Cosmetic Outcome Pterygium Surgery (COPS)

What Is Cosmetic Outcome Pterygium Surgery?

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. Ideally, the surgeon will obtain a good cosmetic outcome and prevent its recurrence. As a result, the eye should look natural and white. 

What To Expect From Your Pterygium Surgery

Before Pterygium Surgery

We start treatment for Dry eyes and UV prevention before the procedure, if possible.

Drops or eye ointment will usually be prescribed. You will put the drops in the affected eye 1-3 days before the procedure. These contain an antibiotic or a combination of an antibiotic and a steroid.

It's normal to feel some apprehension before an eye procedure. 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, we will first confirm your name and the eye to be operated on. We will apply anesthetic drops to 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. It's best not to overdose, lest you fall asleep or have other adverse side effects.

During Pterygium Surgery

You will lie down on a comfortable bed with a neck supporting pillow. Music of your choice will be played. Drapes will be placed over your eye. The microscope light will be focused on your eye.

The best part is, unlike the videos you may have seen, nothing comes directly at your eye. All instruments are 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 on your eye to soothe the discomfort.

After Pterygium Surgery

At the end of the procedure, we apply eye steroid antibiotic eye ointment. The eye is patched to protect the conjunctival graft. You may feel some foreign body sensation, as if there is sand in your eyes.

You may feel some discomfort as the drops wear off. You can apply ice pack over the patch. You may also take a pain killer. It's not common to have severe pain.

What to Know About Pterygium Surgery in Los Angeles

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.

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.

Cosmetic

• High schooler or college going person may find social interaction challenging. 
• At work, people often think a person with surfer's 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 Pseudopterygium

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.

How Is Pterygium Surgery at Khanna Vision Unique?

• Accurate marking. 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. 
• Removal of the entire pterygium. 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.
• Smooth the surface of cornea. It's important to prevent irregularity on the surface of cornea. A smooth surface appears cosmetic. It also decreases you chances of the growth coming back. 
• 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.
• Heat to close vessels feeding it. Mild bleeding may be good, as blood supplies antibacterial support and some minerals to the area. Further oozing can prevent the glue from working and displace the graft. 
• Proportionate conjunctival graft. We use a caliper to measure. Small grafts can leave a bare area of sclera. Large grafts can get stuck to cornea.
• Glue the graft with no stitches. Stiches cause irritation. They can also attract blood vessels.

Meet 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 of 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 of Pterygium Surgery

Prevention of Recurrence

Before operating, we measure ten 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. Pterygia 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. It is also more vascular because it's getting the nutrition it needs to grow.

Surgery For Recurrence

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 drug 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. Attention should be directed to proper numbing of the eye. You might even require oral or IV pain relievers.

During the recurrent pterygium procedure:

• Identify the borders and extensions of the recurrent pterygium.
• Identify the muscles like the lateral rectus, medial rectus and the obliques. Be sure to avoid trauma to them.
• If a 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.

How Much Does Pterygium Surgery Cost?

The cost of cosmetic outcome pterygium surgery varies from $2,000 to $6,000, with an average in 2024 of $3,600. 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 measurement documentation. The cost includes the surgery, drops, ointments, and all follow-up exams. We also include a warranty about recurrence.

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 the 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. This will affect the nutrition of the flap, leading to the destruction of the edges. 

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 uses a highly specialized automated instrument called an 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. Still, 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. Ultimately, it will decrease the total number of visits to the SuperLasik eye surgeon.

FREQUENTLY ASKED QUESTIONS

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. H3: 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.

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.

What are the risks of pterygium eye surgery?

The risks of pterygium eye surgery include infection, bleeding, and recurrence of the pterygium.

What are the benefits of pterygium eye surgery?

The benefits of pterygium eye surgery include improved vision, cosmetic improvement, and comfort.

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.

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, then you may need to take some time off to rest and shield your eye from the sun.

Can I drive after pterygium eye surgery?

Yes, you can drive as long as you have a valid driver's license. However, you may need to wear protective eyewear for a few weeks.

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, 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.

Can I swim after pterygium eye surgery?

You would need to wait at least one to two weeks before swimming or going into a 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. That can cause rubbing and again lead to movement of the graft.

Can I wear contact lenses after pterygium eye surgery?

Yes, after Pterygium has been removed, the surface is smooth enough 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 graft.

It may be best to wait at least 2 weeks before wearing contact lenses.

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.

Can I use eye drops after pterygium eye surgery?

Yes, you can use eye drops after pterygium eye surgery. Ointments 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.

Will my pterygium grow back after surgery?

The risk of recurrence of a pterygium after surgery at our Institution is less than 1%.

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.

Is pterygium surgery considered cosmetic?

The pterygium surgery is considered cosmetic or elective when the growth is on the white part of the eye. It is also cosmetic if the pterygium just invades the cornea.

What is the success rate of pterygium surgery?

For pterygium surgery to be successful cosmetically it should result in a normal appearance. It should also not come back again. At Khanna, our decades of experience have resulted in a success rate of 99% or higher.

What is the cosmetic outcome of femtosecond laser assisted pterygium surgery?

Recently, some doctors have started performing femtosecond assisted laser pterygium removal. The outcomes are good cosmetically.

What are the benefits of pterygium removal?

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 lenses more comfortably. The contact lens is less likely to fall off. 

Eyes also look normal rather than inflamed. Actors and actresses again give better performances without worrying how their eyes look on the camera.

Should I have my pterygium removed?

Consult with a surgeon before making the decision to have your pterygium removed. Ask about their success rate, as well as what guarantee they offer in the event of a recurrence.

How long does it take to recover from pterygium eye surgery?

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.

What should not be done after pterygium surgery?

After the cosmetic procedure, avoid sun and UV radiation. Wearing protective eyewear is important to help you avoid the sun, dust, and allergens during recovery.

How risky is pterygium surgery?

This surgery, when attempted by a casual eye doctor, can be risky. It can lead to recurrence, bleeding, or infection. When performed by an experienced pterygium surgeon, it can be a quick and painless procedure.

What is the average age of people with pterygium?

This disease is induced by UV radiation from the sun. It's logical that the average age is around 40 years. A few decades of exposure are needed to stimulate the unnatural growth.

Pterygium can still occur in younger people even in their teens. Most likely they have some genetic preponderance towards it.

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.

Can pterygium be removed by a laser?

Yes, Pterygium can be removed with a combination of laser and surgery. It cannot be vaporized.

Which laser is used in pterygium?

Two types of lasers have been used: Excimer and Femtosecond laser.

What is the most effective treatment for pterygium?

The most effective treatment for pterygium is meticulous surgical removal with autograft.

What is the latest treatment of pterygium?

The latest treatment is meticulous dissection and proper bleeding control, followed by a glued conjunctival autograft. Lasers may help in some of the steps, but are not essential.

What makes pterygium worse?

Exposure to UV radiation, dust chemicals and dry eyes can hamper the recovery from a surgery.

Is surgery the only treatment that can remove a pterygium?

Yes, it is the only treatment.

How fast does pterygium grow?

They grow slowly. Certain events like intense exposure to UV light can incite them to grow faster.

What are the restrictions after pterygium surgery?

One should not rub their eyes after surgery. A person should also protect the eyes from UV radiation, sunlight, pollution, dust, and chemicals. Take extra care when visiting a spa or pool. Smoke, like in barbecues, should also be avoided. 

Does Medicare pay for pterygium removal?

There are strict guidelines regarding when Medicare will cover for this procedure. One has to remember that Pterygium is more common in younger patients. The average candidate has not reached the age to qualify for Medicare.

Does pterygium surgery affect vision?

Usually, it will improve the vision.

Can an optometrist remove a pterygium?

No, an optometrist is not qualified to do this procedure. Only skilled surgeons are adept in this.