Pterygium
Is the tissue of the white part of the eye that grows onto the surface of the cornea. This pterygium develops from pinguecula and is a degenerative disease of the conjunctiva. The main risk factor is ultraviolet (UV) light from sunlight, which is the primary risk factor, or prolonged exposure to dust and wind, causing inflammation of the conjunctiva eventually.
Symptoms of Pterygium
- Eye irritation, burning sensation, tearing, red eyes, itching
- Blurred vision or double vision if the pterygium progresses onto the cornea. The pterygium presses on the cornea causing changes in vision and astigmatism, or if the pterygium is large enough to cover the pupil, it can cause vision loss.
- Causes cosmetic problems and affects confidence
Treatment of Pterygium
- Medication treatment When the pterygium is acutely inflamed, use artificial tears, antihistamine eye drops, and short-term steroid eye drops to reduce inflammation quickly.
- Surgical removal of pterygium (Pterygium excision) surgery is required in cases where…
- The pterygium is repeatedly inflamed and does not respond to medication
- The pterygium grows larger and extends onto the central cornea, obstructing vision
- The pterygium causes abnormal eye movement due to pulling, resulting in double vision or strabismus
- The pterygium causes astigmatism
- The pterygium is found together with cataracts that require surgery
- The pterygium affects work and confidence in performing tasks
Current Surgical Methods
Involves removing the pterygium along with placing tissue to cover the white part of the eye where the pterygium was removed. There are two types of tissue used to cover the wound:
- Autologous conjunctival graft
- Medical amniotic membrane
There are two main methods to attach the tissue to the sclera:
- Suturing (suture) is the traditional standard method. It is economical but causes more pain and irritation, more inflammation after surgery, and requires suture removal later.
- Using fibrin glue is a new technique. The surgical procedure is the same as the standard method except that fibrin glue is used to attach the tissue instead of sutures. Using fibrin glue results in less postoperative inflammation, less eye irritation, and no need for suture removal.
New Technique Using Fibrin Glue
Fibrin Glue is a biological adhesive used to attach tissue or in various surgeries. It is derived from extracting two substances in blood: fibrinogen and thrombin. When these two substances are mixed, they solidify into a gel that can attach tissue without the need for sutures.
Advantages are:
- Lower recurrence rate of pterygium Many studies have found that the recurrence rate is lower compared to suturing.
- No need for suture removal
- Shorter surgery time Fibrin glue can attach tissue within minutes, making the surgery shorter compared to suturing.
- Less postoperative pain Because there are no sutures, it is more comfortable and causes less irritation after surgery.
- Reduced inflammation Because there are no sutures, the risk of inflammation is reduced.
**Limitations are fewer than suturing because sutures require removal, but with fibrin glue, no suture removal is needed. However, ophthalmologists will schedule follow-up appointments after surgery as usual.**
Is postoperative care the same for fibrin glue as for suturing?
The general principle of postoperative care is similar, which includes maintaining cleanliness and regularly applying prescribed eye drops.
Postoperative Care for Pterygium Surgery
- Keep the eye tightly closed for 24 hours after surgery to prevent tissue displacement
- Avoid water contact for at least 14 days after surgery to prevent infection
- Eye irritation may occur but is much less with fibrin glue surgery
- Use eye drops as directed by the doctor
- Wear sunglasses outdoors every time to prevent recurrence of pterygium
- Attend all follow-up appointments with the ophthalmologist
Pterygium surgery using Fibrin Glue is an effective and safe option
It increases patient comfort, reduces irritation and complications from sutures, and importantly, has a lower recurrence rate than suturing.
Existing research supports that this biological adhesive can become the new standard for pterygium surgery in the future.
Dr. Pitchaya Prapaipanich
Ophthalmologist specializing in Cornea
Head of Eye and Laser Center, Phyathai 1 Hospital
