Pterygium, the English name of pterygium, comes from ancient Greek. Doctors in ancient Greece first observed membranous growth in eyes, like cicada wings. Mild pterygium may only affect the appearance of patients, while severe pterygium may cause irregular astigmatism and even visual dysfunction. Pterygium mainly occurs in coastal areas and high altitude areas, which has a strong correlation with excessive sunlight and ultraviolet radiation. The pathogenesis of pterygium is mainly related to stem cell function, epithelial cell apoptosis, immune injury, matrix metalloproteinase hyperactivity and oxidative stress injury.

Pursuing the ideal surgical treatment of pterygium

The main treatment of pterygium is surgery. The surgical methods are different, such as simple excision, head transfer, modern pedicled conjunctival flap transplantation, amniotic membrane transplantation, limbal stem cell transplantation, lamellar keratoplasty and so on. The recurrence rate varies. With the continuous improvement of people's understanding of the disease, surgical skills and curative effects, pterygium is no longer a simple excision operation, but requires effective repair and healing of postoperative wounds to reduce the recurrence of pterygium.

Postoperative pain of pterygium

There are two main reasons for postoperative pain. One is inflammatory reaction, including the release of inflammatory factors, especially prostaglandin inflammatory factors. Second, the ability of the central system to adjust and receive signals is up-regulated under the stimulation of surgery. Therefore, the main source of pain comes from inflammation, and prostaglandin is the most important inflammatory factor. Personally, I think pterygium should be operated as soon as possible. Less trauma, less reaction, quick recovery, low recurrence rate and little harm to patients. It can range from early degenerative blepharitis to early pterygium.

After corneal epithelial injury in normal people, some corneal epithelial defects will be repaired in about 24 hours. Why?

Because that part of the defect will be repaired by the migration of peripheral corneal epithelium, which comes from corneal limbus stem cells, and the corneal limbus divides constantly to produce corneal epithelial cells, and the apoptotic corneal epithelium can be repaired by migration.

Why do some corneal epithelial injuries persist?

It is caused by corneal epithelial dysfunction. The adhesion function of corneal epithelium, including various junctions (tight junction, gap junction, desmosome junction, hemidesmosomes junction) was damaged.

What are the symptoms of pterygium?

There are no conscious symptoms in the early stage or only symptoms such as dryness and grinding teeth. When the pterygium head invades the corneal limbus, the irritation symptoms will be more obvious, sometimes the feeling will be blurred, the vision will be reduced, and astigmatism will be caused by traction.

What is blepharoptosis?

It is a triangular raised plaque on the bulbar conjunctiva near the eyelid margin, with the bottom facing the cornea and occasionally accompanied by local inflammation.

The difference from pseudopterygium: Cornea is caused by adhesion between bulbar conjunctiva and corneal epithelium after acid, alkali, heat or chemical burns. It occurs in any part of corneal limbus, and its size is related to the degree of burn, and in severe cases it is accompanied by corneal leukoplakia. No progress after stabilization. Slightly clinically, fixed cord-like or triangular conjunctival folds can be seen in corneal opacity, similar to pterygium. However, it is closely attached to the cornea, while pterygium is only attached to the cornea in the corneal epithelium and is in loose contact with the matrix layer. After the head of pterygium is removed during the operation, the pathological tissue attached to the cornea will be torn off by gently tearing it with microscopic tweezers.

Postoperative complications of pterygium: pterygium recurs, corneal wound continues to heal, corneal dry spot and granuloma are formed due to hydrodynamic disorder, and the healing process is disturbed after using anti-metabolic drugs, resulting in persistent corneal or scleral ulcer and even infection.

One of the surgical skills: pterygium only removes a small part of the head, and the rest belongs to the normal conjunctiva. Just put it back in place, and then take a corresponding limbal stem cell tissue according to the defect. Corneal limbal stem cells are taken from below the temporal bone and should be reserved for cataract and glaucoma surgery. Generally, four-needle suture and intermittent suture are used.

Operation skill 2: The suture used in the operation is 10-0, which is usually removed in 7- 10 days, and the recovery is quick. If the suture can be absorbed, the recovery will be slower, the irritation symptoms will be more serious and the time will be longer.

Skill 3: At the beginning of the operation, dilute it with accessory kidney and normal saline (1 right 1) and put it on the head of pterygium to reduce bleeding. Individual reactions are different, some have large pupils and some have small reactions. Preoperative examination showed that patients with shallow anterior chamber, small cornea and glaucoma tendency generally did not need accessory kidney.

Postoperative medication? You can wear a corneal bandage mirror after surgery, and you can start taking hormone eye drops the next day. It is observed that the recurrence rate is high when both sides are long. Brief introduction of the author

Han Yuhong, male, deputy chief physician, Department of Corneal Diseases, Xingtai Eye Hospital, Hebei Province. Working for more than 20 years, he is good at the diagnosis and treatment of ocular surface diseases. The operations carried out include: cataract, glaucoma, dacryocystitis and lacrimal passage surgery, various eye injuries, penetrating keratoplasty, lamellar keratoplasty, corneal transplantation combined with cataract surgery, corneal transplantation combined with intraocular lens suspension, corneal transplantation combined with vitrectomy surgery, corneal transplantation combined with interlaminar staining, deep lamellar keratoplasty, anterior segment reconstruction and posterior scleral reinforcement to treat myopia. He has a unique view on minimally invasive pterygium surgery. "Clinical study of staged surgery for fungal keratitis" won the third prize of scientific and technological progress in Hebei Province. The application of fundus fluorescence and primary color fluorescence angiography excited by different light sources in the diagnosis of fundus diseases won the third prize of scientific and technological progress in Hebei Province.