Persistent Recurrent Pterygium: Management

To hightlight the management of agressive recurrent pterygium in a young patient and use of subconjunctival 5 FU for recurrent pterygium

Bejan singh Eye Hospital, Nagercoil

37 year old male presented with history of bilateral pterygium for 4 years.He gave a history of bilateral pterygium excision 3 years back and again for recurrent pterygium 1.5 years back. His UCVA at presentation was 6/24, BCVA 6/9 in right eye(RE) and UCVA 6/6 in left eye (LE).On examination RE showed grade 3 double pterygium and LE showed grade 3 temporal pterygium. Pterygium excision with amniotic membrane grafting (AMG) and MMC application was done. HPE report showed pterygium tissue with no signs of malignancy. 3 months PO patient presented with grade 2 recurrent temporal pterygium in LE. Repeat pterygium excision with AMG and MMC was done.HPE showed pterygium. 8 months PO patient developed pterygium like growth in the conjunctiva progressing to the cornea in both eyes (LE>RE).Sub-conjunctival 5 FU was given in both eyes and repeated in LE after 3 months to control progression.The progression stopped and the patient had UCVA of 6/9 in RE and 6/6 in LE. Subsequently he developed corneal keloid in the RE with drop in 2 lines of visual acuity for which, PTK was done. Visual acuity inproved to 6/6p. Patient is doing well and is on regular followup for 1 year

Pterygium excision with AMG is useful to treat recurrent prterygium to improve visual acuity and the cosmesis of the patient.5 FU can be a good treatment for agressive early ptreygium to stop progression. It is readily available but patient should be monitored for adverse effects. HPE must be done in cases of recurrent pterygium to rule out malignancy