What does the treatment involve?
Sutureless pterygium surgery involves removing the pterygium without applying sutures. As there is an area without any cells, we must put healthy tissue in its place. The simple removal of the ptergygium may cause a relapse, the pterygium reappears, therefore a graft is always required.
When is this treatment indicated?
When the pterygium starts to grow, it may cause an astigmatism. It may, in turn, cause the cornea to opacity, in which case it has to be removed.
How is it performed?
During the surgical procedure, performed under local anaesthesia, we remove the pterygium in the whole part invading the cornea, and in the part of the conjunctiva. We clean the whole fibrous tissue forming over the years, leaving the area as clean as possible.
It is usually an area of 6 x 8mm, depending on the size of the pterygium.
This whole area will be covered with a graft, which is taken from the eye itself, from the conjunctiva, normally from the superior temporal quadrant, under the upper eyelid.
A small square of tissue approximately 1cm thick, or a little less, depending on the size necessary, is cut with scissors, and is placed in the area from where we have removed the pterygium.
It is important to preserve the orientation of the tissue. Sutures are not used to hold it in place, but rather a fibrin-based biological adhesive that sticks to the tissue perfectly.
Once the surgery is finished, an antibiotic oinment, a dressing, and a compression bandage are applied to keep the graft in position, which would normally be well fixed with the fibrin for 24 to 48 hours until a good level of healing is attained.
In the postoperative period, the eye may be red for a few days or you may experience discomfort. The patient needs corticosteriod treatment, antibiotics and plenty of topical lubrication with ointments, gels and artificial tears so that the graft takes and starts to attach to the surrounding tissue.
The use of this technique means we attain a very low percentage of recurrences. We do not use sutures, which are always uncomfortable for the patient during their postoperative period.
In general, the result is very satisfactory as it is a very simple operation when undertaken by experts. The cosmetic result is usually excellent.
There are few complications. One of them is inadvertent detachment, if the graft does not remain adhered and is lost in the postoperative period.
It is an extremely rare complication that can be seen as soon as the bandage is removed on the first day. A new graft from the same eye or the other eye would be required.
Recurrence is perhaps the most common complication of pterygium surgery. It may be around 5% although it also depends on the patient's individual circumstances, like repetitive sun exposure and race.
It is more common in patients from countries in the equatorial strip, due to the higher level of sun exposure. If the pterygium has not relapsed in the first months, has not recurred, then it will now no longer come back during your lifetime.
The astigmatism caused by the pterygium after removal normally goes away. Otherwise, the patient will need to use glasses or will require cornea surgery to correct it.
Professionals who perform this treatment
Frequently asked questions
Once the pterygium is removed, can it come back again?
Yes, although a sophisticated technique is used, the percentage of recurrences is very low, under 5%. It is necessary that the patient follows their corticosteroid and antibiotic treatment properly during the postoperative period, avoiding sun exposure and irritation of the eye for the first few months or even a year after surgery.
Are there alternative treatments if the pterygium comes back again?
If the pterygium comes back again and the conjunctival graft, which is the best tissue we can apply as a graft in pterygium surgery, cannot be used, then alternative grafts can be used, such as amniotic membrane, the membrane that covers the placenta. It has antibiotic, anti-inflammatory and reparative properties. In any case, studies demonstrate the superiority of the conjunctiva graft compared to using amniotic membrane. In cases of mild reccurence, drugs can be used, such as a direct injection thereof into the area where the pterygium starts to recurr. These are vascular growth inhibitors, such as Bevacizumab. Radiotherapy was used in the past, but it is not currently used. However, there are drug treatments to avoid growth, in cases were the growth itself is small.