Pterygium is a disease of the surface of the eyeball that occurs on the conjunctiva, characterized by fibrous tissue with blood vessels.
This disease is common in countries near the equator with strong sunlight. Although the exact cause or pathogenesis of pterygium is not clearly known, certain risk factors have been identified and are considered causes of the disease. The most important risk factor for pterygium is frequent and prolonged exposure of the eyes to ultraviolet (UV) radiation.
Ultraviolet (UV) Radiation and the Development of Pterygium?
Ultraviolet (UV) radiation consists of three types: UVA, UVB, and UVC. However, the main cause of pterygium is direct exposure to sunlight, where the eyes receive UVB radiation, which causes cellular and tissue changes leading to the formation of pterygium.
Pterygium Can Be Treated in Various Ways
Treatment of pterygium in the early stages or mild cases is usually supportive, involving the use of eye drops and/or topical ointments to reduce irritation, itching, pain, swelling, or inflammation, along with wearing sunglasses. This treatment helps alleviate symptoms and prevent the progression of pterygium.
However, if supportive treatment is ineffective after some time, and the patient experiences worsening vision, increased pain, swelling or redness, restricted eye movement due to pterygium, astigmatism caused directly by pterygium, or cosmetic concerns, the doctor will consider surgical treatment.
5 Common Methods Used in Pterygium Surgery Today
Currently, pterygium excision surgery is performed using one of the following five methods:
- Excision of pterygium leaving the bare sclera (Bare sclera technique)
- Excision of pterygium and pulling the surrounding conjunctiva to the limbus and suturing it closed (Simple conjunctival closure)
- Excision of pterygium followed by autologous conjunctival graft transplantation in the excised area (Resection followed by autologous conjunctival graft)
- Excision of pterygium followed by limbal-conjunctival graft transplantation including the limbus in the excised area (Resection followed by limbal-conjunctival graft)
- Excision of pterygium followed by amniotic membrane graft transplantation in the excised area (Resection followed by amniotic membrane graft)
Postoperative Care for Pterygium Patients
Ophthalmologists will prescribe anti-inflammatory steroid eye drops, which may be potent corticosteroids such as prednisolone acetate, dexamethasone, or soft steroids such as fluorometholone, loteprednol, along with antibiotics to prevent infection after surgery. Other eye drops such as nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclosporine A may also be used for treatment.
Because steroid eye drops must be tapered gradually after pterygium surgery, the treatment duration is relatively long. Studies show that the duration of steroid eye drop use ranges from less than 1 month to more than 3 months, but mostly between 1-2 months.
Long-term use of steroids may cause side effects such as increased intraocular pressure and subsequent glaucoma. Some patients may be more sensitive to steroids than normal and experience a rapid increase in intraocular pressure even with low doses. Therefore, strict adherence to prescribed medication and postoperative follow-up are essential.
Follow-up visits are not only to monitor surgical outcomes and watch for postoperative infections but also to observe and prevent ocular hypertension and glaucoma, which can lead to permanent blindness.
Continuous use of sunglasses after surgery when outdoors remains necessary to help prevent or reduce recurrence. Recurrent pterygium tends to be thicker and redder, and repeat excision surgery is more difficult than the first time.
