Choosing a surgeon to operate on your eye is an important decision. Although pterygium removal is a commonly performed procedure, not every pterygium is the same, and surgical techniques, experience, recurrence rates, and approaches to follow-up care can vary considerably.
If you’ve been told that you may need pterygium surgery, how do you know which surgeon to choose?
Personal recommendations and online reviews can be helpful starting points, but they shouldn’t be the only factors you consider. Before choosing a pterygium surgeon, here are five important questions to ask.
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How much experience does the surgeon have treating pterygium?
Pterygium affects the conjunctiva and cornea, the clear surface at the front of the eye. For that reason, experience with corneal conditions and pterygium surgery should be an important consideration when selecting a surgeon.
A fellowship-trained corneal specialist has completed additional subspecialty training beyond an ophthalmology residency. However, credentials are only part of the picture. You should also consider how frequently the doctor performs pterygium surgery and whether they routinely treat advanced or recurrent cases.
Pterygium surgery can range from relatively straightforward to quite complex. A large growth may distort the cornea and affect vision, while a recurrent pterygium can present additional surgical challenges.
Dr. Franz Michel specializes in pterygium removal and treats patients with primary, advanced, and recurrent pterygia. Patients travel to Ventura County LASIK from throughout California, across the United States, and internationally for evaluation and surgery.
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What is the surgeon’s pterygium recurrence rate?
One of the most important questions to ask a prospective pterygium surgeon is: How often does the pterygium come back after you remove it?
Recurrence is one of the primary concerns following pterygium surgery. However, there isn’t one universal recurrence rate that applies to every surgeon or every patient. Rates vary depending on the surgical technique, whether the pterygium is primary or recurrent, patient characteristics, environmental factors, and other considerations. You can learn more about the factors that influence pterygium recurrence after surgery and steps that may help reduce the risk.
Research illustrates just how much surgical technique matters. A Cochrane review found six-month recurrence rates ranging from approximately 3% to 17% among conjunctival autograft groups in the studies it evaluated. Other research has demonstrated substantially higher recurrence following simple bare-sclera excision.
Dr. Michel’s reported pterygium recurrence rate is less than 1%.
That does not mean recurrence can never happen. No responsible surgeon can promise that. But a surgeon’s own recurrence experience is an important question to ask when deciding whom you want performing your procedure.
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What surgical technique does the doctor use?
Removing the visible pterygium is only part of successful pterygium surgery. What the surgeon does after removing it can have an important effect on healing and the likelihood of recurrence.
One widely used approach is conjunctival autografting. After the pterygium is carefully removed, a thin piece of healthy conjunctival tissue from another area of the patient’s own eye is placed over the surgical site. If you’re unfamiliar with the procedure, you can read more about how conjunctival autograft surgery works and why it is used for pterygium removal.
Research has shown conjunctival autografting to be associated with significantly lower recurrence than bare-sclera excision alone. A Cochrane review also found conjunctival autografting was associated with a lower risk of recurrence at six months than amniotic membrane transplantation overall, with a particularly notable benefit among patients being treated for recurrent pterygium.
The graft can be secured with sutures or tissue adhesive. Fibrin glue is commonly used because it can reduce operating time and postoperative discomfort compared with sutures, although the best approach depends on the individual patient and surgeon.
Older bare-sclera excision, in which the pterygium is removed without covering the exposed area with a graft, has historically been associated with much higher recurrence rates. Reviews have reported recurrence rates ranging from approximately 24% to 89% with bare-sclera techniques, which is why bare-sclera excision alone is now rarely used.
When meeting with a surgeon, don’t hesitate to ask how your pterygium will be removed, how the surgical site will be reconstructed, and why that particular technique is being recommended for you.
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What do other pterygium patients say about their experience?
Patient reviews can provide information you won’t necessarily find on a surgeon’s credentials page.
Google reviews and other independent sources may give you a sense of how patients felt about the entire experience, not simply the procedure itself. Did they feel comfortable with the surgeon? Were their questions answered? Did they understand what to expect during recovery? Was the office responsive when they had questions after surgery?
Don’t place too much weight on any single positive or negative review. Instead, look for patterns across a substantial number of patients, particularly reviews from people who specifically underwent pterygium surgery.
You may also want to look for experiences from patients whose situations resemble yours. Someone with a small primary pterygium may have very different concerns from someone seeking treatment for a large growth, vision changes, or a pterygium that has already returned after previous surgery.
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Does the surgeon give you realistic expectations?
An experienced pterygium surgeon should be confident in their abilities, but confidence isn’t the same thing as guaranteeing an outcome.
No surgeon can responsibly promise that a pterygium will never recur or that every patient will experience exactly the same recovery. Instead, your surgeon should explain the expected benefits of surgery, possible risks, recurrence, recovery, and what happens if something doesn’t proceed exactly as expected.
Ask questions such as:
- What is your recurrence rate?
- How frequently do you perform pterygium surgery?
- Which surgical technique will you use?
- What should I expect during recovery?
- How will you manage discomfort after surgery?
- What happens if my pterygium returns?
- How long will you follow me after surgery?
A surgeon who welcomes those questions and gives you straightforward answers is helping you make an informed decision rather than simply trying to convince you to have surgery.
How to Choose the Right Pterygium Surgeon
So, what should you look for in a pterygium surgeon?
Experience with pterygium and corneal surgery, a modern surgical technique designed to minimize recurrence, documented outcomes, realistic expectations, and attentive follow-up care should all be part of your decision.
This becomes especially important if your pterygium is large, affecting your vision, causing significant astigmatism, or has returned after previous surgery. As a pterygium grows across the cornea, it can change the cornea’s shape and interfere with vision. You can learn more about how an advanced pterygium can affect your vision and why it may be better to address vision changes before the condition becomes more advanced.
Dr. Franz Michel has extensive experience treating pterygium, including advanced and recurrent cases. His reported recurrence rate is less than 1%, and patients travel from throughout the United States and internationally to Ventura County LASIK for pterygium evaluation and surgery.
If you have been diagnosed with a pterygium and are considering removal, a consultation with Dr. Michel can help determine whether surgery is appropriate and which approach makes the most sense for your particular eye.