Pterygium Excision with Graft: A Complete Guide

Introduction to Pterygium and Its Symptoms

Pterygium (pronounced teh-RIJ-ee-um) is a common eye condition where a pinkish, fleshy growth develops on the conjunctiva—the clear tissue covering the white part of the eye. Often shaped like a wedge, it can extend onto the cornea, potentially affecting vision. While the exact cause is unclear, prolonged exposure to UV light, dust, and dry conditions increases the risk.

Symptoms include:

• Redness and irritation
• A gritty or burning sensation
• Blurred vision if it grows over the cornea
• Tearing or dryness
• Visible fleshy growth on the eye

If left untreated, a pterygium can thicken and distort the cornea, leading to astigmatism. While lubricating drops may help mild cases, surgical removal (excision with graft) is recommended if it causes discomfort or vision problems.

What is Pterygium Excision with Graft?

Pterygium excision with graft is a surgical procedure to remove the abnormal tissue and replace it with healthy tissue to prevent recurrence. Unlike simple excision (which has a high regrowth rate), grafting significantly reduces the chances of the pterygium returning.

How it works: The surgeon carefully removes the pterygium and then covers the affected area with a conjunctival autograft (taken from the same eye) or an amniotic membrane graft (donor tissue). This "blanket" of healthy tissue helps the eye heal smoothly and minimizes scarring.

This outpatient procedure is performed under local anesthesia and takes about 30-45 minutes. Most patients experience minimal discomfort and can return home the same day.

When is Surgery Necessary? (Indications)

Not all pterygia require surgery. However, your ophthalmologist may recommend excision with a graft if:

• Vision is affected (due to corneal distortion or growth over the pupil).
• Chronic inflammation persists despite eye drops.
• Cosmetic concerns arise due to noticeable redness or growth.
• Recurrent irritation interferes with daily activities (e.g., driving, reading).
• Risk of scarring threatens long-term eye health.

Surgery is typically avoided in mild, stable cases. However, delaying treatment when necessary can lead to complications like corneal thinning or permanent vision changes.

Pre-Surgical Preparation & Evaluations

Before surgery, your eye doctor will conduct a thorough evaluation to ensure you’re a good candidate. This includes:

• Comprehensive eye exam: Checks corneal health, vision acuity, and pterygium size.
• Corneal topography: Maps the eye’s surface to assess astigmatism.
• Medical history review: Identifies conditions like dry eye or autoimmune disorders that may affect healing.

Pre-op instructions:

• Avoid blood-thinning medications (e.g., aspirin) for 1 week before surgery.
• Arrange for someone to drive you home post-surgery.
• Use prescribed antibiotic drops to reduce infection risk.

Following these steps ensures a smoother procedure and recovery.

Step-by-Step Surgical Procedure

The surgery follows these key steps:

1. Anesthesia: Numbing drops and local anesthesia are applied.
2. Excision: The pterygium is carefully peeled off the cornea and sclera.
3. Graft placement: A thin layer of healthy conjunctiva (from under the eyelid) or amniotic membrane is stitched or glued over the excision site.
4. Protective shield: A temporary eye patch is placed to prevent rubbing.

Advanced techniques: Some surgeons use fibrin glue instead of sutures for faster healing. The entire process is painless, though you may feel slight pressure.

Types of Grafts Used (Conjunctival vs. Amniotic Membrane)

Two primary graft types are used:

1. Conjunctival Autograft:

• Harvested from the same eye (usually under the upper eyelid).
• Gold standard with lowest recurrence rates (~5-10%).
• Slightly longer surgery time due to graft harvesting.

2. Amniotic Membrane Graft:

• Donor tissue rich in growth factors that promote healing.
• Ideal for high-risk cases (e.g., thin conjunctiva).
• Lower recurrence risk than excision alone but higher than autografts.

Your surgeon will recommend the best option based on your eye health.

Post-Surgery Care & Recovery Tips

Recovery typically takes 2-4 weeks. Follow these guidelines:

• Medications: Use antibiotic and steroid drops as prescribed to prevent infection and inflammation.
• Eye protection: Wear sunglasses outdoors and avoid rubbing the eye.
• Activity restrictions: Skip swimming, heavy lifting, or dusty environments for 2 weeks.
• Follow-up visits: Attend all appointments to monitor healing.

Expected symptoms: Mild redness, grittiness, and blurred vision are normal initially. Contact your doctor if you experience severe pain or vision loss.

Potential Risks & Complications

While generally safe, possible risks include:

• Recurrence (5–15% risk): More likely without a graft.
• Infection: Rare but requires prompt treatment.
• Graft displacement: May need repositioning.
• Dry eye: Temporary worsening of dryness.
• Scarring: Minimal with proper technique.

Choosing an experienced surgeon minimizes these risks.

FAQs About Pterygium Surgery