?
31. After the cosmetic procedure sun and UV radiation should be avoided. Wearing protective eyewear is important to avoid the sun and the dust and allergens.
32. How risky is pterygium surgery? This surgery attempted by a casual eye doctor can be risky. It can lead to recurrence bleeding infection. When performed by an experienced pterygium surgeon it can be a quick beanless comfortable procedure with the great cosmetic outcome.
33. What is the average age of pterygium? This disease is induced by UV radiation from the sun. So it’s logical that the average age is around 40 years.  a few decades of exposure are needed to stimulate the unnatural growth. It can still occur in younger people even in their teens. Most likely they have some genetic preponderance towards it.
34. What is the prognosis of pterygium excision? The prognosis is very good in experienced hands. Good care of the eye before during and after the surgery is an important requirement.
35. Can pterygium be removed by a laser? Yes, Pterygium can be removed with a combination of laser and surgery. It cannot be vaporized.
36. Which laser is used in pterygium? Two types of lasers have been used. Excimer and Femtosecond laser.
37. What is the most effective treatment for pterygium? The most effective treatment for pterygium is meticulous surgical removal with autograft.
38. What is the latest treatment of pterygium? The latest treatment is meticulous dissection, proper bleeding control followed by a glued conjunctival autograft. Lasers may help in some of the steps. They are not essential.
39. What is the new treatment for pterygium? New cure is careful planned dissection, removal of underlying tissue, glue a conjunctival replacement.
40. What makes pterygium worse? Exposure to UV radiation, dust chemicals and dry eyes can hamper the recovery from a surgery
41. Is surgery the only treatment that can remove a pterygium? Yes it is the only treatment.
42. How fast does pterygium grow? They grow slowly. Certain events like intense exposure to UV light can incite them to grow faster.
43. What are the restrictions after pterygium surgery? One should not rub the eyes. A person should also protect the eyes from UV radiation, sunlight pollution dust and chemicals like those found in a spa, pool or in industries. Smoke like in barbecues should also be avoided.
44. Does Medicare pay for pterygium removal? There are strict guidelines when Medicare will cover for this procedure. One has to remember Pterygium is more common in younger patients who have not reached the age to qualify for Medicare
45. Does pterygium surgery affect vision? Usually it will improve the vision
46. Can an optometrist remove a pterygium? No an optometrist is not qualified to do this procedure. Only skilled surgeons are adept in this.