What is a pterygium?
A Pterygium is a benign thickening of the conjunctiva that grows into the cornea, usually in the nasal aspect. As the lesion grows, it may become red and irritated. Eventually it may cause visual disturbances by disrupting the normally smooth surface of the cornea and, in some cases, it may reduce or impair the patient’s eyesight.
What causes a pterygium?
Ultraviolet (UV) radiation is the most common cause of a pterygium growth. This explains why a pterygium growth occurs more frequently in geographical locations close to the equator. It is very common in Latin countries. A pterygium is frequently associated with chronic exposure to dusty dry environments. Those who spend a significant time participating in outdoor activities are particularly susceptible. UV radiation causes thickening of the conjunctiva producing irritation, redness, foreign body sensation and ocular fatigue.
Pterygium excision at the Rand Eye Institute is performed utilizing the most advanced technique which includes the use of a conjunctival autograft. This provides an excellent cosmetic appearance and a significantly reduced rate of recurrence.
(less than 3%). In this technique, the pterygium is removed and the bare sclera (white of the eye) is covered with a conjunctival and limbal autograft taken from the superior bulbar conjunctiva. The autograft is secured with the use of modern tissue adhesives such as fibrin glue. This allows for a more rapid return to work and normal activities, as compared to older techniques. After about one week the tissue adhesive dissolves with no residue, allowing the eye to heal comfortably. Over the next 2-3 weeks the eye gradually returns to a normal appearance.
The older “bare sclera” technique, still performed in many centers, leaves the underlying white of the eye (sclera) exposed. Healing usually takes longer and is associated with more discomfort. With the bare sclera technique, the recurrence rate is high (50%). In these cases, the pterygium can grow back with a more aggressive behavior and can grow to a larger size than the original pterygium. To reduce recurrence rates, other techniques have been used including the use of Beta- radiation and/or antimetabolites such as 5-FU or Mitomycin-C. These techniques also have a higher risk of complications and are not used at the Rand Eye Institute.
A recent study (Hirst LW. Axelsen RA, Schwab I. Pterygium and associated ocular surface squamous neoplasia Arch Ophthalmol.2009; 127:31-2) identified ocular surface squamous neoplasia (OSSN) in 9.8% of pterygium specimens. In the Ocular Surface Center at the Rand Eye Institute, all specimens are submitted for pathology analysis to identify possible ocular surface squamous neoplasia (OSSN). In positive cases, a more extensive treatment is provided that includes extended dissection, cryotherapy, use of Mitomycin-C and ocular surface reconstruction using amniotic membrane transplantation.
How to prevent pterygium growth?
The best method of preventing a pterygium is to regularly use UV 400 rated protective sunglasses when outdoors in sunny conditions. Sunglasses with a wrap-around design provide better protection than those with large gaps between the sunglass frame and the eyes. Wearing a hat with a wide brim provides additional protection.
State-of-the-Art treatment at the Rand Eye Institute
The Rand Eye Institute is a comprehensive eye care facility. Located on Sample Road, east of I-95, in Deerfield Beach, Florida. The Rand Eye Institute is one of the largest eye surgery centers in the United States. The Rand Eye Institute’s commitment to eye care has earned it an international reputation for excellence in ophthalmology with patients coming from all over the world. The Rand Surgical Pavilion is a state-of-the-art surgical center licensed by Florida’s Agency for Health Care Administration (AHCA). The Rand Surgical Pavilion is Joint Commission accredited. The Joint Commission is the nation’s oldest and most respected accrediting agency.
Each operating room in the Rand Surgical Pavilion is complete with the finest and most modern equipment, enabling the most advanced precision microsurgery to be performed. Many thousands of eye surgical procedures are performed annually by some of the nation’s most experienced doctors.
At the Rand Eye Institute, the Anesthesiology department supervises and monitors all patients during all types of surgery. This assures maximum safety and surgical quality. The presence of an anesthesiologist allows the surgeon to concentrate on the eye surgery. The Rand-Stein Analgesia protocol, virtually eliminates pain during surgery. General anesthesia is no longer necessary. The patient can be awake and alert during surgery, or can receive minor short-action sedation for anxiety.