Hey you're embarrassing our program not knowing how to manage pterygia. We see a million of them at parkland. We also excised a million in the minors room and put mitomycin c, leaving bare sclera. Unfortunately that doesnt work. I my experience since being out for a year having done well over a hundred pterygia this year sometimes up to five week. In nasty reccurent pterygia you need to do a complete excision, take the darn thing off. make sure when you cut with the wescotts its not difficult to cut tissue if it is, it's dysplastic. Actually recurrent pterygia arent really like the orginal they overexuberant healing. You need to hook the medial rectus and dissect it cleanly. On the really bad ones the size of the graft I have placed is huge 15 mm at the limbus in a arc shape, 13 mm horizontally and 18 mm sup to inf nasally, all the way to the darn caruncle. You just can't get this much conj, and on recurrent cases you need amniotic membrane. But you have to use mitomycin C with it. When sewing on the graft I use tisseal as well as interupted and running sutures. Why? b/c if the graft dehisceses thats where you get over exuberant healing and recurrences. Also I take a pair of 0.3 or 0.5 forceps b/c 0.12 is just too wimpy and pull out the tenons and cut that stuff away. Some people who are out in the sun like all of the surfers I have are a set up for a recurrence. Also don't be surprised when their iop creeps up b/c you affect so much of the native episcleral drainage of the eye. I would recommend your friend see one of the following people she/he should consider Texas Cornea Associates across presbyterian hospital or I would see Dr. Steve Verity. He deals with a lot of these and he is a very meticulous surgeon.
