Pterygium affects around 10-15 million Americans, with higher rates found in the sun-kissed regions closer to the equator, such as southern California. Though many people with a pterygium (or two) are unbothered by this triangular growth of the eye’s whites over the clear cornea, others may be affected by pterygium symptoms such as redness, irritation, and increasing astigmatism.
Time for Pterygium Surgery
A pterygium only needs intervention with a pterygium eye surgeon when it begins to cause trouble. This trouble may be in the form of blurry or distorted vision, frequent episodes of inflammation, rapid progression, or the fact that it just doesn’t look good. A pterygium that only flares up with redness and irritation every once in a while can sensibly be managed with anti-inflammatory eye drops or non-medicated tear supplements as recommended by your eye doctor.
Pterygium removal surgery has come a long way over the last several decades. From simply cutting out the pterygium and leaving the bare eye to sort itself out to now using more advanced techniques such as fibrin glue over sutures or covering the excision site with a piece of conjunctival tissue (conjunctival autografting), pterygium surgeons have a few tricks up their sleeves now to address that age-old problem – pterygium recurrence.
What is a Recurrent Pterygium?
A recurrent pterygium is one that simply won’t leave you alone. It keeps regrowing after it’s been surgically removed. And for pterygium surgeons, recurrent pterygia are the bane of their existence.
Recurrent pterygia often progress more aggressively than the original pterygium, and are most likely to appear within the first year after surgery. Understanding what causes a pterygium in the first place and identifying those triggers for recurrence are pivotal for developing those nifty tricks to avoid or minimize it, from counseling individual patients on their personal risk factors to applying specific techniques in the operating room.
5 Risk Factors for Pterygium Recurrence
- Ultraviolet exposure
UV exposure is known to be one of the major driving factors to developing a pterygium in the first place. It stands to reason that continued high UV exposure – whether from your occupation, hobbies, or just because of where you live – can promote pterygium recurrence.
- Dry eye disease
Dry eye disease is a complex syndrome that can cause various problems, from fluctuating blurred vision to debilitating eye pain. The chronic eye irritation from dryness is also a known risk for pterygium recurrence.
- African American or Hispanic ethnicity
Studies have shown that black and Latino heritage can increase the risk of a recurrent pterygium compared to Caucasian patients. This appears to be true even when using modern pterygium surgery methods but was more marked when the amniotic membrane graft approach was used over conjunctival autografting. The high rates of pterygium recurrence in these communities are possibly due to genetics and the socioeconomic factors found in these cultures.
- Primary pterygium characteristics
The primary pterygium refers to the original pterygium. Larger and more “fleshy” pterygia are more likely to make a comeback after surgical removal, as are those that have a prominent blood supply.
- Surgical technique
Pterygium surgeons can’t tell a surfer to stop surfing so that her pterygium won’t come back, but they can apply specific surgical techniques and treatments to minimize the recurrence risk. The old bare sclera technique involves peeling off the pterygium and leaving the underlying tissues of the eye to fend for themselves as they heal. Unfortunately, this technique is associated with a recurrence rate of up to 88%.
Modern pterygium surgery now employs techniques such as amniotic membrane grafting (covering the wound site with a tissue derived from the placenta) or conjunctival autografting (covering the site with a section of healthy conjunctival tissue from elsewhere in your eye). Add-on treatments with names such as mitomycin C, 5-fluorouracil, and anti-vascular endothelial growth factor, combined with the right surgical technique can reduce recurrence rates to single digits.
Reduce Your Risk of Pterygium Recurrence
Though genetic factors and the characteristics of your original pterygium can’t be modified, you can take steps to minimize your risk of the pterygium returning post-surgery. Protect your eyes from UV exposure with a hat and sunglasses; and manage any existing dry eye disease with tear lubricant eye drops or more intensive treatments like intense pulsed light therapy. And ensure you choose a pterygium surgeon, like Dr. Michel, with the skills and experience to manage your pterygium with the right techniques and treatments.