Although pterygium removal is one of the most frequently performed ocular surgeries, cornea specialists don’t have a go-to roadmap for management. As such, researchers from Mexico and the United States polled experts and reported trends in their surgical and treatment preferences in a study recently published in Cornea.

Investigators sent out a 25-item survey to members of the Cornea Society. The survey included questions about their preference for surgery, surgical technique, use of adjuvant therapy, type and duration of postoperative therapy and treatment of early recurrences.

Researchers reported that, of the 199 cornea specialists who completed the questionnaire, more than 90% said surgery should be performed when there was proximity of the pterygium to the visual axis, pain or redness, eye movement restriction or induction of astigmatism.

The study found 41.7% of the participants felt cosmesis was an appropriate indication.

Also of note: the most frequent technique for pterygium excision was complete resection, including the base and a moderate quantity of Tenon’s capsule followed by autologous conjunctival or limbal-conjunctival graft. Only a minority of surgeons used the bare sclera technique, investigators said.

The survey found fibrin glue was the preferred graft fixation method at 61.2%. This result is understandable, considering that most respondents were from the United States, where fibrin glue is widely available and affordable, researchers noted.

 Most surgeons reported a recurrence rate of less than 5%, and the study found they didn’t use adjuvant agents to prevent recurrence. When early recurrence did occur, the respondents said their preferred agent was corticosteroids.

The survey indicated most cornea specialists used potent steroids such as prednisolone or dexamethasone and usually for more than one month. Only a few used ‘soft’ steroids.

The study also reported some statistically significant differences regarding the preferences of ophthalmologists with less than 10 years of surgical experience compared with more seasoned doctors. Investigators found surgeons with more than a decade of experience removed less Tenon’s capsule, tapered corticosteroids less often and used less fibrin glue and more sutures for graft fixation than ophthalmologists with less experience. On the other hand, no statistically significant differences were found regarding indications for surgery, use of adjuvant therapy, type and duration of postoperative therapy or treatment of early recurrences.

The results of the study may serve as a guide for the management of this pathology, the researchers said. 

Graue-Hernandez EO, Córdoba A, Jimenez-Corona A,et al. Practice patterns in the management of primary pterygium: a survey study. Cornea. August 8, 2019. [Epub ahead of print].