Pterygium surgery with conjunctival autograft

[JujuNomNom]

Oh my dear loorddd D: I have a thing in my eye that looks like a Pinguecula and people say it might turn into this. and if it does affect my vision, I have to get surgery. I still want to get rid of it anyway because it looks unpleasing and when people ask me "What's in your eye?" or "I think there is some dust in your eye" GAH I want it gone! But after seeing the comments (complaints, actually..) and the video it makes me want to keep it there.. (I mean I have no vision problems...)

[prototype123ism]

man i am ganna come back tommorow and vote a next 10!!! Slyfix we love yoU!!!!!!!11

[ThisGuyUnderMeIsGay]

i just had conjuctiva removed from my eye as well, but i dont think any autograft was involved. As far as i know, these stitches are supposed to dissolve soon, but there is discomfort.

[alovi]

@ThisGuyUnderMeIsGay Ask for your doctor.

[alovi]

My opinion is to go back to your eye doctor and tell him all your questions. If he can't solve then it's time to ask for another point of view with other eye doctor.

[alovi]

The best option is to make an appointment with your eye doctor. This place its not to give counseling in eye diseases. It's to show how the surgery is made.

[JMichelle2012]

@alovi My husband had his small pterygium removed in a doctors office. After three weeks his eye was still red and bothering him. So we went back and the doctor said he had grown a cyst so he removed it. It"s been a week and doesn't look good, his eye is still red, he has a little ball towards the top of the eyelid, and he sees blurry. He also gave him eye drops that don't seem to do anything. Is this normal or should I go to another doctor? Does anyone know?

[elarmeropr]

I had this done on Nov 23, 20120 and still dealing with it. The grafts fell. I had to go into surgery on Dec 8 to get them stitched and one of them fell and I have to go in today Dec 17, again to get the left graft stitched again. WTF!!!

[gjonesii]

If it is small, leave it alone. I has a small one removed. It grew back immediately. For the next (2) years, I endured a red irritated eye. Wednesday, I had the pterygium properly removed. There is some post operative pain and discomfort but I hope this surgery works. I wish I had never bothered the small pterygium.

[Uruyagua]

My sister and I both need this proceedure done. How long is recovery time?

[alison6043]

if you are thinking about this surgery i suggest the no stich method over the stich method. you will experience less pain and a faster recovery.

[xwishmasterx2]

@alison6043 thanks for recommendation allison.

[alison6043]

I had this pteryguim surgery in late July 2010. I did not feel anything during surgery but i had alot of discomfort from the 3 stiches used to hold the graft. If i had this procedure again i would go with the no stich method for sure.

[xwishmasterx2]

@alison6043 discomfort for how many days? were you able to work?

[Munroman]

The pain from this is unbelieveable. How the place at Hurstville can advertise it as pain free is beyond me.

[Efficks]

I have one of these on my eyes but it's only small and i don't think there is any point getting it seen to.

[extremefire100]

gross!

[SUNNDAYS9333]

I had it removed from my left eye

[xwishmasterx2]

@SUNNDAYS9333 How you fell now?

[SUNNDAYS9333]

I had a Dermoid Cyst Removal from my left eye today nad mines was on the bottom part of the Cornea and they removed it... Took like only 5min for them to remove it... But they said that i was going to have scar tissue but it isnt noticeable.. Tomorrow i will have the patch off to see what it looks like... Right now it hurts when i blink my eyes sometimes and when i look side to side.

[MysteryAnaGirl]

@Waffensuchtler1993 I AM SO GROSSED OUT

[alovi]

It's local topical and infiltration with xilocaine+epinefrine as you can see in the video. To harvest the tissue for the graft I use the infiltration of the xilocaine+epinefrine. The intention it's to take conjunctival tissue only.

(pearl) As less tenon layer you take less contraction and scarring under the graft at long time. It's more comfortable to patient if you left a graft with only conjunctiva.

[tomekdtw]

When harvesting the donor tissue, is it a conjunctiva + tenons layer, or just conjunctiva?

Is the donor site left to heal by secondary intention with exposed sclera or are the conjunctival edges sutured together?

Gracia.

[alovi]

The donor tissue is just conjunctiva.

The esclera is not exposed, there remains the tenon´s layer.

It´s not possible suture the edges of the donor site, is very wide.

[drahmedalijerash]

@alovi Do you prefer to do this operation under general or local anaesthesia ?

[alovi]

@drahmedalijerash Its local, first eyedrops of tetracaine, and later infiltration of xiolcaine-epinefrine of the tissue in the body of pterigyum.

[improveyourmind]

Dr Lozano, si uno tiene pinguecula esto puede degenerar a Pterigion?. Y si eso es correcto, me podria decir como se puede prevenir.

He oido que las lagrimas artificiales tienen efectos adversos. Es cierto eso?. Gracias por anticipado por su respuesta.

[alovi]

@improveyourmind

En realidad son entidades separadas, sin embargo pueden parecerse. Las lagrimas artificiales mejoran los sintomas de muchos de los pacientes antes y despues de operarse, incluso algunos deciden no operarse y mantenerse con lagrimas artificiales por largo tiempo.

[improveyourmind]

@alovi

Gracias por su respuesta!.

A su vez, me gustaria saber si algun tipo de suplemento en la alimentacion ayuda a prevenir este tipo de problemas en la conjuntiva.

Gracias.

[Mayi1965]

Doctor la proxima semana me realizan la operacion el doctor me dice que me va a poner un parche con glue reabsorbente pero usted dice que no lo recomienda porque los ojos se ponen rojos me podria decir por cuanto tiempo quedan rojos con este parche? gracias

[mightykc123]

Ha tenido experiencia con el uso de fibrin glue?

[alovi]

No, ninguna experiencia.

[alovi]

La zona de donde se retira el injerto libre se deja así. No es posible suturar un defecto tan grande sin ocasinar otros problemas. Además esa zona esta cubierta por el párpado.

[pedrovozza]

doctor .cuando extrae la conjuntiva para el parche , el lecho queda desnudo o lo sutura con la conjuntiva adyacente

[alovi]

The sutures are non absorbable. Must be retired in the doctor office 2 weeks after surgery. Some sugeons prefer use of absorbable sutures but it increases the redness in the postoperative period in my experience.

[1f5sda]

Were those stitches able to dissolve or were those stitches not made for dissolving?

[Roly0981]

Saludos Doctor Lozano

Quiero realizarme la cirugía pero por mi trabajo tiene que ser en al menos 2 meses más...Pero tengo muy irritado el ojo y siento como una basura constantemente, hay algo que pueda usar para aliviar estos síntomas hasta realizarme la cirugía. Gracias

[seggismundo]

Dr.

- Que tipo de anestesia se utiliza en la operación?

- El paciente ve normalmente mientras lo operan?

- Cuanto tiempo demora en sanar el paciente?

Gracias de antemano

[alovi]

Anestesia topica en gotas y la infiltración local con xilocaina con epinefrina como se aprecia en el video.

El paciente esta bajo una sedación superficial vigilada por un anestesiólogo siempre. Es posible que el paciente olvide muchos de los detalles de la cirugía, pero es capaz de obedecer las ordenes que se le dan durante la misma.

Las suturas se retiran a los 12 a 14 días de la cirugía, la zona de donde retiró el pterigion se epiteliza nuevamente a mas tardar en 48 horas.

[alovi]

El tiempo e recuperación es mas corto con esta técnica que con la de excision simple y esclera desnuda (bare slcera).

Espero esto sea de ayuda.

[Sirjosh408]

jeje your an atheist well i still have faith in science and god even tho im not acuerdo with your beliefs but i still respect them, im not a damn jehova witness that likes to bother people and try to convice other people in their faith im roman catholic and i sin but that does not mean i cant aqquaint with an atheist, and thank you doctor letting me know that you told me i have to visit a ophthalmologist makes me feel better because you did not tell me i have to undergo a surgery.

[alovi]

I respect your position.

[Williams716]

SaLUDOS,

QUISIERA SABER CUANTO M COSTARIA APROX. LA OPERACION EN AMBOS OJOS , AGRADESCO ANTICIPADAMANTE SU RESPUESTA

[alovi]

17mil pesos por ambos ojos, es muy molesto, pero si se aguanta no hay problema.

[alovi]

it´s an autograft. It´s a tissue from the same eye.

The reason to cover the bare esclera is to avoid the excesive cicatrisation and to decrease the possibility of reccurrence. Also the autograft decrease the discomfort in the postoperative period.

[xwishmasterx2]

Why they cover with a new tissue the affected area?

[jonyblum]

Hola Dr. Lozano. Quisiera saber segun su experiencia que praparacion, concentracion, tiempo de exposicion de Mitomicina C llega a utilizar y en que casos.

Gracias

[alovi]

No la uso.

[Sirjosh408]

exuse me doctor i have something in my left eye, i see like a black spot when i open my eyes and this happened for 3 weeks now idk what it is but its getting annoying i have 3 choices waiting for you to respond for advice,or i could go to my docor and let her now my situation, or pray so if theres anything you can do or let m know please tell me i just want to live a normal life

[alovi]

You have to make an appointment with an eye doctor.

It could be a simple problem or a big one.

Only an ophthalmologist can tell you what is your problem.

[Sirjosh408]

muchas gracias eso voy aser en 3 semanas para mi proxima cita con el doctor ojalai que no tenga que darme una sirugia yo tengo miedo a eso porque algunas veses ay errores y los resultados pueden ser grave

[pixiepqueen]

I wouldn't be able to sit still if somebody did this to me, even with a local.I'd just freak I think.

[vernflavius]

yeah but amniotic membrane have not been approved for use in eye surgery...And you cannot refute that Professor lawrence Hirst's method of removal is the best. Best recorded literature..

[alovi]

I agree with your opinion.

[vernflavius]

I am currently researching the best method for my pterygium removal. I came accross three names. Dr Hovanesian Dr Gulani and professor Lawrence Hirst. Dr Gulani used mitomicin C which can cause further complications, so he's ruled out. Dr Hovanesian used amniotic membrane which may contain transferable viruses.Professor Lawrence Hirst of Australia uses the graft method and has had only 1 minor reccurance in over 800 consecutive pterygium surgeries. surgeons should use the best method,not easiest

[ankonieczny]

I wanted to comment on your statement. Mitomycin C is an antineoplastic antibiotic agent isolated from the fermentation filtrate of Streptomyces caespitosus, it inhibits DNA, RNA, and protein synthesis with a similar action to alkylating agents (short lived free radical). Mitomycin C has been EXTENSIVELY researched and proven safe in LONG TERM EVALUATION STUDIES with use of MMC in pterygium surgery.

[ankonieczny]

It is used for prophylaxis of corneal haze and has proven to decrease the incidene of recurrance in surgical excision of primary and recurrent pterygia. Intra-operative mitomycin delivery involves the surgeon delivering the medication directly to the patient, this eliminates the higher risk of complications associated with topical MMC via eye drop delivery administered by the patient post-operatively which was popular in the early 1990s

[ankonieczny]

and followed with several studies on adverse events that correlated with MMC and pterygium excision. Today most surgeons use SHORT INTRAOPERATIVE MITOMYCIN DELIVERY in conjunction with usually a fluoroquinolone for infectious prophylaxis. IT IS IMPERATIVE TO USE MMC IN A CONTROLLED USE WITH SELECT PATIENTS

[ankonieczny]

(careful selection when dealing with Sjögren syndrome, severe keratoconjunctivitis sicca, acne rosacea, atopic keratoconjunctivitis, or herpes keratitis) INCONJUNCTION WITH AMNIOTIC MEMBRANE GRAFT TRANSPLANTATION FOR AN OPTIMAL OUT COME. As for your concern on the safety of the graft, Each amniotic membrane allograft is cleaned, sterilized and secured in double peel pouch packaging

[ankonieczny]

amniotic membrane allografts are procured and processed according to standards established by the American Association of Tissue Banks (AATB) and the United States F.D.A and are subject to unyielding high standards to ensure tissue safety.

[lachflaash]

iiiiiiiiiiiiiiii

[dudeface96]

why does this have to be done?

[zabalajohn]

this is a surgery for people suffering from an abnormal conjunctival growth....

[minnonikki]

So..does the patient see this all happening? Sorry if this has already been asked.

[Meryemm93]

Dit ziet er eng uit

ik zou dit later ook wille doen ma nu

begin ik toch van gedachte te verandere

nu ik deze video heb gezien ..

[alovi]

Don´t worry, usually a sedative drug is used during surgery and you can cooperate, like the great majority of patients, with the procedure.

This video is to ilustrate the way i do this surgery, the technique may vary with the surgeon.

its no my intention to cause horror.

I´ts to help others with the problem of pterygium.

[orangebus333]

Oh god I'm meant to be having this surgery soon and I don't know why I watched this. That looks terrible! I can't believe I have to be awake during this :'(

[alovi]

Thanks for the comments.

The size of the instruments may vary, it depends of the manufacturers, models and surgeon preferences. But the main objetive of the surgery is the same: Avoid the pterigium recurrence.

[cosmogang]

This Dr.'s utensils are huge! why? The doctor I work with uses much much smaller tools.

[lala1987b]

I had this surgery about 6 months ago and am getting my other eye done in about 5 hours. I study nursing at uni so i found the whole surgery exciting and was happy to be the patient for once. Honestly, it does not hurt during surgery,all I can remember from the surgery is laughing with the surgeon when i positioned my eye to the wrong side. I even said " thankyou" with my hands up in the air as they wheeled me out of the room. Slight discomfort after but good painkillers will resolve this

[alovi]

Probablemente sea mejor que lo comentes con tu oftalmólogo personalmente todas las dudas que tengas sobre la prescripción que te ha dado.

[diegods1]

hola que tal padesco de pterigion no es muy avanzado el oftalmologo me receto modusik-A y genteal clorido quisiera saber si mi carnosidad se puede desvaneser con esas gotas o es necesario una operacion?

[alovi]

Es variable dependiendo de la persona, hay personas que hace cicatrizacion exagerada, queloides, pero en la mayoria los resultados son cosmeticamente aceptables, la cicatriz en la córnea puede variar dependiendo del tiempo que hayas tenido el pterigion, mientras mas tiempo lo tengas mas cicatriz corneal queda. En los ancianos es practicamente imposible quitarlo de la cornea sin dejar cicatriz.

[Williams716]

esta tecnica "autoinjerto conjuntival" te deja alguna cicatriz

[alovi]

claro, puedes operarte, pero primero averigua cual es la técnica que van a emplear. Sería mejor el autoinjerto conjuntival.

[Williams716]

tengo 22 años y quiero operarme de pterigion que te tengo desde los 14 me molesta mucho se ve feo, me recomiendan operarme sgradecers sus respuestas anticipadamente lima-peru

[tarqdar]

I've heard that Pinguecula can be removed by using laser is this right.

can it be used for Pterygium.

[mynamekeisha]

I doubt it. I was just diagnosed with this. It seems like something that really needs to be "cut" off. I really do not want to have to do this surgery it is scary. I wonder if you can go blind if they mess up...

[alovi]

Any surgery have a risk, but this is a safe surgery. Maybe looks scary because of blood, but I avoid the use of cautery to prevent the scar formation and recurrence. The vision is not threatened.

[Teekly]

is that like the extra skin?

[alovi]

What do you mean extra skin?

[caseyw1286]

I just had this done a 2 days ago. I hardly felt anything but it feels like my eye is now a little blurry and hurts when I try to move it.

[alovi]

Its normal, just keep your eyes protected from uv radiation, use sunglasses at outdoors.

[angeldevil011]

really???!!

[xwishmasterx2]

@caseyw1286 your surgeon used stitches or fibrin glue? can u update how you feel now?

[penzomatteo97]

@caseyw1286 How are you now?

[eyemechanic]

I have done this technic many times here in the Philippines. However, in very few cases there were still recurrences. Have you had any experience using this technic combined w/ application of Mitomycin-C?

[alovi]

In my personal experience no. I always use this technique in primary and reccurrent cases. As you can see the size of the graft is very important. I try to clean up of Tenon capsule and sometimes cleaning off fibrous tissue from the rectus muscle. And never use the cautery to avoid excessive ciatrization and fibrosis.

[itjustathought]

thanks for posting this video

[bmaw69]

I just had this done yesterday. The removal of the Pterigyum went well but I'm in pain! I cannot sleep. I have to be at work in 5 hours.

Should I feel guilty if I take another day off from work? This would be my 2nd day.

[alovi]

Yes, take another two days at least!

[dineshjiawan]

This is also how we do it in Suriname(South America). Residence ophthalmologist.

[alovi]

It´s an excellent technique that I reccomend in a lot of cases.

But every case is unique.

[rockout746]

do they put the patient asleep?

[alovi]

nop, its just under local anaestesia and sedative drugs via intrevenous. Tha patients don´t feel pain during surgery.

[koezan]

so what was the surgens doing to the eye apart from what seems to be cutting some of its skin off

[LILSISTASUGA]

can ptergyum cause blindness

[alovi]

Only in advanced cases. When the tissue invades the optic axis of cornea, I mean, the center of the cornea. Ussually not. The evolution depends on the lattitude you live. It´s more frecuent in near ecuator countries.

[Pirulajo]

So... in short, there is no way to predict the result from an aesthetical point of view?

That's pretty much my only concern about the surgery (I know the other one is the posibility that the pterygium re-appears).

Thanks a lot for taking the time to answer :)

Cheers

[alovi]

If the surgeon uses the same technique and take the best care in it, the possibilities of recurrence is lower than 5%. In other techniques such as " bare sclera" the posibility of recurrence could be between 30 and 50%.

[Pirulajo]

Yeah, that was I read when Googled for some info.

Again, thanks for your answer.

[Pirulajo]

I ask that because my eye already look ugly and pretty much, everytime that I meet someone, he/she looks at me like: "Do you have an alien in your eye or what?" ROFL, and I was thinking... "Ok, I need that surgery because the pterygium must be removed or it will grow forever (at one point, affecting my vision, I presume), but it would suck if after the surgery, my eye ends looking as bad as now.

[Pirulajo]

Hehe, well I live in Chile and I suspect you don't :P

Regarding my question, yes... that's what I meant, a scar on the cornea in the zone over the iris. I wanted to know how high are the chances to end with some kind of scar that makes my eye to look "ugly".

[Pirulajo]

Thanks a lot for posting this video, I have a pterygium, so that surgery is a must for me.

Anyways, I have a question for you: After the healing, does the eye end with any kind of visible scar (specially over the iris)?

[alovi]

Do you mean about a scar on the cornea, that´s the name of the transparent tissue over the iris. Sometimes, but usually not. If you wish you cant make an appointment to my office for a check-up. ;)

[Pirulajo]

Hehe, well I live in Chile and I suspect you don't :P

Regarding my question, yes... that's what I meant, a scar on the cornea in the zone over the iris. I wanted to know how high are the chances to end with some kind of scar that makes my eye to look "ugly".

[xotaKux]

i've been had this kind of surgery this morning. :\