What are the other Names for the Procedure?
- Pterygium Removal
What is the Pterygium Excision surgical procedure?
Pterygium Excision is a procedure that improves vision through the removal of a pterygium, which are abnormal benign tissue that grow over the cornea.
What part of the Body does the Procedure involve?
A Pterygium Excision procedure involves the eye, cornea, and conjunctiva, which are membranes that cover the eye.
Why is the Pterygium Excision surgical procedure Performed?
A Pterygium Excision is performed for the following reasons:
- To restore vision to normal
- To improve visual appearance
What are some Alternative Choices for the Procedure?
- Pterygium recurrence is a major problem with the use of surgery to remove this abnormal corneal growth. A few alternative techniques that follow a surgery include:
- MMC: The use of mitomycin C (MMC) drops to reduce risk of recurrence
- Beta irradiation: It works by preventing the rapid cell division that is common to a pterygium
What are the Recent Advances in the Procedure?
The surgical techniques used for Pterygium Excision have undergone advancements to reduce pterygium recurrent rates, minimize scarring, and enable a smooth corneal surface after the procedure.
What is the Cost of performing the Pterygium Excision surgical procedure?
The cost of a Pterygium Excision procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding an Pterygium Excision procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
http://www.aao.org/publications/eyenet/201011/pearls.cfm (accessed on 06/12/2015)
Prior to Pterygium Excision surgical procedure:
How is the Pterygium Excision surgical procedure Performed?
A Pterygium Excision procedure is performed under local or topical (using eye drops) anesthesia.
- The ophthalmologist uses an instrument called speculum to keep the eyelids open during surgery
- The surgeon then cuts and removes the pterygium
- After excising the pterygium, the bare area of the sclera (the white of the eye) may be left as it is or covered with a part of the patient’s conjunctiva (the clear tissue over the white of the eye) taken from another area of the eye
- An amniotic membrane (the sac-like tissue that contains the growing baby in the womb) may also be used to cover the bare sclera after a Pterygium Excision
Where is the Procedure Performed?
The Pterygium Excision procedure is usually performed in an out-patient surgery center facility or a hospital.
Who Performs the Procedure?
An ophthalmologist performs a Pterygium Excision surgical procedure.
How long will the Procedure take?
The procedure usually takes less than an hour to perform.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Pterygium Excision procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for the Pterygium Excision procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Pterygium Excision surgical procedure?
A complete eye examination is required before the Pterygium Excision procedure.
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is Pterygium Excision surgical procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
- What are the costs involved?
During the Pterygium Excision surgical procedure:
What kind of Anesthesia is given, during the Procedure?
Topical anesthesia by topical application and sedation, or local anesthesia by injection and sedation is administered prior to the procedure.
How much Blood will you lose, during the Procedure?
There is no blood loss during the Pterygium Excision procedure.
What are the possible Risks and Complications during the Pterygium Excision surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Pterygium Excision surgery are:
- Infection within the eye
- Anesthetic complications
What Post-Operative Care is needed at the Healthcare Facility after the Pterygium Excision surgical procedure?
At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.
After the Pterygium Excision surgical procedure:
What are the possible Risks and Complications after the Pterygium Excision surgical procedure?
The possible risks and complications that may arise after the Pterygium Excision procedure are:
- Infection within the eye
- Pterygium recurrence
- Abnormal scarring
What is the Prognosis after the Surgery?
A complete recovery from a Pterygium Excision procedure is usually achieved. The prognosis is generally excellent without any serious complications being observed. However, pterygium recurrence risk remains fairly high.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Worsening pain or fluid drainage from the eye
- Complete or temporary loss of vision
- Signs of an infection
- Headache, muscle aches
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Pterygium Excision surgical procedure?
At home, the following post-operative care is recommended, after a Pterygium Excision procedure:
- Avoid sunlight exposure for the first 6 weeks after the procedure. Wear UV protection sunglasses to avoid a direct exposure
- Individuals should wear an eye patch at night while sleeping, to protect the eye
- Avoid all activities that are physically strenuous for about 3 weeks after the surgery (as advised by your physician)
- Complete the course of prescribed medication as advised by your physician
- Take antibiotic medication to help combat or prevent infection, per your physician’s advice
- Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)
- Using steroidal eye drops can help decrease the possibility of an infection (under advice of your physician)
- Resume driving a few days after the procedure or once the eye patch is removed (if prescribed); however, do follow your physician’s instructions
How long does it normally take to fully recover, from the Procedure?
It usually takes approximately 3 weeks to fully recover from this procedure.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed, as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Pterygium Excision surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient surgical facility or a hospital
- An anesthesiologist (if anesthesia was administered)
- A pathologist
- An ophthalmologist
The patient is advised to inquire and confirm the type of billing, before the Pterygium Excision surgical procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA