EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/129516
54 May 2013 EW CORNEA Surgical continued from page 53 handle the tissue graft with conjunctival forceps to avoid tears." Dr. Lee said he would then place the autologous conjunctival tissue over the scleral bed and secure it with interrupted 10-0 vicryl or Biosorb sutures. To finish, he would give a subconjunctival dexamethasone injection after surgery, as well as antibiotic or corticosteroid cream prior to pressure patching the eye. Dr. Jacobs said she has addressed pterygium with both conjunctival autografts and the use of mitomycin-C. "I have a pretty high threshold to operate because I have healthy respect for the potential for recurrence, so I generally only operate if the pterygium is visually significant," she said. This means that it is inducing astigmatism or there is a documented growth beyond three Her eye disease. millimeters. Dr. Jacobs said she would also operate if the patient was losing best corrected vision, but not if the patient was simply unhappy. She stressed the importance of discussing options for surgery and what is known about recurrence and about possible complications with a patient before proceeding. Our motivation. Other factors in pterygium surgery There are a number of other factors to consider in pterygium surgery, depending on a patient's pre-existing medical conditions or previous surgeries. For example, Dr. Chan said that for patients who have glaucoma, it is important to note the possibility that they may need a trabeculectomy procedure in the future, which would require an intact superior conjunctiva. "In such patients, the surgeon could consider either harvesting the conjunctival autograft from the inferior bulbar conjunctiva or from the fellow eye," she said. In addition, age may be a factor in recurrence rates of pterygium. "Those with recurrent pterygia have been reported as being a decade younger than those who did not experience recurrence," Dr. Chan said. Dr. Lee also stressed the importance of identifying a patient with severe glaucoma. He said that for patients who have undergone prior conjunctival surgeries, the surgical technique for pterygium may need to be altered. "In these cases, use of a conjunctival graft may be impossible, and adjuncts such as amniotic membrane may be required," he said. "In some circumstances, an inferior autologous conjunctival graft may be obtained, but this does carry an increased risk of inferior symblepharon formation as compared to a superior bulbar conjunctival graft." Future studies and options Dr. Lee said that there are a number of prospective studies that demonstrate a low recurrence rate with large autologous conjunctival grafting techniques. "However, large, randomized controlled trials comparing various surgical techniques remain the gold standard for assessing what technique works the best," he said. "And this type of study is lacking thus far in the ophthalmic literature." EW Image is designed to represent nondescript visual impairment and is not intended to be medically accurate. For illustrative purposes only. To learn how Santen is advancing the ophthalmic field, scan this code with your mobile device or visit www.santeninc.com. At Santen, our single focus in ophthalmology enables research of novel therapies in uveitis, glaucoma, and dry eye/corneal disorders—therapies determined to challenge eye disease, one patient at a time. Editors' note: Dr. Chan has no financial interests related to the article. Dr. Jacobs has no financial interests related to the article. Dr. Lee has financial interests with Allergan (Irvine, Calif.), Bausch + Lomb (Rochester, N.Y.), and Merck (Whitehouse Station, N.J.). Contact information Inspiring ophthalmic medicines © 2012 Santen Pharmaceutical Co., Ltd. All rights reserved. SAN-269.00 07/12 Chan: clarachanmd@gmail.com Jacobs: djacobs@bostonsight.org Lee: Lee0003@aol.com