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Surgical and Medical Management of Pterygium
Ashok Garg, Essam El Toukhy, Belquiz A Nassaralla, Sunil Moreker
CHAPTER 1:
Pterygium: An Overview
INTRODUCTION
Trends in Treatment Modalities of Pterygium
CHAPTER 2:
Pterygium: Descriptive Nomenclature of the Past
ACKNOWLEDGMENTS
CHAPTER 3:
Etiology, Epidemiology, Pathophysiology and Classification of Pterygium
ETIOLOGY AND EPIDEMIOLOGY
Pathophysiology
Classification
CHAPTER 4:
Pathogenesis of Pterygium—Molecular, Genetic and Immunologic Considerations
INTRODUCTION
Pathogenesis
SUMMARY
CHAPTER 5:
Clinical Signs and Symptoms of Pterygium
INTRODUCTION
Clinical Signs and Symptoms
CHAPTER 6:
Pterygium: Differential Diagnosis
INTRODUCTION
Pseudopterygium
Pinguecula
Limbal Dermoid
Phlyctenular Keratoconjunctivitis
Liymphoma of the Conjunctiva
Squamous-cell Carcinoma of the Limbus
Nodular Episcleritis
Bowen's Epithelioma
Papilloma
CHAPTER 7:
Current Concepts in Treatment of Pterygium— An Evidence Based Review
MANAGEMENT OF PTERYGIUM
Role of Routine Histopathology
Topical Treatment
Subconjunctival
Primary Non-surgical Irradiation
Adjuvant to Surgery
Lasers
Surgery
Recent Advances in Grafts
Autologous Cultivated Grafts26
Complicated Pterygia
Double Headed Pterygium
Symblepheron
Treatment of Complications
Scleral Melt After Pterygium Surgery29
Pterygium with Tarsorrhaphy30
Pain Relief after Surgery
Materials Used
Role of Surgeon Experience37
Medications in the Pipeline
Curcumin38
Tacrolimus39
Nitric Oxide and Superoxide Dismutase40
Recombinant Growth Factor if Persistent Epithelial Defect41
CHAPTER 8:
Role of Lidocaine Gel (2%) in Pterygium Surgery
CHAPTER 9:
Free Conjunctival Autograft for Primary and Recurrent Pterygia
INTRODUCTION
Preoperative Evaluation
Preoperative Preparation
Anesthesia and Sedation
Surgical Technique (Figures 9.1 to 9.24)
Postoperative Care
Complications
Management of Recurrences
CHAPTER 10:
Fibrin Sealant and Conjunctival Autograft in Pterygium
CHAPTER 11:
Mitomycin C in the Management of Pterygium
INTRODUCTION
Rationale of Use
Evidence of Use
Methods of Use
Preoperatively3
Intraoperative
Postoperative Eyedrops
Complications
Recent Advances
CHAPTER 12:
Management of Recurrent Pterygia
INTRODUCTION
Surgical Excision
Adjunctive Therapy
CHAPTER 13:
Pterygium Surgery: An Update
INTRODUCTION
Causes
Differential Diagnosis
Pathogenesis
Signs and Symptoms
Pterygium Surgery
Adjunctive Therapy
Corticosteroids
Thiotepa
Interferon Alpha-2b
Mitomycin C
5-Fluorouracil
Beta Radiation
Amniotic Membrane
Surgery Complications
Clinical Pearls
CHAPTER 14:
Medical Management of Pterygium
ADJUNCT THERAPY FOR SURGICAL INTERVENTIONS
Mitomycin C (MMC)
Background
Methods of MMC Application
Complications
5-Fluorouracil (5-FU)
Background
Use and Complications
Thio-TEPA
Background
Use and Complications
Beta-irradiation
Background
Use in Pterygium
Complications
Cyclosporine A (CsA)
Background
Use and Complications
Bevacizumab (Avastin)
Background
Use in Pterygium and Complications
Under Trial
CHAPTER 15:
Beta Therapy in the Treatment of Surfocular Pterygium
ELECTROMAGNETIC RAYS AND RADIOACTIVE “RAYS”
Radioactive Elements
Radioactive Units
Action of Radiation in Tissues
RADIOACTIVE APPLICATORS
CLINICAL APPLICATION OF BETA THERAPY
Application of Beta Therapy Without Surgery
Application of Beta Therapy after Surgery
Dose and Penetration of Irradiation
Delay and Fractionation of Radiation
CLINICAL RESULTS
Complications and Recurrences
Personal Experience
CONCLUSION
CHAPTER 16:
Pterygium: Evolution of the Medical and Surgical Treatments
ANCIENT MEDICAL TREATMENTS
ANCIENT SURGICAL TREATMENTS
NEW MEDICAL AND SURGICAL TREATMENTS
ADDITIONS TO THE SIMPLE EXCISION
Transposition of the Pterygium
Pediculate Conjunctival Autotransplant
Free Conjunctival Autotransplant
Bucco-mucose Autotransplant
Amniotic Membrane Transplantation
Superficial Keratectomy
Corneal Transplantation
Limbal Transplantation
Cauterization
Addition of Corticosteroids
Addition of Thiotepa
Addition of Cyclosporin
Addition of Mitomycin
Addition of Fluorouracil
Addition of Interferon
Addition of Antifibrotics
Sutures and Adhesives
Beta Therapy
CHAPTER 17:
Indocyanine Green Angiography in Pterygium
INTRODUCTION
Why Angiography?
Method
NORMAL ANGIOGRAPHY OF THE CONJUNCTIVA8
ANGIOGRAPHIC FEATURES IN PTERYGIUM 8
ANGIOGRAPHIC FINDINGS FOLLOWING CONJUNCTIVAL AUTOGRAFTING 8
Angiographic Findings in Amniotic Membrane Graft after Pterygium Excision10
MOREKER– KATARIA GRADING OF VASCULARIZATION AND TREATMENT IN PTERYGIUM
A. Preoperative
B. Postoperative
CONCLUSION
CHAPTER 18:
Optical Considerations of Pterygium
INTRODUCTION
Changes on Corneal Surface
Theories for Cause of the Astigmatism 1,2
Visual Symptoms
EXAMINATION
Refraction
Slit Lamp Biomicroscopy
Investigations
Kataria-Moreker Classification of Clinic-visual Disturbances and Treatment
Complete Loss of vision
Astigmatism
Aberrations
Treatment of Pterygium Induced Astigmatism
CHAPTER 19:
Application of the Amniotic Membrane in Ocular Surface Pathology
HISTORY
HISTOLOGY
IMMUNOLOGY
EXTRACTION AND PRESERVATION
CLINICAL PROPERTIES
INDICATIONS
LIMITATIONS
SURGICAL TECHNIQUE
CHAPTER 20:
DALK in the Management of Recurrent Pterygium and Complications of Pterygium Surgery
OPTIONS IN RECURRENT PTERYGIUM
Indications of DALK in Recurrent Pterygium
DALK Surgical Procedure
DALK in Corneoscleral Melts/Perforation
Postoperative Treatment
CHAPTER 21:
Phototherapeutic Keratectomy (PTK)
INTRODUCTION
RECURRENT EROSION
Summary
ANISOMETROPIA DUE TO IATROGENICALLY-PRODUCED REFRACTIVE ERRORS
Treatment
Conclusion
KERATOCONUS
Evaluation
Treatment
Conclusion
ASTIGMATISM
Conclusion
CORNEAL SCARS
Evaluation
Treatment
CORNEAL DYSTROPHIES
Conclusion
BAND KERATOPATHY
Conclusion
PTERYGIUM
Conclusion
SUMMARY
CHAPTER 22:
Stem Cell Surgery in Ophthalmology
INTRODUCTION
LIMBAL STEM CELL DEFICIENCY
LIMBAL STEM CELL TRANSPLANTATION
PREOPERATIVE PREPARATION
SURGICAL TECHNIQUE FOR LIMBAL ALLOGRAFT
From Cadaver Eye
From Live Related Donor
RECIPIENT EYE
AMNIOGRAFT
SURGICAL TECHNIQUE FOR LIMBAL AUTOGRAFT
LIMBAL STEM CELL TRANSPLANTATION WITH KERATOPLASTY
LIMBAL STEM CELL TRANSPLANTATION WITH AMNIOTIC MEMBRANE GRAFT
POSTOPERATIVE COURSE
POSTOPERATIVE DRUG THERAPY
SUCCESS RATES
RECENT ADVANCES
Transplantation of Ex Vivo Expanded Limbal Epithelial Stem Cells
Using Collagen shield as Transfer Substrate
Using Amniotic Membrane as Transfer Substrate
Using Fibrin as Transfer Substrate
Gene Therapy
KEY POINTS
CHAPTER 23:
Cultured Limbal Stem Cell Transplantation
INTRODUCTION
WHAT ARE LIMBAL STEM CELLS
WHAT IS LIMBAL STEM CELL DEFICIENCY (LSCD)
CAUSES OF LSCD
Kruse Classification of Caused of LSCD
Clinical Features
Diagnosis
Management
Current Indications of Cultured Stem Cell Transplant
Contraindications
Preoperative Considerations
Technique
Postoperative Management
Conclusion
CHAPTER 24:
Recurrent Pterygium— An Update
ASSESSMENT OF RECURRENT CASES
MANAGEMENT OPTIONS
Surgery
Surgical Excision with Applying a Graft
Preparing the Recipient's Bed
Use of Conjunctival or Limbal Autograft
Harvesting the Graft
Placement of the Graft
Complications
Other Available Grafts
Amniotic Membrane Grafting
SURGICAL EXCISION WITH ADJUVANT TREATMENTS
Role of Lasers
Argon Laser
Excimer
Keratoplasty
Nonsurgical
5-Fluorouracil
Interferons
CHAPTER 25:
Pterygium and Pinguecula Surgery: Next Day Cosmetic Outcomes (The Future of Ocular Surface Surgery)
ACKNOWLEDGEMENTS
INDEX
TOC
Index
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