Indications for surgical resection include corneal distortion, recurrent symptomatic flares and poor cosmesis. Younger patients seeking treatment may expect no less than a perfect outcome. Therefore, patients should be counselled that recurrence is possible, typically within the first year, and that recurrent pterygia can be larger than before.
Simple surgical excision has recurrence rates approaching 80 per cent; therefore, several adjunctive techniques are available to reduce recurrence. In New Zealand, the most common procedure involves harvesting a patch of conjunctiva from the superior aspect of the globe and placing this “autograft” onto the area of the excised pterygium.
While the autograft can be fixed using sutures, the most common way to achieve adherence is with tissue glue consisting of thrombin and fibrinogen, which provides patients with a significantly more comfortable recovery and a markedly reduced rate of recurrence (<5 per cent).
A video of pterygium excision using the conjunctival autograft and fibrin tissue glue technique can be found here: https://youtu.be/nhs9QYPhE30
Antimetabolites such a mitomycin C can also be used to further reduce the risk of recurrence, but their use is usually reserved for recurrent cases.
Pterygium excision is a day case procedure performed under local anaesthetic. It takes approximately 20 minutes and is very comfortable with the use of topical and subconjunctival anaesthesia, with or without sedation. Resected tissue is occasionally sent for biopsy to ensure a cancer is not missed.
Patients are advised to use regular mild analegisa for the first few days and are often able to return to work after 48 hours, especially if the lesion had been asymptomatic. A regimen of topical steroids for several weeks is used to reduce inflammation – a powerful stimulator of pterygium recurrence.
Patients may experience some ocular dryness, which can be allieviated with ocular drops as described earlier. Although many patients will only need one intervention, sunglasses should continue to be worn throughout their lives to prevent recurrence.