I have been seeing an increasing number of folks coming in for an opinion about their pterygium.  Most don’t know that is the name of the fleshy-looking growth on the nasal side of the cornea.  It has a triangular shape which looks somewhat like a wing, therefore the name “pterygium” which from the Greek means “wing.”  The pterygium may first appear as a reddish area on the nasal side of  the dark central part of the eye (the iris provides the color and the cornea is the clear window over it) only to grow onto the cornea as a fleshy membrane.  If left untreated, it has the potential to grow across the center of the cornea and result in a severe loss of vision.  It seems that the growth and development of pterrygia are related to sunlight so if you have noticed a small pterygium, get some good quality sunglasses. 

 There is no reason to treat small pterygia (as most don’t become large pterygia) unless they are irritating and/or growing.  I don’t often see middle aged people with pterygium problems, usually it becomes symptomatic  in people in their 20’s and 30’s.  I have found that the pterygium become stationary later in life.  Quite frequently patients will ask me to remove a pterygium which they have had for many years while I’m operating their cataracts; this is very possible.  Many people ask to have the pterygium removed for cosmetic reasons, ie, they are tired of answering the question: “what is that growing on your eye?”  But if the pterygium is growing, it is time to act and the only action is surgical removal.

The removal of a pterygium is low risk as the entire procedure is conducted on the outside of the eye.  The main risk is that it will recur after removal.  When I began doing this surgery early in my career, the recurrence rate was as high as twenty-five percent.  Back then we used low dose radiation applications to the eye to prevent recurrence.  This approach was inconvenient and didn’t do much good.  The next advance was the use of conjunctival grafts, that is, after the pterygium was removed we took a piece of the white filmy cover of the eye (conjunctiva) from under the eyelid and moved it to the surgical site and sewed it into place.  This helped reduce the recurrence rate but it made the surgery long and tedious.  At the same time we began using a drug called Mitomycin which was developed in the 1950’s for chemotherapy.  The Mitomycin was applied to the surgical area with sponges for several minutes to inhibit new scar formation and reduce the chances of regrowth.

All of this has evolved to the state of the art which is the use of an amniotic membrane  graft http://www.osref.org/medical-education-materials.aspx made of human placenta (only the inner basement membrane which is very thin) which is glued into place with fibrin glue http://www.baxter.ca/htdocs/en/doctors/biosurgery/products_tisseel.html (a human byproduct).  The placenta is first lab tested for contaminants then frozen and shipped to us.  When placed on the eye it provides stemcells which reduce inflammation and a barrier to recurrence.  It is readily absorbed onto the surface of the eye.  This approach coupled with Mitomycin has made the surgery reasonably fast and effective in terms of reduction of the recurrence rate.  Postoperative course consists of one night with a patch then several weeks of eyedrops; vision is good immediately and folks can resume their usual activities in a day or so.

This technique has its greatest benefit in patients who have had prior pterygium surgery with a poor outcome, that is, a recurrence.  If a graft with fibrin glue and Mitomycin is not done in these people, a further recurrence is a good probability. 

While this technique is not fullproof, it is currently the most effective treatment for pterygium.