Anterior Segment: Pterygium
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Petrygium surgery
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Anterior Segment: Pterygium
- 1. Anterior Segment Surgery J. Alberto Martinez, M.D. Visionary Ophthalmology Rockville, Dec 7, 2014
- 2. Doente atado como preparaĆ§Ć£o para cirurgia a pterĆgio OUTLINE Pterygium Conjunctivochalasis Limbal stem cell deficiency Glaucoma microimplants
- 3. PTERYGIUM
- 4. Pterygium ā¢ Still a fascinating, mysterious disease. ā¢ Etiology still unknown ā¢ Optimal management still very controversial ā¢ Management is still fraught with complications
- 5. Pterygium:Etiology UVR? THEORY: ā¢ UVR>> ā¢ Mutations>> ā¢ Proliferation
- 6. PTERYS
- 7. Pterygium: Genetic predisposition New evidence: certain populations/families are susceptible to pterygium ā¢ Genetic polymorphism (DNA variability) analysis
- 8. Ethiology ā¢ Most researchers feel pterygium is a TUMOR ā¢ P53, tumor suppression gene mutations and decreased of P53 protein ā¢ Pterygium can be a precursor of Squamous Cell Carcinoma
- 9. Still a Mystery ā¢ Many Cases with very little UVR exposure and no family history ā¢ WHY?
- 14. State-of-the artā¦..20 years ago
- 15. Procedure 23 years ago ā¢ Conjuntival autograft ā¢ 9-0 prolene or 10-0 biosorb sutures ā¢ Cauthery as needed ā¢ No amniotic membrane ā¢ MMC for recurrent only ā¢ 2.16 % recurrence rate
- 16. Pterygiectomy: Current Procedure ā¢ No cauterization ā¢ TISSEEL Fibrin glue; No sutures ā¢ Amniotic membrane ā¢ Over donor site ā single pterygium ā¢ Over nasal defect ā double pterygium ā¢ Intraoperative Mitomycin-C (2 Min.) ā¢ Temporal pterygium ā¢ Recurrent pterygium
- 18. Double Pterigiae Pre- Op 12w Post- Op
- 19. Complications ā¢ < 1% recurrence rate (Unpublished) ā¢ 1-2 % Dellen ā¢ Cornea limbal scarring ā¢ Ptosis ā¢ Sub-graft hematoma>>fenestration ā¢ One corneal ulcer in close to 10000 pterygia ā¢ 2 Upside down grafts (One necrosed, one regrafted)
- 20. Patient KG, after 4 pterygiectomies in Florida.
- 21. Pterygium Study (2002- 2005) ā¢ Retrospective ā¢ 500 Pterygiae (390 Patients) ā¢ Same surgeon (JAM) in all cases ā¢ Average f/u period: 8.9 mo ā¢ Low Recurrence Rate (2.16%) in High Risk Population ā¢ Higher Temporal Recurrence (4%)
- 22. Recurrence
- 23. Recurrence ā¢ EVERYONE āCLAIMSā LOW RECURRENCE ā¢ Published recurrence rates decreasing ā¢ Most recurrences are unexpected (Risk Factors?) ā¢ A genetic ārecurrenceā profile may help predict who may reccur. ā¢ Management would be modified. (i.e. MMC)
- 25. Pterygium Research at VO ā¢ Questions: ā¢ What is our current recurrent rate? (DEFINITION?) ā¢ Does AMT on donor site decrease healing time? ā¢ Does AMT on donor site increase PTOSIS ā¢ What happens to goblet cells in donor/host sites ā¢ What is the effect of surgery on the endothelium?
- 26. Pterygium research at VO ā¢ Data collected in 90+ patients include: ā¢ PREOP: Full exam, pentacam, ant seg OCT, ECC, Osmolarity, external photos, Impression cytology ā¢ INTRAOP: Video recording, Surgical time, speculum separation, size , bleeding rate variations ā¢ POSTOP: Blood under graft, graft coverage, elevation, pain scores, ptosis, healing rate
- 27. COSMETIC OUTCOME!? The 500 pound gorilla in the room
Editor's Notes
- Typical histologic features of Pterygium: In the advancing head of thepterygium, conjunctival-like epithelium merges abruptly with corneal epithelium. The underlying bowmanās layer is fragmented and precedes a fibrovascular stroma(asterisc)
- Goblet cell hyperplasia. Note double arrows. B: Pterygium C: normal conjunctiva.
- Elastotic changes