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Pterygium surgery: Go ahead and refer
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Recently a colleague referred a patient with a pterygium extending 2 mm onto the cornea (see “before” photo) that had been causing redness and irritation for several years. Artificial tears provided no meaningful relief. Topography confirmed the presence of irregular astigmatism affecting the central optical zone.
The patient had seen two ophthalmologists in the past and was told that there would be a 50/50 chance of recurrence if surgery were performed, and surgery was a very painful process. Her optometrist, who was familiar with the more modern approach to pterygium surgery, recommended she seek a third opinion.
 The pterygium extended 2 mm into the cornea.  The patient underwent a successful procedure. Images: Hovanesian J |
New advances in pterygium surgery have improved results so that in the hands of experienced surgeons using modern grafting techniques that use conjunctiva and amniotic membrane, recurrence rates are as low as 1%. Substituting fibrin adhesive for sutures in pterygium surgery has also improved the comfort of the healing period tremendously. Still, many symptomatic patients who deserve relief from their discomfort and from the threat of deleterious visual effects from pterygium go untreated because of perceptions that the results of yesteryear have not improved.
This patient underwent uncomplicated pterygium surgery and is now symptom-free and grateful to have had such a successful procedure (see “after” photo).
Take-home message: Modern pterygium surgery techniques yield far greater comfort and far less recurrence (as low as 1%) compared to older techniques. Clinicians should consider early referral for patients whose pterygia are symptomatic.