Recurrent pterygium – features of surgical treatment

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Abstract

Pterygium is a fibrovascular degenerative condition of the subconjunctival tissue that proliferates and grows into the cornea in the form of a vascularized fold, destroying the surface layers of the stroma and Bowman’s membrane. This disease is common throughout the world. The etiology is not clear, but it is known that the appearance of pterygium is associated with exposure of the eye to ultraviolet rays. The treatment of the de novo occurring pterygium is a relatively simple task and involves surgical removal. But a simple excision is currently unacceptable due to the high recurrence rate. In order to minimize the risk of relapse, numerous adjuvant treatment methods are used, which include anti-metabolites such as Mitomycin C and 5-fluorouracil, amniotic membrane, various types of conjunctival and or limbal grafts; medications such as anti-vascular endothelial growth factor are sometimes used. In the clinical case presented in the article, we successfully used the technique of anterior lamellar keratoplasty and autoconjunctival transplantation in combination with intra-operative use of anti-metabolite Mitomycin C in a young patient with recurrent stage IV pterygium (degree of activity 3) twice unsuccessfully operated on. As a result of this surgical technique, the transparency of the cornea was restored and high visual acuity was obtained.

About the authors

Inna A. Riks

Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russia

Email: riks0503@yandex.ru
SPIN-code: 4297-6543

МD, PhD, Assistant, Ophthalmology Department

Russian Federation, Saint Petersburg

Sergey Yu. Astakhov

Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russia

Email: astakhov73@mail.ru

МD, PhD, DMedSc, Professor, Head, Ophthalmology Department

Russian Federation, Saint Petersburg

Sanasar S. Papanyan

Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russia

Email: Dr.papanyan@yandex.ru
ORCID iD: 0000-0003-3766-2211
SPIN-code: 9794-4692

МD, PhD, Ophtalmologist, Ophthalmology Department

Russian Federation, Saint Petersburg

Maggie B. Ezugbaya

Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russia

Email: Maggie-92@mail.ru

МD, Postgraduate Research Student, Ophthalmology Department

Russian Federation, Saint Petersburg

Rafik Boutaba

Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russia

Author for correspondence.
Email: boutabarafik@yahoo.fr

МD, Clinical Resident, Ophthalmology Department

Russian Federation, Saint-Petersburg

Ivan A. Sokolov

Almazov National Medical Research Centre

Email: md.iasokolov@yandex.ru

neurosurgery resident

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Right eye (October 2019): recurring (operated on three times) stage IV pterygium (according to Z.D. Titarenko), degree of activity 3 (according to the D. Tan classification)

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3. Fig. 2. Left eye (October 2019): recurrent (twice operated on) stage IV pterygium (according to Z.D. Titarenko), degree of activity 3 (according to the D. Tan classification)

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4. Fig. 3. Left eye (January 2020): pterygium progression

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5. Fig. 4. Left eye with soft contact lens, Day 1 after surgery

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6. Fig. 5. The left eye 5 months after surgery, visual acuity with a correction 1.0

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Copyright (c) 2020 Riks I.A., Astakhov S.Y., Papanyan S.S., Ezugbaya M.B., Boutaba R., Sokolov I.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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