Surgical Treatment Methods for Pterygium Management
Summary
Pterygium, a fibrovascular proliferation of conjunctival tissue extending onto the cornea, poses both cosmetic and visual challenges. Surgical excision remains the definitive treatment for lesions causing astigmatism, restricted ocular motility or significant discomfort. Traditional bare sclera excision, while straightforward, is associated with high recurrence rates. Consequently, tissue grafting techniques have become the standard of care. Conjunctival autograft mobilisation, with or without limbal tissue inclusion, lowers recurrence by restoring a barrier to fibrovascular ingrowth. Amniotic membrane transplantation offers an alternative graft that dampens inflammation and promotes epithelial healing, albeit with slightly higher recurrence than autograft. Surgical refinements include sutureless fixation using fibrin glue, which reduces operative time and postoperative irritation. Adjunctive measures administered intraoperatively or immediately post-excision further mitigate recurrence. Antimetabolites such as mitomycin C and 5-fluorouracil inhibit fibroblast proliferation but require careful dosing to avoid complications. Anti-vascular endothelial growth factor agents and targeted radiotherapy have emerged as supplementary approaches, targeting neovascularisation and scarring. Recent advances focus on optimising graft survival, standardising lesion grading and minimising adverse effects. Taken together, these developments underscore a shift towards combined mechanical and pharmacological strategies that balance low recurrence with patient comfort and global applicability.
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Surgical Treatment Methods for Pterygium Management publication trend
The graph below shows the total number of articles in surgical treatment methods for pterygium management across all publications each year (not limited to Nature Index journals).
Technical terms
Pterygium: A triangular fibrovascular growth of conjunctiva onto the cornea, often UV-induced.
Bare sclera technique: Excision method leaving scleral bed uncovered, associated with high recurrence.
Conjunctival autograft: Transplant of patient’s own conjunctival tissue to cover the scleral defect post-excision.
Amniotic membrane transplantation: Use of preserved amniotic membrane as a graft to promote healing and reduce inflammation.
Mitomycin C (MMC): Antimetabolite applied intraoperatively to inhibit fibroblast proliferation and reduce recurrence.
Anti-VEGF agent: Biological inhibitor targeting vascular endothelial growth factor to prevent neovascularisation.
References
- Anti-fibrotic, anti-VEGF or radiotherapy treatments as adjuvants for pterygium excision: a systematic review and network meta-analysis. BMC Ophthalmology (2017).
- Inhibition of Pterygium Fibroblast Migration and Outgrowth by Bevacizumab and Cyclosporine A Involves Down-Regulation of Matrix Metalloproteinases-3 and -13. PLOS ONE (2017).
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