Taking a New Look at Pterygium Removal

It seems fitting that the general manager of an ophthalmology clinic would be a guinea pig for a new surgical treatment on the eye. And so it was that Dean Powrie of PersonalEyes in Sydney rolled up one morning late last year to have his ‘very advanced’ pterygium removed by Dr. Kerri Meades.

Pterygium is believed to result from prolonged exposure to UV radiation from bright sunlight and dry, windy, dusty environments.

Dr. Meades says its incidence is on the rise. “Pterygia are UV related so the incidence in Australia is high, and it is more common in northern Australia than in southern areas such as Tasmania. Hopefully, as the population is encouraged to protect themselves from UV radiation, the incidence will decline.

Pterygia are UV related so the incidence in Australia is high, and it is more common in northern Australia than in southern areas such as Tasmania

“Unfortunately we are seeing a group of people coming through that were sun lovers and were not concerned about protection, particularly when young. Their radiation exposure has accumulated over many years and results in these recalcitrant lesions,” she said.

While pterygium is most commonly associated with surfers, for obvious reasons, people who work as patrol officers, farmers, deep-sea divers, fishermen, jackaroos, truck drivers and gardeners are also at greater risk than those who spend the majority of time indoors. Children who grow up in the sun without sunglasses and other adequate sun protection are more likely to develop pterygium, 10 years or more down the track.

Dean Powrie puts his case down to being a keen surfer. “I’m the only staff member within PersonalEyes who has had a pterygium – I’m the only one who has not taken enough care of my eyes,” said Mr. Powrie. “And I’m the first person in the practice to have had this new procedure.”

Multiple Advantages of AmnioTek

The procedure, known as the AmnioTek, was first used in 1940 to reconstruct the eye’s surface when damaged by chemical burns. More recently, surgeons determined that AmnioTek could also successfully be used for reconstruction following removal of pterygium.

Dr. Meades said during surgery, the pterygium is removed with fine surgical excision and a cryopreserved amniotic membrane, taken from a placenta, is applied to the raw area. Essentially, this tissue graft leads to stem cells restoring the normal anatomy of the eye’s surface. The procedure is performed under local anaesthesia and takes about 40 minutes.

She said the procedure compared favourably with simple excision or sub-conjunctival tissue grafts traditionally used to remove pterygium, “AmnioTek avoids the use of a graft from the patient which would leave a large raw area on the patient’s eye, if a conjunctival graft was used,” she explained. “It is designed to aid stem cell regeneration and decrease tissue reaction in the area, acting as a substrate for normal conjunctival regrowth.”

The AmnioTek procedure has proven to be less painful, resulted in less swelling, required less time in surgery and had a faster recovery time. Additionally, pterygia were less likely to reoccur following the AmnioTek procedure and it was possible for the treated eye to receive additional treatment if required down the track for diseases such as glaucoma – something not possible following a sub-conjunctival tissue graft.¹

“In Australia, almost every person has some UV damage to their skin and eyes, and many choose to live with pterygia due to the pain associated with removal. This treatment adds to our knowledge of healing and is an exciting step forward for us,” said Dr. Meades.

Terrific Results

For Mr. Powrie, the procedure was “terrific”. Experiencing little discomfort, he was back at work two days after surgery. The functional vision in his treated eye, which was 6/9 prior to surgery, stabilised at 6/5+ within two weeks.

“I was very confident going into surgery, but I’d have to admit, still slightly anxious – as is anyone. It’s normal to have some degree of anxiety. There’s a lot of wonderful work being done with amniotic membranes in many areas, particularly with the cornea, so conceptually that was fine. I had very mild pre-op anxiety and post-op it was straightforward. Despite my vision being blurry, I could still see out of the treated eye. I wore a shield over it for the night and had my eye checked the day following surgery. In terms of pain, my eye was sore for the first 24 hours, which was relieved with normal analgesics. By day two it was doing well,” he said.

“All the staff remarked on how quickly my eye recovered in comparison to eyes treated with a sub-conjunctival graft – they’re not used to people going back to work within two days,” said Mr. Powrie.

Dr. Meades agreed that overall, the surgery she performed on Mr. Powrie had been successful. “Dean had a very advanced pterygium so post-op there has been a small reoccurrence. I think this may have been avoided with the associated use of mytomycin C. However, considering his pterygium covered almost 50 per cent of his cornea, the result has been pleasing both cosmetically and comfort wise.

She said Mr. Powrie’s procedure was further complicated because he was a ‘steroid responder’; “Steroids had to be discontinued shortly after the surgery, which means tissue reaction and recurrence is more likely. Despite this, the reaction is considerably less than Dean would have experienced with traditional pterygia surgery.”

With no sign of pterygium on his right eye, Mr. Powrie said there should be no need for further surgery, however he wished he’d moved sooner to have his left eye corrected.

“I’m probably a bit annoyed that I didn’t have it done earlier but on the other hand, happy that I had this procedure rather than sub-conjunctival tissue graft. Both my parents and brother have glaucoma so I was keen not to have the autograft in case that prevented me from having glaucoma treatment down the track.”

Reference
1. www.biotissue.com/patients/our-products/patients-amniograft-amnioguard.aspx