Consult Pterygium

Definition
Pterygium is a wig-shaped fibrovascular proliferating tissue originating at the lens epithelium at the border between conjunctiva and cornea.

History

  • Highest incidence in "desert belts"
  • Causes: sun, dust, and dryness
  • Can impair vision

Counseling
The origins, treatment, and prognosis of pterygium was discussed. Local recurrence after complete surgical excision1 ranges from 29% to 89%. Conjunctival autografting is reasonably effective and appears to be safe; however, it is considerably more time consuming than other methods.

Adjuvant therapy such as radiation and cytostatics (eg. mitomycin C) are recommended, but ideal treatment is unknown at this time and conflicting studies exist.2 Beta-radiation after surgical resection have reduced the recurrence to 2%-16%. However, low rates of significant scleral necrosis approaching 5%, 3-20 years after treatment have been reported. Mitomycin C have late complications that are similar to those of radiation.

Plan
We offered 2400 cGy beta-radiation with strontium-90 in 3 session, one session per week. Patient understands that optimal dose and fractionation for Pterygium has not been reported. Benefits and complications including scleromalacia and corneal ulcerations were discussed. After all of his/her question were answered, patient reported an understanding of the discussion and would like to proceed with treatment.

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