Excision or transposition of pterygium; with graft
CPT4 code
Name of the Procedure:
Excision or Transposition of Pterygium with Graft
Common Names: Pterygium Surgery, Pterygium Removal with Conjunctival Autograft
Summary
Pterygium surgery involves the removal of a pterygium, which is a benign growth of the conjunctiva on the cornea. This growth can cause discomfort and vision problems. The procedure often includes a graft from the patient's own conjunctiva, which helps to prevent recurrence.
Purpose
Medical Condition: Pterygium (also known as “Surfer’s Eye”)
Goals: Remove the pterygium to alleviate symptoms like irritation, redness, and blurred vision, and to prevent further growth and recurrence by placing a conjunctival graft.
Indications
- Persistent eye irritation or redness
- Blurred vision or visual impairment due to pterygium encroaching onto the cornea
- Cosmetic concerns or eyelid discomfort
- Rapid growth of the pterygium
Preparation
- Pre-Procedure Instructions:
- Avoid wearing contact lenses for a specified time before surgery
- Follow fasting guidelines if sedation will be used
- Arrange for transportation home
- Diagnostic Tests: Comprehensive eye exam, measurement of the pterygium size, and assessment of overall eye health
Procedure Description
- Anesthesia: Local anesthesia with sedation is typically used.
- Excision:
- The surgeon uses a microsurgical technique to carefully remove the pterygium from the cornea and sclera.
- Graft Placement:
- A conjunctival graft is taken from the upper part of the same eye or from a donor site. This graft is then placed over the excision site and secured with sutures or surgical glue to promote healing and prevent recurrence.
- Tools and Equipment: Microsurgical instruments, surgical microscope, surgical glue, and sutures
Duration
The procedure typically takes about 45 to 60 minutes.
Setting
The procedure is usually performed in an outpatient clinic or surgical center.
Personnel
- Ophthalmic Surgeon
- Surgical Nurse
- Anesthesiologist (if sedation is used)
Risks and Complications
- Common Risks: Redness, swelling, mild discomfort
- Rare Complications: Infection, graft dislodgement, recurrence of pterygium, scarring, or vision changes
Benefits
- Expected Benefits: Relief from symptoms, improved vision, and cosmetic enhancement.
- Realization Time: Most patients see improvement within a few days to weeks post-surgery.
Recovery
- Post-Procedure Care: Use prescribed eye drops to prevent infection and reduce inflammation. Avoid rubbing or touching the eyes.
- Recovery Time: Initial recovery lasts about 1 to 2 weeks. Full healing can take a few months.
- Restrictions: Avoid strenuous activities and swimming for a few weeks. Follow-up appointments for monitoring healing and graft integration.
Alternatives
- Medical management with lubricating eye drops for mild cases
- Radiation or anti-metabolites to reduce recurrence, though these may carry additional risks
- Pros and Cons: Alternatives may be less invasive but are generally less effective for advanced or symptomatic pterygia.
Patient Experience
- During the Procedure: Mild discomfort due to local anesthesia. Sedation helps reduce anxiety and pain.
- After the Procedure: Some discomfort, redness, and tearing are normal. Pain is usually manageable with prescribed medications and cold compresses.