PTERYGIUM SURGERY
WHAT IS A PTERYGIUM?
A pterygium is scar tissue of the conjunctiva (skin lining the surface of the eyeball). It grows over the front of the cornea (the clear window at the front of the eye). A pterygium usually grows very slowly, over many years. It is more common in people who have been exposed to a lot of sunlight during their lifetime.
A pterygium may cause one or more of the following:
- No symptoms at all
- Discomfort in the eye, such as a dry or gritty sensation. This isusually relieved by using regular lubricating eye drops.
- Change in the shape of the cornea known as astigmatism. This maybe a reason to consider surgery for a pterygium before having cataract surgery, even if it has been there for a long time and not caused any problems before.
- Dissatisfaction with the cosmetic appearance of the eye. Surgery is not recommended for this reason because of the potential for complications
- In severe cases a pterygium can grow over the central part of the
- cornea causing blurred vision. If your pterygium is growing towards the Centre of your cornea, we recommend surgery before it affects the vision.
PTERYGIUM SURGERY
- Pterygium surgery is usually performed under local an aesthetic (whilst you are awake). Drops will be used to numb your eye, and a small amount of local an aesthetic injected under the conjunctiva (surface ‘skin’ of the eye). You will be able to move your eye to assist the surgeon during the procedure, and the eye should feel completely comfortable.
- Sometimes people feel they will not cope well with being awake for the surgery and choose to have a general an aesthetic (when you are asleep).
- Please let us know in advance if you want a general an aesthetic so that this can be arranged for you.
- A routine pterygium operation would be expected to last about 45 minutes. You will be able to go home on the day of your operation.
Tisseel Glue
Tisseel glue is used during the surgery to position the conjunctival graft. This makes the operation faster and more comfortable. Research suggests that it reduces the chance of a recurrence of the pterygium compared to stitching it in place. The glue is made from human plasma (blood). It therefore may carry a risk transmitting infections such as viruses, or prion disease (CJD). However, Baxter Healthcare, the manufacturer, says that they are not aware of any reports of transmission in over 17 million applications of the glue. If you have any concerns about the use of Tisseel glue please tell us before the day of your surgery.
Surgery for recurrent pterygium
A recurrent pterygium may require additional surgical techniques, which could include the use of other transplantation materials such as amniotic membrane or sclera, and may also require the use of anti-scarring drugs on the eye such as mitomycin C, or 5-fluorouracil try to prevent another recurrence. The risks of surgery for a recurrent pterygium tend to be higher and success rates lower. This will be discussed with you by your surgeon.
BENEFITS OF SURGERY
The main reason for removing a pterygium is to prevent future loss of eyesight by stopping the pterygium from growing over the central area of the cornea. Other symptoms such as redness or discomfort are not as easily treated by surgery and are best treated by using lubricant eye drops where possible.
RISKS OF SURGERY
There are a couple of risks associated with every operation. As for the pterygium surgery, like any other surgery, there is a minor possibility for bleeding and infection. Also, in case of using fibrin glue, since it is a blood-derived product, it may carry the risk of transmitting viral infections and diseases. But the most important risk for this surgery is the return of pterygium after being removed. Although the recurrence is not very common and it only happens in a small percentage of cases (men experience it more than women), the surgeon needs to do follow-up examinations, as it may reappear between 2 and 6 months after surgery. The recurrence of pterygium is highly related to the size of the removed pterygium (less than 5 mm of base width has a lower chance of recurrence), as well as the competency of the surgeon, and the operation method. It can be controlled by medications and eye drops to prevent growing back, but in some cases, a second surgery is needed. As the most competent doctors do the pterygium surgery in Iran with the best methods, the chances of recurrence are extremely low.
Before Ptertgium Surgery
Before pterygium surgery in Iran, an ophthalmologist performs an extensive examination on the patient’s eye, reviews their health history, and gives them general guidelines about the surgery. In case of consuming special drugs such as blood thinners, the patient is asked to stop them for about two weeks before the surgery. As general anesthesia can cause problems in the stomach, such as nausea, the patient may be asked to fast from the night before surgery. Also, if the patient wears contact lenses, it may be required to stop using at least twenty-four hours before the surgery.
POSSIBLE COMPLICATIONS DURING THE OPERATION
One of the eye muscles lies partly underneath the operation site. It is possible, though unlikely, that this muscle could be damaged during the operation, causing double vision and requiring further surgery. The risk is higher during surgery for recurrent pterygium, when there is much more scarring. Very rarely, the internal structures of the eye could be damaged, causing loss of eyesight. This is more of a concern when operating on an eye that has already had surgery or where the eye has been damaged by previous injury or other eye diseases.
POSSIBLE COMPLICATIONS AFTER THE OPERATION
Pain or discomfort Some pain is very common in the first 24 to 48 hours after surgery. This is because the corneal surface previously covered by the pterygium is left bare (see surgical diagram) and takes 24 to 48 hours to heal. You may take simple painkillers such as paracetamol, and use the drops given to you after the surgery. You will need to use steroid eye drops to control the inflammation caused by surgery. This may take several weeks or sometimes months to settle fully, and the eye may still appear slightly red and feel dry or gritty. Steroid eye drops can cause the pressure in your eye to go up and should not be used unsupervised. We will keep a check on this in clinic. After corneal surgery the eye surface is often slightly bumpy, and the tear film tends to dry out on the surface of the bumps. If severe, the eye can be prone to infection or ulceration. Preservative-free lubricant eye drops (artificial tears) are recommended in the first few months after surgery and possibly long-term in some cases.
Poor eyesight
After the operation the corneal surface previously covered by the pterygium is often slightly irregular and scarred. This means that in cases where the pterygium has grown over the central cornea the vision may remain poor, even when the pterygium has been removed. This is why surgery is recommended before this stage where possible.
Recurrence of the pterygium
The chance of a pterygium recurring in the first year after the first operation is approximately 1 in 20 or less (5%). It is very important to use the eye drops given to you to keep the inflammation of surgery controlled and avoid excessive scarring, report any worsening redness or inflammation, and attend your follow-up appointments. Recurrent pterygium can be more difficult to treat, but early treatment may avoid the need for further surgery.
Corneal ulceration or infection
Severe problems such as corneal ulceration or infection are rare but may require intensive treatment and can lead to scarring that may affect your vision or, very rarely, perforation of the eye. If the ulceration is severe a corneal transplant may be needed, sometimes as an emergency.
Further surgery
Further surgery is unlikely, but patients who require further surgery, including surgery for recurrent pterygium may also have complications arising from the additional surgery or treatments required. This could include corneal or scleral thinning or ulceration, perforation of the eye, cataract, glaucoma, poor eyesight or complete loss of eyesight in the operated eye, loss of the operated eye or inflammation in the other eye (extremely rare).
Recovery
After the surgery, an eye patch or pad is used to cover the eye and prevent infection or dislodging the attached tissue by rubbing the eye. Usually, the patients spend at least one day resting with their heads elevated on a pillow. Sometimes, ice packs are used to reduce swelling.
After any surgical procedure, some discomfort can be expected, and pterygium surgery is not an exception either. some patients experience a dull headache, discomfort, and temporary numbness after the surgery. It is normal for patients to feel some redness, dryness, or discomfort a few days after the operation. Having bruising and swelling for a few days is normal as well. They also might experience some blurriness during recovery. The recovery time for each person is different. The type of technique used in surgery might affect the healing time, as well. But it usually takes a couple of weeks to a couple of months for a person to completely heal. And based on the medical history and physical health, patients can go back to work one week after the surgery or sooner. They can start watching TV, using a computer, or reading within 1-2 days after pterygium surgery. Patients are not allowed to participate in any exercise programs including aerobic for at least two weeks. They mustn’t use contact lenses for at least two weeks after surgery, as well, and they should consult with their doctor before using them again. Also, patients need to be examined one day and one week after the surgery. Other examinations during the first year are needed to make sure the conjunctiva isn’t growing back.
Cost in Iran
Although Iran’s healthcare system has been rated as excellent by UNICEF, and it has a high rate of cosmetic procedures, the price of medical procedures, compared to other countries, is not high. This is due to economic reasons, which makes the cost of travel, surgery, and other services more affordable than in other countries. Therefore, pterygium surgery prices in Iran are lower than other countries. Feel free to contact us for more information about the cost of pterygium surgery in Iran.
