PTERYGIUM REMOVAL

[EMMYS]

I HAVE JUST BEEN TOLD BY MY EYE DOCTOR THAT I NEED TO HAVE THE PTERYGIUM REMOVED FROM MY LEFT EYE,HE SAYS THAT THE ONLY WAY TO HAVE IT REMOVED IS UNDER GENERAL ANASTHETIC WHICH I HAVE A PHOBIA AGAINST .IS THIS TRUE THAT THE PROCEDURE CAN ONLY BE DONE IN THIS WAY? I HAVE ALSO READ THAT IT CAN COME BACK AGAIN AFTER REMOVAL SO WHY IS MY DOCTOR OFFERING ME THIS IF IT'S JUST GOING TO COME BACK AGAIN? PLEASE HELP AS AM NOT SURE WHAT TO DO AS THE DOCTER THAT I HAVE SEEN I WAS NOT COMFORTABLE WITH AND SEEMED IRRITATED BY ME GETTING UPSET ABOUT HAVING THE PROCEDURE DONE AND THE QUESTIONS THAT I WAS ASKING.

[John C Hagan III, MD, FACS]

A Pterygium (Latin derative mean 'wing shaped') is when tissue from the outer layer of the eye conjunctiva starts to grown over the cornea. They normally occur at the 3 and 9 o'clock position are and usually due to sun damage. The frequency of ptyerygia increases as one lives closer to the equator.

A pterygium does not have to be removed if its small, not growing, no irritated and not interferring with vision.

The most common complication is re-occurence and the rate varies depending on the size and irritation of the pterygium but 10-15% is ball-park.  If you're an optomist you have a 85-90% chance of it not coming back.

I have never done a pterygium surgery under general nor have I ever heard of it being done under general. This procedure is 100% local anesthetic maybe with some IV sedation.

Since you're not comfortable with the eye surgeon and if the ophthalmologist is insisting on general anesthesia and you prefer local I would go to a different surgeon for another opinion and one willing to use local anesthesia if it needs to be done. As a bonus if you have the opportunity you might see an eye MD that specializes in corne surgery.

JCH MD FACS Eye MD

[erikb]

I have a pterygium also, which is very irritating and I'm considering having it removed.  I suggest checking out the harvard eye institute web site, they are performing new procedures for removal (without stitches).  they claim that the success rate is excellant.  they supposedly performed this new type of surgery on hundreds of patients with no regrowth on any of them.  Too bad I have to travel from Michigan to California

[John C Hagan]

There may be some things that can only be done at Harvard (their eye teaching hospital is Mass. Eye and Ear Infirmary) but pterygium is definitely not not one of them. First of all pterygium is so common that most ophthalmologists are very competent and comfortable removing them. Second there are many techniques that are used depending on things like the size, location, age and whether it is a recurrent pterygium. Such techniques include but are not limited to bare sclera technique, misdirection and resuture of pterygium head, removing the pterygium with a diamond dusted brush, amniotic fluid graphs, "self" grafting with conjunctiva from opposite eye, use of anti-metabolites and several more. Many of these technqiues were developed in Sun Belt Cities, Hawaii and other countries lying near the equator where the intense sun causes a high rate of pterygia.

So you need not concern yourself that if you don't make the trip to Harvard that you are receiving less that leading edge care. A cornea specialist found in all large cities, many to most medium size cities and a few smaller cities should have all of these techniques at their disposal.

JCH MD Eye Physician and Surgeon

[erikb]

Thank you for all of your insight, it is reassuring to hear your professional opinion.  The Harvard Eye web page on pterygiums leads you to believe that they and only they have the "break-thru" technology to perform the no stitch procedure with a very high success rate.

After researching and trying to gather as much information on this eye problem as I can, I think I will continue to try eye drops (eventhough they provide very little relief) & postpone surgery unless my pterygium becomes more severe or begins to affect my vision.  My symptoms are very sporadic and I can deal with them when it flares up; however, the only thing that really ever relieved the irritation is an eye drop that contains a mild steroid which I never use because I do not want to cause another condition on top of the one I already have.  Do you recommend a certain type of eye drop?

Thanks
Erik

[moorejaca]

I had a pterygium removed last summer and it less than 6 months.  I thought that recovery from  this surgery  was the most intense pain that I had ever experienced!I have had two children and their births did not compare to the pain that I experienced after surgery.  I had a local sedative, but was awake through the entire process. Being awake during the surgery was not pleasant either. My doctor told me that I should be able to handle the pain.  The only medication that I was given was over the counter Tylenol. I was not comfortable going outside for atleast a month following this surgery.
I am once again trying to figure out what to do with the reoccurence of the pterygium.  I am interested in knowing if there is another way to remove the pterygerium that is far less uncomfortable.
I would love to hear a success story of this procedure!  

[John C Hagan]

Do you recommend a certain type of eye drop?

Thanks
Erik

ANSWER: generally I recommend frequent use of artifical tears, perhaps a lubricating gel at bedtime (all over the counter). No tanning booths or "laying out in the sun" for tanning, a hat with a bill and UV blocking sunglasses outside.

If you do have a flareup the careful and judicious use of a very mild steroid like ALREX is generally safe. Most problems with steroids come from use of strong steroids (example Pred Forte) for long periods of times OR using it for a condition other than what they were prescribed for (examples steroids on herpes simplex, corneal ulcers, on contact lens, etc).

You should see you ophthalmologist if the condition seems different than a typical pterygium irritation and of course have an annual comprehensive medical eye examination by your Eye MD.

JCH MD

[John C Hagan]

I had a pterygium removed last summer and it less than 6 months. I thought that recovery from this surgery was the most intense pain that I had ever experienced!I have had two children and their births did not compare to the pain that I experienced after surgery. I had a local sedative, but was awake through the entire process. Being awake during the surgery was not pleasant either. My doctor told me that I should be able to handle the pain. The only medication that I was given was over the counter Tylenol. I was not comfortable going outside for atleast a month following this surgery.
I am once again trying to figure out what to do with the reoccurence of the pterygium. I am interested in knowing if there is another way to remove the pterygerium that is far less uncomfortable.
I would love to hear a success story of this procedure!

Hello Moorejaca,  Wow, what a tough thing to go through. I can assure you that your experience was not typical. I have done hundreds of pterygium surgeries in the past without those types of complaints. I have done all my surgeries under local anesthesia with IV sedation. I routinely prescribe a major pain reliever in case over the counter meds (three aspirin, or three tyleno or 4 ibuprofen don't work).  The pain often comes from the cornea so often a bandage contact lens is place on the eye during the healing process.

I would suggest you consider consulting an ophthalmologist that specializes in corneal surgery and be sure they understand the problems you had with the first procedure.

There are many reactions to the same procedure. Several years ago I tore a rotator cuff. My patients told me it was one of the most painful things they ever went through, one woman did say it was worse than childbirth and some said they could not get they shoulder to work normally.  I was very fearful and discussed it with my orthopedic surgeon that gave me an over-view of his results.  I have virtually no pain and recovered 100% of my shoulder movement. Your first operation was not a typical experience.

Good luck.

JCH MD Eye MD Ophthalmologist

[ll1988]

Yes, my pterygium surgery was a success!  It will be one year in August.

It took some research to find a good eye specialist.  

This was my second surgery to remove it.  The first was done by a doctor who was not experienced enough.  Thus, the reason for the research.

Almost immediately the growth returned and grew bigger after the first surgery.  I made a 4 hour trip to have my second surgery.  This doctor knew what he was doing and I trusted him with my eye.  

I regularly visit him to check and make sure nothing is awake and growing on my eyes.

If you would like the name of this specialist let me know.  He is world-renowned and actually developed special insruments and techniques just for this type of problem.

The right doctor will be the right surgery.

[erikb]

I would like the name & location of your doctor, I am trying to gather all the information I can.  I may need to have this eye sore removed someday.

Thanks,
Erik B

[ll1988]

Here is the eye specialist I know helped me and my case was a tricky one.

Dr. Arun Gulani
8075 Gate Parkway West
Suite 102 & 103
Jacksonville, Florida   32216
904  296 7393

It takes me a whole day to see him, but he is worth the trip.

One day if you meet him, tell him the girl with the minature donkeys says, HI!

I know you will be pleased to know him.  I wish you well!

[mary hansel]

I had a pterygium removed a month ago on my right eye, i agree it was painful afterwards,, but my main concern is the eyedrops my doctor has me using,  Pred Forte,, 10mi. i was told to use it 4 x times a day, and that has been right a month a week,, I read that you should not use it for that long, I have to get my left eye done in three weeks and then start again with the Pred Forte in that eye,, I still have redness in my right eye, I thought should be gone by now,,, any input on this would help

[John C Hagan III, MD, FACS]

Hello Mary,   long term use of steroid eye drops WITHOUT AN OPHTHALMOLOGIST MONITORING AND CHECKING FOR SIDE EFFECTS IS DANGEROUS. Right now your ophthamologist is trying to keep the pterygium for re-occuring.  Good luck on the second operation.

JCH III MD Ophthalmologist

[mary hansel]

I had a ptergium removed a month ago, on my right eye, i found it to be very painful afterwards ,  my main concern is the eyedrops my doctor has me using, Pred Forte, 10 mi, i was told 4 x a day, and that has been over a month and a week, I read you should not use it that long, I have to get my left eye done in three weeks, and then start the pred forte in that eye,  I still have redness in my right eye, I thought should be gone by now,, He used the glue instead of sitches,  any input would be helpful,, I see 20/20 in my right eye ,, but still things seem blurrie,, when i just open my right eye, is this normal,  i would really like some news, before i go to get my left eye done,,, thanks

[stndingrl]

I just had a pterygium removed this week...too soon to tell if it will return, but
I must say that I was very happy with the results.   I was awake under a "twilight" type of anesthesia, and actually was aware during the surgery.  My doctor used lazer surgery
as his mode of attack.   I'm taking two different drops..one antibiotic and one
steroid for 7-10 days.   I suffered no pain after the surgery, but have had some
side effects of the drops; blurred vision, sensitivity to light.   It's minimal, however.   I would recommend this surgery.  
for anyone who suffers from this type of growth.  I am hopeful that by keeping with
the post care instructions, I will enjoy a clear eye.
Signed:  Middle-aged beach bunny in Sunny California who now wears UV protected sunglasses!!

[mary hansel]

where you awake  when they numbed your eye before surgery?  when I had mine removed, they put me in a deep sleep for maybe 14 min,, while they numbed my eye, then I was awake during the surgery,  like in a half awake state I would say, I could hear, and feel a little going on with my eye.  Then afterwards,, when all that wore off,, It hurt, but its getting better, its been 7 weeks,,,

[Gmaw]

I am seriously considering pterygium removal but am having trouble finding the right surgeon. Can anyone make a recommendation for a corneal surgery specialist in the Boston or New England area?

[John C Hagan]

To Gmaw  you can use the  wesbsite of the american academy of ophthalmology www.aao.org and use the Find an Eye MD feature to locate a board certfied local ophthalmologist (Eye MD) that specializes in corneal disease.


JCH III MD

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