Pterygium surgery involves removal of the abnormal tissue from the sclera and cornea of the eye. Today’s techniques offer a significantly higher success rate than conventional surgery.
In traditional “bare sclera” pterygium removal, the underlying white of the eye is left exposed. Healing occurs over two to four weeks with mild to moderate discomfort. Unfortunately, “bare sclera” pterygium surgery has a high rate of re-growth; this occurs in up to 50% of patients. In many cases, the pterygium grows back larger that its original size.
Over the years, surgeons have used several different techniques to lessen the likelihood of pterygium recurrence, including radiation treatment and the use of “antimetabolite” chemicals that prevent growth of tissue. Each of these techniques has risks that potentially threaten the health of the eye after surgery, including persistent epithelial defects (ulceration in the surface of the eye), and corneal melting.
Conjunctival Autograft with Stitches
Most corneal specialists today perform pterygium surgery with a conjunctival autograft because of a reduced risk of recurrence. In this technique, the pterygium is removed, and the cornea regains clarity. However, the gap in the mucous membrane (conjunctiva) tissue, where the pterygium was removed, is filled with a transplant of tissue that has been painlessly removed from underneath the upper eyelid. Although the procedure requires more surgical skill than traditional surgery, this “auto-graft” (self-transplant) helps prevent re-growth of the pterygium by filling the space where abnormal tissue would have re-grown.
In conventional autograft surgery, stitches are used to secure the graft in place on the eye. These can cause discomfort for several weeks.
The autograft is held in place with tiny stitches that may dissolve after a few weeks or can be removed in the surgeon’s office. Stitches on the eye frequently cause discomfort, however, after pterygium/autograft surgery. The desire for a quicker, more painless recovery has led to the development of no-stitch pterygium/autograft surgery.
No-stitch pterygium/autograft surgery allows most patients to return to work within one or two days of surgery. A research study on 85 patients with pterygium conducted at Harvard Eye Associates has shown that patients undergoing no-stitch surgery had significantly less pain after surgery than those having traditional surgery. The no-stitch technique also reduced surgery time from an average of 21 minutes to 14 minutes. No pterygium recurrences were found in any patients in the study.
Technique for No-stitch Pterygium/Autograft Surgery
In no-stitch surgery, the patient is lightly sedated to ensure comfort, and the eye is completely numbed, so there is no way to see the surgery occurring and no sensation of discomfort. The abnormal corneal tissue is removed and replaced with a thin graft of normal tissue. Over the next 2-3 weeks, the eye gradually returns to a normal appearance.
No-stitch surgery is made possible by the use of modern tissue adhesive. Composed of clotting proteins normally found in human blood, tissue adhesive allows the surgeon to secure a conjunctival autograft in seconds rather than minutes. After about one week the tissue adhesive dissolves with no residue, leaving the eye to heal comfortably. Although tissue adhesive is derived from human blood products, no cases of blood borne infection have ever been reported among millions of patients treated with this material in heart and lung surgery.