Ans. D: Mitomycin- C A pterygium sometimes recurs after removal. Post-operative therapy with Mitomycin-C drops has been tried, but complications such as scleral necrosis, cataract and iritis have been repoed Pterygium/ Surfer's Eye It most often refers to a benign growth of the conjunctiva. A pterygium commonly grows from the nasal side of the sclera. It is usually present in the palpebral fissure. It is associated with, and thought to be caused by ultraviolet-light exposure (e.g., sunlight), low humidity, and dust. Pterygium in the conjunctiva is characterized by elastotic degeneration of collagen (actinic elastosis) and fibrovascular proliferation. It has an advancing poion called the head of the pterygium, which is connected to the main body of the pterygium by the neck. Sometimes a line of iron deposition can be seen adjacent to the head of the pterygium called Stocker's line. The location of the line can give an indication of the pattern of growth. The pterygium is composed of several segments: - Fuchs' Patches (minute gray blemishes that disperse near the pterygium head) - Stocker's Line (a brownish line composed of iron deposits) - Hood (fibrous nonvascular poion of the pterygium) - Head (apex of the pterygium, typically raised and highly vascular) - Body (fleshy elevated poion congested with touous vessels) - Superior Edge (upper edge of the triangular or wing-shaped poion of the pterygium) - Inferior Edge (lower edge of the triangular or wing-shaped poion of the ptyerygium). Symptoms of pterygium It include persistent redness, inflammation, foreign body sensation, tearing, which can cause bleeding, dry and itchy eyes. In advanced cases the pterygium can affect vision as it invades the cornea with the potential of obscuring the optical center of the cornea and inducing astigmatism and corneal scarring Management As it is a benign growth, pterygium typically does not require surgery unless it grows to such an extent that it covers the pupil, obstructing vision or presents with acute symptoms. Some of the irritating symptoms can be addressed with aificial tears. However, no reliable medical treatment exists to reduce or even prevent pterygium progression. Definitive treatment is achieved only by surgical removal. Long-term follow up is required as pterygium may recur even after complete surgical correction. If there is recurrence after surgery or if recurrence of pterygium is thought to be vision threatening, it is possible to use strontium (90Sr) plaque therapy. 90Sr is a radioactive substance that produces beta paicles, which penetrate a very sho distance into the cornea at the site of the operation. Conjunctival auto-grafting is a surgical technique that is effective and safe procedure for pterygium removal. Amniotic membrane transplantation with Tisseel glue application and Mitomycin-C has shown excellent cosmetic outcomes with a surface free of redness, stitching, or patches, which makes the ocular surface suitable for vision correction surgery sooner