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,