Managing Pterygium After Retinal Detachment Surgery: Risks and Solutions

Retinal detachment surgery (with silicone oil tamponade) associated with postoperative keloid formation?

Hello Doctor, the patient reports that the right eye underwent retinal detachment surgery on June 25 (with silicone oil filling), and the left eye had laser surgery three months ago.
However, a month ago on August 25, the ophthalmologist informed that there is an issue with keloid scar fibrosis in the right eye.
The doctor indicated that despite the injection of steroids during the surgery, the postoperative scar enlargement problem could not be resolved.
During a follow-up on September 30, the keloid issue continued to expand, and the attending physician recommended another surgery on October 16 (for retinal fold repair), but mentioned that the surgery would not cure the related issues.
If keloids continue to occur, repeated surgeries would be necessary; otherwise, there is a risk of blindness.
I would like to ask if there are any other methods to cure or prevent blindness in such cases besides repeated surgeries.
Additionally, the vision in the left eye, which has already undergone laser treatment, has currently returned to normal, but I would like to know if there is a possibility of developing keloid issues in the future.
I look forward to your response.
Thank you.

Miss Yang, 30~39 year old female. Ask Date: 2015/09/30

Dr. Wang Zhangji reply Ophthalmology

Keloids are a reaction associated with a specific constitution.
Currently, corticosteroids are the most commonly used treatment, but unfortunately, they cannot alter the underlying constitution.

Reply Date: 2015/09/30

More Info

Managing pterygium after retinal detachment surgery can be quite complex, especially when complications such as scar tissue formation arise. Pterygium, often referred to as "surfer's eye," is a growth of fleshy tissue on the conjunctiva that can extend onto the cornea. It can be exacerbated by various factors, including previous surgeries, UV exposure, and inflammation. In your case, the presence of pterygium after retinal detachment surgery raises several important considerations.

Risks Associated with Pterygium After Retinal Detachment Surgery
1. Vision Impairment: Pterygium can lead to vision problems if it grows large enough to obstruct the visual axis or induce astigmatism. This is particularly concerning after retinal detachment surgery, where maintaining optimal vision is crucial.

2. Recurrent Growth: As you mentioned, the recurrence of pterygium after surgical intervention is common. Even with steroid injections during the initial surgery, scar tissue can form, leading to further complications.

3. Potential for Blindness: If the pterygium continues to grow and affects the cornea significantly, it can lead to severe vision loss or even blindness. This risk is heightened in patients who have undergone retinal surgeries, as the integrity of the eye may already be compromised.

Solutions and Management Strategies
1. Surgical Intervention: While you have been advised that surgery may not completely resolve the issue, it is often the first line of treatment for significant pterygium. The procedure typically involves excising the pterygium and may include grafting tissue to reduce recurrence rates. Discuss with your ophthalmologist the possibility of using amniotic membrane grafts, which have shown promise in reducing recurrence.

2. Medication: Post-surgical management may include the use of topical corticosteroids to reduce inflammation and prevent recurrence. Non-steroidal anti-inflammatory drugs (NSAIDs) may also be prescribed to manage pain and inflammation.

3. Regular Monitoring: After surgery, regular follow-ups with your ophthalmologist are essential to monitor for recurrence. Early detection can lead to timely interventions.

4. Lifestyle Modifications: Protecting your eyes from UV exposure by wearing sunglasses and avoiding irritants can help reduce the risk of pterygium development. Additionally, maintaining good eye hygiene and managing any underlying conditions that may contribute to inflammation can be beneficial.

5. Alternative Therapies: Some patients explore alternative treatments, such as the use of anti-inflammatory supplements or topical agents, but these should be discussed with your healthcare provider to ensure they do not interfere with your current treatment plan.

Concerns for the Left Eye
Regarding your left eye, which has undergone laser treatment, it is indeed possible for pterygium to develop in that eye as well. The risk factors remain similar, including UV exposure and inflammation. Regular eye examinations are crucial for early detection and management of any potential issues.

Conclusion
In summary, managing pterygium after retinal detachment surgery requires a multifaceted approach that includes surgical options, medication, and lifestyle adjustments. While recurrent pterygium can be challenging, proactive management and regular follow-ups with your ophthalmologist can help mitigate risks and preserve vision. Always consult with your healthcare provider before making any changes to your treatment plan or exploring new therapies. Your eye health is paramount, and staying informed and engaged with your care team is the best way to navigate these challenges.

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