Despite the prevalence, pterygium removal techniques not substantiated by sound data

WAIKOLOA, Hawaii — While many case reports and small case series have been published on pterygium removal, specialists lack solid data on which methods are most effective and prevent recurrence, according to a corneal expert speaking here.

Penny A. Asbell

"No matter where you're practicing, in what state or what part of the world, [pterygium] is a very common problem," OSN Contact Lens Section Editor Penny A. Asbell, MD, FACS, MBA, said. "What is interesting about pterygium is that evidence-based, peer-reviewed literature is actually somewhat sparse."

Speaking at Hawaiian Eye 2008, Dr. Asbell encouraged attendees of the meeting to consider undertaking large-scale clinical trials to produce more statistical evidence.

"Many of you have large practices. If you're ready to do a clinical trial, this does not involve the [U.S. Food and Drug Administration], but it would involve your [institutional review board]," she said. "This is an opportunity to give us real information to help decide which [pterygium removal] technique is better since statistical data do not really give us a clear-cut answer in terms of efficacy of amniotic membrane, rotational autografts, limbal conjunctival autografts and the use of mitomycin-C and/or glue."

In her presentation, Dr. Asbell provided an overview of the prevailing or conventional pterygium removal techniques, including the bare sclera approach, which has a high recurrence rate, and beta radiation, the standard of care years ago that has since fallen out of favor.

A newer technique that has become popular is conjunctival autograft, as it is believed to provide a barrier to prevent the fibrovascular tissue that forms the pterygium from growing back. Rotational autografts are also increasingly common if there are two pterygia present.

Dr. Asbell said use of tissue glue and amniotic membrane grafts are also garnering significant interest, as well as the use of mitomycin-C. Each of these newer options needs more study to fully evaluate the risks and benefits, she said.

"If you can think of a technique for removing pterygia, then someone has done it. There is no technique that hasn't been explored to some extent, from excising with blade, with a laser or with a muscle hook," Dr. Asbell said. "You name it, people have tried doing it."