UTSouthwestern

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I have a friend who has one that has been excised once and is now regrowing. One opthamologist recommended re-operating on it, but another told her to wait until she was having visual disturbances. She has approached me about this but I have no clue what to tell her. Any thoughts on this subject?
 

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Main indications for surgery:

1) visual decline
2) high astigmatism
3) encroachment into the visual axis
4) patient bothered by appearance or has repeated irritation
 
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UTSouthwestern

UTSouthwestern

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Andrew_Doan said:
Main indications for surgery:

1) visual decline
2) high astigmatism
3) encroachment into the visual axis
4) patient bothered by appearance or has repeated irritation
Thanks Andrew. I should have just PM'd you. I'm just not sure if it is wise to wait until the pterygium is already affecting the visual field as I am not sure if there is a potential for damage during the excision.
 

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UTSouthwestern said:
Thanks Andrew. I should have just PM'd you. I'm just not sure if it is wise to wait until the pterygium is already affecting the visual field as I am not sure if there is a potential for damage during the excision.
Yeah, I was wondering the same thing. If you see the pterygium slowly moving toward the visual axis, do surgeons every just take it off before it actually begins causing vision problems?
 

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UTSouthwestern said:
Thanks Andrew. I should have just PM'd you. I'm just not sure if it is wise to wait until the pterygium is already affecting the visual field as I am not sure if there is a potential for damage during the excision.
Yes.. it is reasonable to do surgery if you feel the pterygium is getting near the visual axis.
 
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Andrew_Doan said:
Yes.. it is reasonable to do surgery if you feel the pterygium is getting near the visual axis.
That's why I am telling my friend to go back to the first optho that saw her as I don't think it is wise to have the pterygium near/on the visual axis before removing it as her current ophtho is telling her he will wait for.
 
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Andrew and fellow opthamologists, I wanted to dredge up this thread again because my friend has now had three excisions in the past year with subsequent regrowth of the pterygium. The excisions have each been done just prior to affecting the visual axis.

At this point, the opthamologist has told my friend that he doesn't know what else to do. I asked him to tell me what he had done in terms of topical treatments as well as his intraoperative technique, but he was less than forthcoming. My friend will be requesting all of her medical records and will be looking for a new opthamologist in the next week.

However, according to her, he has given her medicated eye drops to use and has stated that he has applied medication intraoperatively (Mitomycin? Steroid?).

My question now is that if she has failed all conventional therapy (and the pterygium is already back and again about to cross the visual axis), what alternative therapies can she inquire about with her new physician?
 

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did she have an amniotic membrane graft or conj autograft placed? Is her MD sure it is a pterygium (was path sent?).

Sounds like she wither has a pretty nasty pterygium (or other growth).

You know, your medical center has exceptional cornea/ ant seg - maybe she could try someone there.
 

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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.
 
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ckyuen said:
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.
Thank you VERY much for this reply. Unfortunately, she was going to Parkland but was being seen by a different physician each time and she was sure it was a resident each time because of the way they handled themselves. At this point, she just doesn't want her sight to be affected. Once I receive her medical records, I will post the salient details here (with her permission already given) to see what feedback you guys might have.

I will also pass along your recs for the docs you have listed.