Pterygium Frequently Asked Questions

What should I do if I see a separation in the graft edge at nasal fornix in the early post-operative days?

This happens because of poor fibrin glue adhesion or excessive fibrin glue trapped in between. To avoid this, stretch the membrane with the muscle hook toward the cornea to squeeze excess glue out. If the area of graft shows hyperemia or inflammation, give an injection of Kenalog to avoid granuloma formation in one month.

Why would pyogenic granuloma develop and how do you treat it?

Pyogenic granuloma (Fig. 10) may develop for several reasons including exposed sclera or subconjunctival tissue, suture induced trauma, residual fibrovascular tissue, large mass of fibrin glue left, and/or lack of good contact with the MMC soaked sponge during incubation. One can avoid this complication by fully covering the bare sclera with amniotic membrane using fibrin glue without sutures, by making sure there is full contact between the caruncle tissue and the MMC sponge by pushing caruncle down during MMC incubation time via 0.12 forceps, and by carefully monitoring inflammation of the host conjunctival tissue at one month postop visit. If pyogenic granuloma develops, one can increase PF to q2h for one or two weeks. Once the stalk is not congested, it can simply be excised in the office

What are the advantages of amniotic membrane transplantation over conjunctival limbal autograft in pterygium surgery?

Although the use of free grafts of conjunctiva and limbal tissue is reported to have better success rates, cryopreserved amniotic membrane has the following advantages:

(1) Less pain (as no donor site is injured)

(2) Shorter surgical time

(3) Faster patient recovery

(4) Amenable to cover a larger defect

(5) Saves the donor site for other surgeries such as glaucoma

(6) Better cosmetic outcome

Amniotic membrane can provide consistently better results than conjunctival autograft. However, to achieve this goal, one will have to use intraoperative MMC.

Can we use MMC in patients who have had previous radiation treatment?

It is advisable to avoid using Mitomycin C in such cases as there is increased risk of scleral melting due to pre-existing ischemia.

How far should the pterygium head and body be removed?

If the semilunar fold can be identified, the truncation is made before the fold. It is important not to excise the fibrovascular tissue/Tenon in the fornix to allow fat to prolapse (herniated).

How is the corneal epithelial defect handled during pterygium surgery?

For primary pterygium, the cryopreserved amnion graft does not need to go beyond the limbus to cover the corneal defect because the corneal healing occurs rapidly without any complications.

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