Pterygium Surgery with
Amniotic Membrane Graft
Pterygium (ter-e-je-um), is a fleshy tissue that grows over the cornea. It is also known as “surfer’s eye.” UV radiation (usually from sunlight) is the most common cause of pterygium and they occur more often in people who spend a great deal of time outdoors, especially in sunny climates like Santa Cruz. This explains why pterygium occurs with increasing frequency in climates approaching the equator. Other causes include continuous exposure to dry, dusty environments. People who spend significant time in water sports (surfing or fishing) are particularly susceptible to pterygium because of the intense exposure to UV that occurs in these environments. When the eye is continuously assaulted by UV rays, the conjunctiva may thicken in a process similar to callus formation on the skin. The sensitive structures of the outer eye often can not comfortably tolerate this degenerative process, and irritation, redness, foreign body sensation, and ocular fatigue can result.
When a pterygium becomes red and irritated, eye drops or ointments may be used to help reduce the inflammation. If your pterygium is very small and does not bother you, then you should try using mild, soothing eyedrops such as artificial tears such as Blink tears, Soothe, or Tears Naturale. These could be used several times a day for dry or smoggy days when your eyes are likely to become red. Try to keep your eyes from becoming red, because that is a sign of the inflammation which tends to make pterygia grow larger. Wearing sunglasses when you are out in bright sunlight is also helpful.
If the pterygium is large enough, causes excessive irritation, interferes with sight, grows or is unsightly, it can be removed surgically. When symptoms of redness, irritation, or blurred vision are resistant to conservative treatment, or when vision is affected by progressive growth of a pterygium, surgery is considered.
In pterygium surgery, the abnormal tissue is removed from the cornea and sclera (white of the eye). Over the years, pterygium surgery has evolved significantly, and modern pterygium surgery has a significantly higher success rate than conventional surgery.
In traditional "bare sclera" pterygium removal, the underlying white of the eye (sclera) is left exposed. Healing occurs over two to four weeks with mild to moderate discomfort. Unfortunately, the pterygium may grow back in up to 50% of patients. In many cases, the pterygium grows back larger than its original size. Over the years, however, surgeons have used several different techniques to lessen the likelihood of pterygium recurrence, including the use of amniotic membrane grafts and adjuvant use of a "anti-metabolite" chemical called Mitomycin that prevent growth of tissue. When this amniotic membrane grafts is used during the surgery, the recurrence rate drops to about 5%. Mitomycin is usually well tolerated with no side effects. Possible side effects include delayed healing, sometimes with actual atrophy or withering away of the tissue in the bed of the pterygium.
Amniotic Membrane Graft with Fibrin Glue (No Stitch Surgery)
Dr. Fishman performs pterygium surgery with either a conjunctival autograft or amniotic membrane graft because of a reduced risk of recurrence. In some instances, he uses adjuvant Mitomycin C to further improve results. In this technique, the pterygium is removed, and the cornea regains clarity. The gap in the conjunctival tissue, where the pterygium was removed, is filled with a amniotic membrane graft.
No-stitch surgery is made possible by the use of a modern tissue adhesive called Tisseel*. Tisseel is a fibrin sealant that allows Dr. Fishman to secure an Amniotic Membrane Graft in seconds rather than minutes. After about one week the tissue adhesive dissolves with no residue, leaving the eye to heal comfortably. Although tissue adhesive is derived from human blood products, no cases of blood borne infection have ever been reported among millions of patients treated with this material in heart and lung surgery.
The eye may be red for up to two weeks, but ultimately there is almost no scar. Plan on being off from work for one week. (You can safely return to work immediately if you wish, but usually the eye is quite red for about a week). Ice bags and pain pills are advised for the first day, but after that you just need to instill antibiotic-steroid eyedrops four times daily for two weeks.
The best method of preventing pterygium re-growth is to regularly wear UV 400 rated 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 skin around the eyes. Wearing a hat with a wide brim provides valuable additional protection.
*Fibrin tissue adhesive is a drug approved by the FDA for abdominal surgery. Although its use in eye surgery has not yet been specifically approved by the FDA, our research suggests that this technique is a safe and effective alternative to eye surgery using stitches.