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Pterygium Surgery

A pterygium is a growth on the cornea (clear front window of the eye) and the conjunctiva (the thin filmy membrane that covers the white part of your eye). These growths are believed to be caused by ultra-violet (UV) exposure, dry eye and exposure to wind and dust). In many cases no treatment is needed. Sometime eyedrops and ointments may be used to reduce inflammation (swelling). If the growth threatens site or causes persistent discomfort, it can be removed. You should understand that despite proper surgical removal the pterygium may return. If a pterygium returns, additional surgery may be necessary, particularly if there is persistent inflammation or progression of the new growth towards the centre of vision.

Surgery
Surgery may be performed in rooms or in a theatre setting. It is performed under local anaesthetic, and if in a day theatre setting with sedation. During the surgery the pterygium is removed, and a conjunctival autograft is taken from under the upper eyelid and inserted into the bed of the pterygium and sutured in place. Conjunctival transplantation moves a piece of your own conjunctiva to the area where the pterygium is excised (removed). This technique may be used for the management of both primary and recurrent pterygium and greatly reduces the risk of recurrence.

Post-operative drops are required for between 1 and 6 months following this surgery. It is recommended that you take at least one week off work following this surgery. You must be careful NOT to rub the eye. It is recommended that you avoid anything too vigorous after the surgery and avoid swimming in a swimming pool for several weeks. After the surgery you will experience some pain in the eye especially when blinking. This is normal and may be helped with simple analgesics (eg paracetamol). Topical lubricants can also be very helpful to reduce irritation.  To reduce swelling and bruising, we advise that you put ice (or frozen peas) in a tea towel over the operation site for about 10 minutes every hour (while you are awake) for the first two days after the operation. The pain should improve over the following days. The eye will look red for several weeks after the surgery, and sometimes a few months. This gradually diminishes with time. The vision may be blurry for several weeks after surgery due to a change in the shape of the cornea after surgery and a change in the prescription of the eye. This may settle on its own, but may require a change in your glasses.

The goal of pterygium excision (removal) is to decrease irritation/inflammation, achieve a normal, smooth ocular surface, improve the decreased vision caused by the pterygium, and prevent regrowth, if possible. However the aim of surgery is more to prevent further deterioration in vision rather than improve vision already lost.

Mitomycin C
Mitimycin-C (MMC) may be used during excision to minimise the recurrence likelihood. MMC was first used as an anti-cancer drug. Ophthalmologists use MMC for other purposes “off-label” as part of the practice of medicine. (Off label use is based on firm scientific method and sound medical evidence, but means that the drug has been approved by the Food and Drug Administration (FDA) for a different treatment originally). The decision to use MMC is based on the evaluation of the advantages and potential disadvantages in each individual case. Handling of Mitomycin C is extremely important. Please keep out of reach of children and animals and please bring back any unused drops to Eyes Wide Bay for disposal. Mitomycin C may cause blurred vision, ocular pain, ocular surface irritation, sensitivity to light, in addition to the usual discomfort following pterygium surgery.

(See Pterygium)

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