A pterygium is a non-cancerous, fleshy growth that develops on the conjunctiva, the clear membrane covering the white part of the eye. This wing-shaped growth often starts in the corner of the eye nearest the nose and can extend over the cornea. Common symptoms can include redness, swelling, irritation, and a persistent feeling of having something in the eye. In more advanced cases, a pterygium can distort the shape of the cornea, leading to blurred vision.
When these symptoms become disruptive or vision is affected, surgical removal is a common treatment. The surgery addresses the immediate physical and cosmetic concerns and prevents further growth that could obstruct vision.
Understanding Pterygium Excision with Graft Surgery
The surgical treatment for a pterygium is a two-step process performed under local anesthesia. First, the surgeon carefully excises the abnormal pterygium tissue from the surface of the cornea and conjunctiva. This step requires precision to clear all the aberrant tissue while leaving underlying ocular structures intact.
Following the excision, a graft is placed over the bare area where the pterygium was removed. The most common type is a conjunctival autograft, where a thin piece of healthy conjunctival tissue is harvested from another part of the patient’s own eye. This tissue is then transplanted to the site of the excision.
Another option is an amniotic membrane graft, which uses tissue from the inner layer of a donated human placenta. This tissue serves as a biological dressing to promote healing on the eye’s surface. The graft is positioned and secured over the exposed sclera using either very fine, absorbable sutures or a specialized fibrin glue.
The Role of the Graft in Preventing Recurrence
The primary reason for placing a graft after pterygium excision is to reduce the likelihood of the growth returning. When a pterygium is removed without a graft, a technique known as bare sclera excision, the area is left exposed. This older method has a high rate of recurrence, with the pterygium growing back in 24% to 89% of cases.
A graft acts as a physical barrier, covering the exposed sclera and preventing abnormal conjunctival cells from migrating back onto the cornea. The transplanted tissue provides a layer of healthy cells that integrates with the surrounding tissue. This helps to restore the normal anatomy of the ocular surface and creates an environment that is less conducive to regrowth.
The use of a conjunctival autograft is particularly effective, lowering the recurrence rate to between 2% and 10% in most cases. This contrast in outcomes underscores the importance of the grafting step in achieving a lasting surgical result.
The Post-Surgery Recovery Experience
In the first 24 to 48 hours after surgery, patients wear an eye patch to protect the surgical site. It is common to experience discomfort, significant redness, and a scratchy sensation in the eye. Vision may also be blurry during this initial phase, and your surgeon will prescribe pain medication as needed.
Over the first few weeks, these initial symptoms will begin to subside. You will use a regimen of antibiotic and steroid eye drops for several weeks to prevent infection and control inflammation. It is important to follow post-operative instructions, which include avoiding rubbing the eye, as this could dislodge the graft.
In the months that follow, the eye continues to heal, and the redness will fade. Patients are advised to avoid activities like swimming and to protect the eye from dusty or windy environments for at least three weeks. It may take a couple of months for the eye to heal completely, and regular follow-up appointments are necessary to monitor the process.
Surgical Outcomes and Potential Complications
Pterygium excision with a graft is a successful procedure for most patients. It removes the growth, alleviates symptoms, and achieves a good cosmetic result with a low chance of recurrence. The use of a conjunctival autograft helps restore the eye’s natural appearance.
While the procedure is safe, any surgery carries potential risks. Though uncommon, complications can include infection, graft failure or displacement, prolonged inflammation, or scarring. In rare instances, a more serious complication called scleral melt, a thinning of the white part of the eye, can occur.
The faint scar left on the cornea is not visually significant unless the original pterygium had grown over the central part of the vision. Adherence to post-operative care instructions is an important part of achieving a successful outcome.