Ptyergium (Carnocidad) Surgery Video - Lotemax SM post op - Toyos Clinic

Ptyergium
Carnocidad en los Ojos
The conjunctiva is a clear tissue that covers the surface of the eye, not including the cornea, and the inner surface of the lids. The conjunctiva on the eye is called bulbar conjunctiva and the part on the lids is called the palpebral conjunctiva. When patients have excess sun exposure with or without Dry Eye Disease, DED, the bulbar conjunctiva starts to lose its normal architecture and appears rough and raised. We call this diseased conjunctiva a pinguecula. Sometimes the changes to the conjunctiva can extend on to the cornea causing a pterygium. In both cases even the slightest irritation will cause the abnormal tissue to inflame looking even more unsightly. In the case of a pinguecula with concurrent conjuctivochalsis, covered in my previous blog, I will remove the pinguecula and excess conjunctiva helping the patient’s function and appearance. The conjunctiva that is covered by the lower and upper lid when the eye is opened is not exposed to the elements and appears cosmetically better. I will utilize the normal appearing conjunctiva and create an autograft to place in the exposed area. In a pterygium I will remove the abnormal tissue on the conjunctiva and cornea. When removing the pterygium it can leave a scar on the cornea in the area where the abnormal conjunctiva has attached. That is why I counsel patients with a pterygium to have surgery before it extends to the center of the cornea.
Removal can be problematic because pterygium can return due to post-operative inflammation. Some surgeons utilize Mitomycin C, a antimetabolite that prevents fibrosis after surgery. The original use for Mitomycin was in cancer patients to prevent growth of the cancer cells. Sometimes MMC can disrupt normal tissues leading to thinning of the sclera necessitating a graft to prevent a penetration of the posterior tissues. I have stopped utilizing MMC because of the possible complications.
You will find the worse pterygiums in patients who live closer to the equator. It is more common in males than females. I have been treating a large share of pterygiums in my career because I have large Hispanic patient population who work all day in the sun and do not use sunglasses to protect from the elements. These patients have a high recurrence rate and we have developed techniques to decrease recurrence. In the past I have tried radiation plaques, MMC, steroid injections, and grafts. But I believe surgical technique is more important in preventing recurrence than anything else. I was introduced to a technique by a retired Brazilian surgeon 15 years ago while I was there conducting a cataract surgery course. During lunch the topic turned to pterygium. He told me of his many years of treating pterygiums explaining his theory and technique. I tried his technique with great results. Over the years I have modified the procedure for greater success. The short explanation the technique involves using an autograft and meticulous attention to the tenons, a thin membrane of tissue under the conjunctiva.
Post Operative drops are just as important. We have been utilizing Lotemax SM.