Removing the root – Reducing the recurrence
Many pterygia can be safely left alone and just watched. Patients can do this reasonably well themselves by just looking in the mirror although some components of the pterygium near the pupil may be difficult to detect without magnification. It is probably useful for most patients with a pterygium to have an examination with their eye care professional (general practitioner, optometrist or ophthalmologist) every year or two to check that the pterygium is not growing.
In those patients in whom redness is the main concern, the occasional use of an over the counter drug such as Albalon®, Albalon Relief®, Albalon-A®, Antistine- Privine Eye Drops®, Murine Clear Eyes®, Murine Sore Eyes®, Naphcon-A®, Naphcon Forte®, Optazine®, Prefrin®, Prefrin-Z® or Visine Allergy®*, can give temporary relief for important social occasions or times when the eye is very irritated. However, long-term and frequent use of such eye drops is not advisable as the eye can become increasingly red on withdrawing these drops. Toxic reactions, allergies and side effects can occur as a result of the long-term use of these drops.
In some cases, surgery may be the appropriate method to treat this condition. The principal reasons that surgery may be required are for those patients in whom over the counter drops do not give sufficient relief for chronic irritation and redness, in patients in whom the pterygium is large enough to be a cosmetic blemish, or in patients in whom the vision is either affected already, or may be affected by continued growth of the pterygium.
Because of the improved surgical treatment to be described below it is reasonable to consider a broadening of formally fairly strict reasons for removing a pterygium. Now, it is reasonable to remove a pterygium in patients who do not like the appearance of the pterygium no matter what the size of the pterygium.
There is no perfect method of removing a pterygium. The major complication of pterygium removal is that the pterygium can recur, and sometimes when it recurs it may be larger and more troublesome than the pterygium that was removed. The risk of recurrence varies according to the scientific reports, but it is unlikely to be under 5 percent and perhaps up to 15 percent. If a pterygium is going to recur, our research group has shown that more than 95 percent of them will start to recur within the first year.
There are at least a dozen methods of removing a pterygium but a conservative approach would suggest that it is preferable not to use additional “chemo” drugs or radiotherapy if this can be avoided. The potential for long-term side effects from these methods, which are advocated by some surgeons, is such that extreme caution needs to be exercised in their use.
Although there would be considerable dispute about the method of pterygium removal which is most successful in preventing a recurrence, it is our view and the view of many other pterygium surgeons that removal of the pterygium and filling the resultant defect on the surface of the eye with a piece of membrane (conjunctiva) taken from another place on the surface of the eye is the technique associated with the least risk and the highest success rate. This is called a pterygium removal with autoconjunctival transplant or conjunctival autograft.
It is our impression that many pterygium removals are treated as trivial procedures and managed in the doctor’s offices under anaesthetic drops with only simple excision, or with the use of chemicals during or after the surgery which are capable of severe side-effects. Unfortunately the recurrence rate after simple excision may be as high as 50 or 60%. The addition of the chemicals will reduce the recurrence rate to 5-10%. Once a pterygium recurs subsequent removals may be far more problematic than the original removal.
*(Albalon/Allergan:Albalon Relie/Allergan:Albalon-A/Allergan:Antistine-Privine Eye Drops/Novartis:Murine Clear Eyes/Aspen:Murine Sore Eyes/Aspen:Naphcon-A/Alcon:Naphcon-Forte/Alcon:Optazine/Uhlman & Eyrand (Switzerland):Prefrin/Allergan:Prefrin-Z/Allergan:Visine Allergy/Pfizer Consumer Health Care)