EyeWorld India September 2020 Issue

EWAP SEPTEMBER 2020 11 FEATURE W hen to take a patient to the OR for primary pterygium surgery depends on several factors. Lawrie Hirst, MD, said the indications for removal can depend on the success of your preferred pterygium surgery. For example, if you can’t promise a good cosmetic outcome, he said, you might have more stringent indications for doing surgery, which most often are visual changes and irritation. John Hovanesian, MD, said large pterygium can be disfiguring, which is another indication for surgery. Many patients also have dry eye, causing even more irritation with the pterygium. “You can’t fix dry eye, but you can manage it. Pterygium you can fix; you can take it out of the picture. Patients, whether they have dry eye or not, tend to have good results with pterygium surgery,” Dr. Hovanesian said. Removal techniques The seminal paper published more than 30 years ago by Ken Kenyon, MD, is still cited when discussing primary pterygium removal. 1 “In my view the best substitute for conjunctiva is conjunctiva,” Dr. Hovanesian said, crediting Dr. Kenyon for this concept. But the technique of conjunctival autografting for primary pterygium surgery has evolved in some ways since the 1985 paper, and there are other techniques for handling these cases. Dr. Hovanesian described three pterygium removal techniques. He most frequently performs the classic conjunctival autograft, but it’s not his preferred technique. He said he actually gets a lower recurrence rate when he performs conjunctival autograft with an amniotic membrane, with the amniotic membrane serving as a biologic membrane surrounding the graft tissue. Dr. Hovanesian said he reserves conjunctival autograft plus amniotic membrane for cases that are at higher risk for recurrence because there is not a mechanism to reimburse for the amniotic membrane. The third technique Dr. Hovanesian described was Removal of primary pterygium: Techniques and other considerations by Liz Hillman Editorial Co-Director AT A GLANCE • There are several methods for primary pterygium removal, but the most common uses a conjunctival autograft. • Typical conjunctival autografting has a recurrence rate from 5–15%, but one surgeon published a series showing a more surgically involved technique that has a recurrence rate of less than 1%. • Pterygium can be irritating to the ocular surface, and removal of these growths can improve some of the patient’s sensations, though it won’t resolve underlying dry eye. • Experts did not recommend mitomycin as an adjuvant for pterygium surgery. Contact information Hirst: lawrie@tapc.net.au Hovanesian: johnhova@gmail.com Desai: desaivision2020@gmail.com This article originally appeared in the June/July 2020 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Large nasal primary pterygium before surgery. Four months after P.E.R.F.E.C.T. for PTERYGIUM. Source (all): Lawrie Hirst, MD