INTRODUCTION
Pterygium derived from Pterygion (ancient Greek word means wing) is non-malignant slow growing proliferation of wing shaped fibrovascular tissue arising from the subconjunctival tissues which may extend over the cornea thus disturbing the vision. Pterygium is classified as a corneal degeneration.
It most commonly affects the individuals living in tropical and subtropical areas and greater in peoples exposed to outdoor environment specially dry, dusty and sunny weather.
Until last decade Pterygium was considered to be a trivial, small time problem both by ophthalmologists and the patient because in most of the cases it is not sight threatening unless it is advanced extending over the cornea close to the visual axis. Now due to latest advancements in corneal surgery and more cosmetic conscience patients equation, has totally changed. In last 10 years I have seen more and more patients coming for Pterygium management with sole aim of cosmetic improvement.
Due to serious optical considerations, corneal astigmatism and changes related to corneal first surface wavefront aberrations, the ophthalmologists have taken seriously the medical and surgical management of Pterygium specially lasik surgeons. Advanced cases of Pterygium certainly put hinderance in patient post lasik 20/20 vision.
Trends in Treatment Modalities of Pterygium
Historical treatment of Pterygium during 1000 BC when susruta treated it with pulverizea salt and palm branches and tore it out with ancient forceps when inflamed and swollen. In 469 BC Hippocrates (Greece) treated Pterygium with eye drops containing lead, zinc, copper, iron, bile juices, urine and mother milk. Now following medical and surgical options are available for the management of Pterygium.
- Bare sclera with intraoperative Mitomycin C.
- Bare sclera with Beta irradiation.
- Sliding or rotational autograft.
- Conjunctival autograft.
- Amniotic membrane transplant.
- Anterior segment Indocyanine green angiography with conjunctival autograft transplantation.
- Air-assisted Pterygium surgery.
- Sutureless small incision Pterygium surgery with Fibrin tissue Glue.
- Antimetabolites.
- Thiotepa
- 5-FU
- Mitomycin C (MMC)
- Keratoplasty specially deep anterior lamellar keratoplasty.
- Medical management specially with Avastin.
Fibrin Glue application and antimetabolites use have shown significant results specially in relation to Recurrent Pterygium as recurrence rate reported is 2–40% which is clinically significant and nightmare both for treating ophthalmologist and affected patient. Successful treatment is still a great challenge inspite of advances in various treatment modalities. In this book, various International authors have emphasized the need and urgency to understand and treat the Pterygium in a better and effective way to the cosmetic and visual needs of the patients worldwide which are more conscience now and their expectations are clearly very high in this modern science era.