Deep pterygium excision can pose surgical challenge

Pterygium surgery can be challenging due to the extent of corneal involvement. In addition, postoperative recurrences can often be more difficult to manage than primary pterygium. Hence, there is a large menu of surgical techniques to choose from to optimize outcomes.In this column, I describe a case of pterygium with deep corneal stromal involvement that requires gentle dissection especially in the areas of significant corneal stromal thinning in order to prevent intraoperative iatrogenic corneal perforation. To augment the area of recipient corneal bed thickness, an anterior lamellar keratoplasty is added to the surgical technique using an automated microkeratome and an artificial anterior chamber. This lamellar disc is then dissected to fit the recipient corneal stromal bed. It is important to shape the edges appropriately to provide a uniform, smooth surface at the margins of the donor recipient corneal tissue to provide adequate patient comfort and to facilitate uniform tear film spread to this region of the newly created ocular surface. This is complemented by covering the surface with cryopreserved amniotic membrane to facilitate healing while minimizing inflammation.