Pterygium removal by a corneal specialist or high-volume surgeon may reduce the odds of recurrence; the only problem remains potential barriers to these providers.

Pterygium removal by a corneal specialist or high-volume surgeon may reduce the odds of recurrence; the only problem remains potential barriers to these providers. Photo: J. James Thimons, OD. Click image to enlarge. 

Removing a pterygium is a delicate procedure. Though it can be excised quickly, the simple excision method is more likely to result in recurrence than more complex removal techniques, and recurrence has been linked to decreased patient satisfaction and increased healthcare costs.1,2

To help inform practice patterns, researchers at the Harvard Medical School investigated risk factors associated with pterygium reoperation in a retrospective cohort study of the IRIS Registry.3 In this cohort, the 87,042 patients with pterygium (57% male, median age: 58) had a 5.7% probability of reoperation within five years of the first excision. The researchers reported that the majority of those who underwent reoperation were younger, identified as Hispanic, lived in the northeast and were less likely to have had their first surgery performed by a corneal specialist or high-volume surgeon.

Whereas surgery performed by a corneal specialist showed lower risk of reoperation (HR 0.63), the following were associated with a higher risk:

  • Younger age: HR 1.36 per decade

  • Male sex: HR 1.18

  • Public insurance: HR 1.37

  • Surgery performed by a low-volume surgeon: HR 1.46

“Although the association of pterygium recurrence with age and sex has been reported previously,” the researchers wrote in their paper, “the association with insurance type is novel and may suggest that differences associated with socioeconomic status, such as occupational or environmental exposures, may increase recurrence risk, although unmeasured confounding factors may also influence decisions to undergo reoperation.”

Noting that reoperation was less likely when the initial surgery was performed by a corneal specialist or high-volume surgeon, the researchers suggested there could be a “potential benefit to studying the techniques and adjuvant therapies used by these surgeons.”

1. Parker JS. Surgical approaches to pterygium. Review of Ophthalmology 2021;28:1:28-30.

2. Ghiasian L, Samavat B, Hadi Y, et al. Recurrent pterygium: a review. J Curr Ophthalmol 2022;33:4:367-378.

3. Oke I, Hall N, Elza T, et al. Risk factors associated with pterygium reoperation in the IRIS Registry. JAMA Ophthalmology 2022; Supp. October 6, 2022. [Epub ahead of print].