NO-STITCH Pterygium Surgery
More Comfortable Removal –Shorter Recovery Period
What is Pterygium?
Pterygium is a pinkish-yellow, triangular wing shaped growth or an encroachment of conjunctiva on the cornea. Mostly, it occurs on the nasal side and in some cases it can occur both nasally & temporally .Mostly if affects 20 to 40 years of age group.
Causes of Pterygium:
Pterygium occurs more frequently in hot, dry, windy, dusty and smoky environment. Hence, incidence of pterygium is higher in tropical countries like India. It also affects people living in equatorial regions like Asia and Africa.
The most common cause of pterygium is exposure to UV-radiation, usually from sunlight.
People engaged in out-door activities are more prone to develop this entity, as they are likely to have more exposure to UV-radiation e.g. farmers, fishermen,civil contractors and people who spend more time in water sports like surfing or fishing etc. It usually grows slowly and painlessly. A small pterygium is barely visible. However, a larger one appears red and cosmetically ugly. It may cause irritation, and affect the vision seriously. In severely progressive cases, a pterygium can block the patients’ vision entirely.
- Redness of eye
- Affects vision when it encroaches on the central part of the cornea
- Cosmetic blemish
In early stages one can get symptomatic relief by medical management. But, if it progresses further towards the central cornea, the only option of management is surgical removal.
No – Stitch Pterygium surgery:
In pterygium surgery, essentially the abnormal tissue is removed from the cornea and sclera ( white portion of the eye is called sclera).
Earlier, pterygium surgery was associated with re-occurrence of the disease as high as up-to 50 %. Hence, the surgery was considered as last option by many eye surgeons. Over these years, pterygium surgery has evolved significantly. According to the recent concepts we now understand that a pterygium is a manifestation of localized limbal stem cell deficiency.
It is now established that amongst the various available surgical option, pterygium excision with Autologus Conjuctival Grafts is that best surgical method with a very low recurrence rate.
In this technique, pterygium is surgically excised and the defect is bridged by an Autologous Conjunctival Grafts usually harvested from the supero-temporal limbus stem cell deficiency. Hence, compared to other surgical procedures it offers very low recurrence rate and high safely. This grafts can either be stitched or applied with tissue adhesive e.g. fibrin sealant.
Usually stitches would take weeks to dissolve on their own. While, if fibrin sealant is used, the eye becomes quiet within a week after the surgery and permits patients to return to work within 1 or 2 days of surgery.
Research studies have shown that patients undergoing no-stitch surgery had significantly less pain and discomfort after surgery than those having traditional surgery. The no-stitch surgery also reduced over all surgical time by 20-30%.
If pterygium has covered larger area on cornea, after its excision, one can use Amniotic Membrane Grafts to reduce scarring and promote faster epithelisation of the corneal surface. Amniotic membrane is also useful tool in recurrent pterygium surgery to prevent fibrosis and achieve over all better surgical outcome.
The advantages of using Glue (Fibrin sealant):
- No irritation from stitches
- No need to remove stitches
- Rapid, painless healing
- Good cosmetic result
- Reduced chances of recurrence
- Early recovery
The best method of preventing pterygium is to regularly wear UV 400 rated sunglasses in sunny conditions. Sunglasses with a wrap-around design provide better protection than those with large gaps between the sunglass frame and the skin around the eyes. Wearing a hat with a wide brim provides valuable additional protection.
The patients should avoid the direct exposure to dusty, sunny and windy climate in order to avoid possibility of recurrence of the disease process.