Should Cataract Surgery Be Prioritized Over Pterygium Treatment?

Should cataract surgery be performed first before addressing a pterygium that is close to the pupil?

Dear Dr.
Liang,
My father recently underwent an eye examination and has been diagnosed with both a pterygium and cataracts, both of which require surgery.
The examining physician has recommended performing cataract surgery first, and then deciding later whether to address the pterygium.

From my understanding, the pterygium is the more pressing issue, while the cataract is secondary.
If we do not treat the pterygium first and proceed with the implantation of an intraocular lens for the cataract, wouldn't the preoperative and postoperative measurements be inaccurate? I would like to inquire if there is a correct order for these procedures.
I appreciate your guidance on this matter.
Sincerely,
Doctor Q&A Teams

Yicheng, 40~49 year old female. Ask Date: 2022/07/11

Dr. Liang Ce reply Ophthalmology

It is recommended that you discuss the above situation with your attending physician to determine if further examinations are necessary.
Thank you, and wishing you good health!

Reply Date: 2022/07/11

More Info

When considering whether cataract surgery should be prioritized over pterygium treatment, it is essential to understand the nature of both conditions and the implications of their surgical interventions.

Cataracts are a common age-related condition where the lens of the eye becomes cloudy, leading to blurred vision, difficulty seeing at night, and other visual disturbances. Cataract surgery is a well-established procedure that involves removing the cloudy lens and replacing it with an artificial intraocular lens (IOL). This surgery is typically straightforward and has a high success rate in restoring vision.

On the other hand, pterygium is a growth of tissue on the conjunctiva that can extend onto the cornea. It is often associated with exposure to UV light, dust, and wind, and can lead to discomfort, redness, and visual impairment if it grows large enough to obstruct vision. Surgical removal of a pterygium is also common, especially if it causes significant symptoms or affects vision.

The recommendation to prioritize cataract surgery over pterygium treatment is generally based on several factors:
1. Visual Impairment: If cataracts are significantly impairing vision, it is usually advisable to address this issue first. Restoring clear vision can improve the patient's quality of life and may also provide a clearer view for subsequent evaluations of the pterygium.

2. Surgical Outcomes: Performing cataract surgery first allows for a more accurate assessment of any remaining visual issues after the cataract is removed. If pterygium surgery is performed first, the resulting changes in the eye's surface could complicate the cataract surgery or affect the outcomes.

3. Postoperative Assessment: After cataract surgery, the eye's refraction (the way light is bent as it enters the eye) can change, which may influence the decision on whether and when to remove the pterygium. If the pterygium is removed first, the new lens from cataract surgery may not be optimally positioned due to the altered surface of the eye.

4. Healing and Recovery: Each surgical procedure requires a recovery period. By addressing the cataract first, the patient can have clearer vision sooner, which may help in the overall recovery process and in determining the necessity and timing of pterygium surgery.

5. Risk of Recurrence: Pterygium surgery can sometimes lead to recurrence of the growth, especially if the eye is not adequately protected from UV exposure post-surgery. Addressing cataracts first may allow for better management of the eye's health and protection strategies.

In conclusion, while it may seem counterintuitive to treat the condition that presents first (pterygium) after addressing the cataract, the rationale is primarily based on the impact of each condition on vision and the overall surgical outcomes. It is essential to follow the recommendations of the eye care specialist, who can assess the specific circumstances of your father's eye health and make the best decision for his treatment plan. If there are still concerns or uncertainties, seeking a second opinion from another ophthalmologist may provide additional clarity and reassurance.

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