HISTORY OF PTERYGIUM TREATMENT
PTERYGIUM has a long history of difficult treatment.
THE word pterygium comes from the Greek word pterygos, which means ‘wing’.
AMBROSE PARE (16th century) said, “You’ve learned that a pterygium is an illness that always recurs, even when you’ve done everything in your power to cure it.” This concept has remained true to the present day!
MANY TREATMENTS HAVE BEEN USED TO IMPROVE SURGICAL OUTCOMES:
1962 Use of antimitotics to prevent recurrence
1964 Use of amniotic membrane to repair the conjunctival tissue loss following excision of the pterygium
1985 Grafting autologous conjunctiva (own conjunctiva harvested from another area) over the open area
THE BASIC SURGICAL TECHNIQUES USED TODAY
Apposisional repair : Repairing the wound by suturing the edges together with vicryl, silk or nylon 8/0 (10-25% recurrence)
Torsional flap : Repairing the wound with a flap of adjacent healthy conjunctiva (5-10%recurrence)
Free flap : Use of autologous conjunctiva or amniotic membrane to cover the wound, sutured with 8/0 (5-10% recurrence)
Despite all efforts, surgical outcomes have remained indifferent.
UNTIL RECENTLY, OUTCOMES of pterygium surgery have been, to say the least, indifferent. The affected eye often remained red and inflamed, with visible scarring and a high rate of recurrence. But with a new technique that uses the tissue glue Tisseel, the cosmetic results have improved significantly, and the recurrence rate has dropped to less than 1% in the authors last 4 years of surgery.
Not all South African eye surgeons are currently performing the new procedure, which requires a bit of practice, but the results are so astonishing that it will soon gain ground.
The new technique still involves an autologous free conjunctival flap, usually harvested from the conjunctiva below the upper eyelid – but instead of sutures fastening the new flap over the bare area, Tisseel glue is now used.
WHAT IS TISSEEL?
WHAT ARE THE ADVANTAGES OF TISSEEL OVER SUTURES?
Inflammation is much less because the area is covered but there are no sutures that irritate the surrounding area. Less follow-up is needed (day one post-op and the 1 month later). In my hands the results are definitely far superior.
My experience with Tisseel surgery since 2007
– Where I used Tisseel I found the following:
There was no need for antimetabolites. Recurrences after previous conventional surgeries were successfully treated. The patient comfort was superior from day one. Cosmetic results were also superior.
In a retrospective questionnaire of my first 100 pterygium surgery patients done in 2007, we scored an average of 9/10 for subjective impression of success and cosmetic results.
-One of the 100 cases involved pterygium surgery performed on a bride-to-be only six weeks before her wedding. I would never have dreamt of attempting pterygium surgery using the ‘older’ techniques!!
With the low risk profile of Tisseel it is now safer to do pteryguim surgery on even the small cosmetically worrying lesions.
ABOVE LEFT: The eye a week before the procedure. ABOVE RIGHT: One month later
