Eye Whitening

“Scissorless” Sutureless Pterygium Surgery: Dr. Soroudi’s Invented, Exclusive Surgical Technique (the “PECAC” Operation)

Including Conjunctival or Amniotic Membrane Grafting

Large pterygium growing over the cornea and pupil (Dr. Soroudi’s actual patient).
This person was “legally blind” from this pterygium with over 9 diopters of astigmatism; he now sees 20/20!
A pterygium (pronounced “ter y gee um”) is small “wing-shaped” fleshy membrane that slowly grows over the cornea. Although it usually grows in the nasal aspect of the eye (closer to the nose), it can grow on the temporal aspect as well, and it is not uncommon to see them cover both sides of the cornea at the same time (kissing pterygia).

It is not exactly clear why they develop, but it is understood that there is a genetic component as well as a history of high exposure to sunlight (people who live in equatorial regions of the earth tend to get them more frequently). Pterygia affect millions of people’s eyes and causes chronic irritation, redness, and tearing. In severe cases, they can cause severe astigmatism and even blindness.

Although regular lubrication with artificial tears and the use of vaso-constrictive eye drops (Naphcon or Visine) helps relieve some of the symptoms of pterygia, they never regress spontaneously and require surgery to avoid worsening symptoms and improving vision.
Pterygia can be surgically removed using local anesthesia only. Once removed, it is very important to cover the area that used to be involved with either a small piece of the conjunctiva (the thin clear skin that covers our eyeballs) from one’s own eye in order to prevent the pterygium from coming back.

A small piece of conjunctiva (the thin clear skin that covers the eye ball) is removed and placed over the area where the old pterygium used to be. Even today, this graft is resected by ophthalmologists using a blade or scissors. This makes the eye bleed profusely and makes the surgery much more difficult, lengthy, and invasive. Dr. Soroudi has invented a procedure that allows this graft to be removed without scissors, which makes the patient much more comfortable, the procedure bloodless, and the recovery period much more pleasant.

Once removed, Dr. Soroudi applies a small amount of an “anti-fibrotic” medication (Mitomycin-C) to the involved area. This has been shown to help prevent recurrences in a majority of patients. Some surgeons apply radiation to the operated eye, which causes severe scarring, and can potentially cause tremendous problems if the pterygium recurs. Dr. Soroudi never uses radiation to treat pterygia, and actively discourages this technique for anyone.

The graft is usually taken from the top part of the eye which is covered by the eyelid. Alternatively, a processed Amniotic Membrane Graft can be utilized to cover the defect, which minimizes the amount of dissection and obviously, post-operative discomfort. There are several pros and cons to using Amniotic Membrane Grafts. Contrary to common belief, although much more expensive, they are not always the best choice for every patient, and you should discuss your options with Dr. Soroudi carefully prior to your procedure.

Most surgeons use sutures to keep these membranes in place which can cause severe irritation and redness during the post-operative period. Instead of sutures, Dr. Soroudi utilizes Tisseel Fibrin Sealant, which is a special glue that helps keeps the grafts in place beautifully without any post-operative pain, redness, or irritation, making the recovery period very pleasant for his patients.

Before surgery (surgery was done on both sides of the right eye and the left (nasal) side of the left eye). This patient had already been operated on twice by other surgeons and his pterygium recurred for the third time.

After surgery by Dr. Soroudi (surgery done on both sides of the right eye and the left (nasal) side of the left eye).

Conjunctival Reconstruction (with Amniotic Membrane)

Anytime the skin of the eye (conjunctiva) is damaged or excised (e.g., during pterygium surgery), the affected area needs to be covered up in order to avoid pain, irritation, infection, and problems with the underlying sclera (the white skeleton of the eye-ball). To this effect, most eye surgeons have to reconstruct the bare surface of the eye-ball. Oftentimes, a small patch of the eye’s skin (conjunctiva) is borrowed from under the top of the eye as this part is covered by the upper eyelid anyway and doesn’t cause any pain / irritation. This is the best way to reconstruct the eye, but there are instances where this part has either been previously removed or damaged (e.g. during previous pterygium or glaucoma surgery). In such patients, a small patch of a thin processed amniotic membrane can be used to reconstruct the defective area.

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