What is a pterygium?
What symptoms can be caused by a pterygium?
What can be done to prevent the pterygium from getting larger?
Can the pterygium be removed?
What is conjunctival autografting?
How does the graft stay in place?
What should I expect after the PECG procedure?
What are the risks of the PECG procedure?
When can I return to work?
Is this procedure covered by my medical insurance?
A pterygium is an abnormal growth of the conjunctiva (the skin of the eye.) A pterygium is benign (not cancer), but if not removed, it can continue to grow and cover the cornea and limit vision.
Pterygiums are caused by sun exposure, and are more common in people who have lived in tropical climates, or who have history of prolonged sun exposure. Most often a pterygium is located on the part of the conjunctiva closer to the nose, and can appear as a yellow-red “bump” on the eye.
Some people will have no symptoms when the pterygium is small. However, pterygiums will grow slowly and can cause decreased vision if it grows over the pupil. Pterygiums can also cause astigmatism as they grow, requiring a need for glasses if the pterygium is very large. Pterygiums can also cause eye irritation, a dry eye feeling, and redness of the eyes.
Not much. We recommend wearing UV sunglasses when you are in direct sunlight.
Yes. The modern technique of pterygium removal is called pterygium excision with conjunctival autografting (PECG). This is an out-patient procedure and takes about 15-20 minutes.
During the procedure, you are awake, but you are given medicine that will make you relaxed so you do not feel any pain, and often you do not remember the procedure. Dr. Levinson will remove the pterygium in the operating room, and place a conjunctival autograft in its place.
If the pterygium is removed and an autograft is not placed, then there is a high risk of the pterygium returning. The conjunctiva surrounding the pterygium has also been damaged by the sun, and there is a risk that the pterygium can return larger after the procedure. Using a conjunctival graft greatly reduces this risk.
A small piece of conjunctiva from under the eyelid is transplanted to replace the pterygium. (The conjunctiva under the eyelid has not been exposed to the sun and rarely turns into a pterygium.)
Because this tissue comes from you, it is called an autograft, and there is no chance that the graft will be rejected by the body.
In the past, we used to sew the graft in place with microscopic sutures. However, sutures in the eye can be uncomfortable. We now use a surgical glue which binds the graft to the eye in seconds – no sutures required!!! The glue is formulated from the natural compounds in the human body which allows us to heal when we have cuts on our skin.
You will have a patch over your eye after the procedure, which will be removed the next day in the office. Your eye may feel gritty, or have a “foreign body” feeling for a few days.
Some people have mild to moderate eye pain for 2-3 days after the surgery, and this can be treated with eye drops or pain pills.
Most people do not have much discomfort, just the awareness that their eye feels “different” for a few days. Your eye will be more red for 1-2 weeks after surgery. The graft will become very red after 2-3 days. This is normal. The graft needs to develop a new blood supply so it can live in its new location.
All surgery has some risk, but the risks involved with PECG are minimal. The largest risk is that the pterygium returns. The rate of recurrence of the pterygium with the PECG technique is about 5%. (The risk of recurrence if an autograft is not used is about 50%.)
Another risk is that the graft does not stay in place after the surgery. This is uncommon (less than 1% risk.) If the graft does not stay in place, then there is a greater chance that the pterygium can return. Other rare risks include eye infections, and changes in vision.
Most people can return to work 1-2 days after the procedure.