What is the treatment for pterygium?

Treatment of Pterygium

Surgical excision with conjunctival autografting is the gold standard treatment for pterygium, with mitomycin C often used as an adjunctive therapy to reduce recurrence rates. 1, 2

Clinical Presentation and Indications for Treatment

• Pterygium is a fibrovascular growth of conjunctiva that crosses the limbus and extends onto the peripheral cornea 2
• Indications for surgical intervention include:
  • Visual impairment due to encroachment on the visual axis
  • Increasing astigmatism
  • Ocular surface discomfort
  • Cosmetic concerns 3, 2

Surgical Management Options

First-Line Surgical Approach

• Conjunctival autografting is the most effective surgical technique with the lowest recurrence rates 1, 4
  • Procedure involves excision of the pterygium followed by transplantation of the patient's own conjunctival tissue to cover the defect
  • This technique provides better outcomes than bare sclera technique alone 4

Adjunctive Therapies

• Mitomycin C application is commonly used to prevent recurrence 1, 2

  • Typically used at a concentration of 0.02% (0.2 mg/ml) for a brief period (e.g., 15 seconds) 5
  • Caution: Must be used judiciously due to potential long-term risk of sight-threatening complications 1

• Other adjunctive options include:

  • Beta-irradiation (used with caution due to potential complications) 1
  • 5-fluorouracil 2
  • Anti-VEGF agents (newer approach still under investigation) 2, 6

Alternative Surgical Techniques

• Amniotic membrane grafting - useful alternative when conjunctival tissue is limited 2, 4
• Limbal conjunctival autograft - particularly effective for recurrent cases 2

Postoperative Care

• Topical steroids to reduce inflammation and prevent recurrence 3
• Preservative-free lubricants to improve comfort and healing 3
• Long-term UV protection is essential to prevent recurrence 3

Potential Complications

• Recurrence - the most common complication, with rates varying by surgical technique 1, 4
• Diplopia - can occur due to damage to the medial rectus or scarring 7
• Strabismus - including exotropia from medial rectus damage or esotropic restrictive strabismus from scarring 7
• Ocular motility problems from florid scarring associated with recurrence 7

Risk Reduction Strategies

• Use of topical rather than retrobulbar anesthesia to reduce risk of postoperative diplopia 7
• Careful surgical technique to avoid damage to extraocular muscles 7
• Regular postoperative follow-up to monitor for early signs of recurrence 4

Special Considerations

• The risk of recurrence is higher in younger patients and those with a history of previous pterygium surgery 4
• Surgical technique should be chosen based on the size and extent of the pterygium, as well as the surgeon's experience 4
• For recurrent pterygium, more aggressive approaches combining multiple techniques may be necessary 2, 6