A pterygium is a benign growth of abnomal conjunctival tissue that grows onto the cornea. It can be unsightly, painful, and if left to grow, a potential permanent threat to your vision.
Dr Hay-Smith is skilled at removing pterygiums and prides himself in an excellent cosmetic appearance and low rate of recurrence. Very important to Dr Hay-Smith is avoiding the sometimes considerable and uncessesary pain that can accompany some tecniques favoured by other surgeons.
Conjuctival Autograft to reduce recurrence.
Dr Hay-Smith always uses a conjuctival autograft. This has been shown in multiple studies to very significantly reduce the rate of recurrence. A very thin graft of the patients own healthy conjunctiva from under the lid, where it has been protected from the long term effects of the sun is harvested. Once the pterygium itself is removed from the cornea and the globe the healthy graft is glued over the site where the pterygium was. The graft allows for limbal stem cells to re-establish themselves and so help prevent recurrence.
Tissue glues to reduce post operative pain and discomfort.
Dr Hay-Smith does not routinely use any stitches at all. Instead he favours tissue glues. The advantage of tissue glue is rapid healing and far less post operative discomfort. He was a very early adopter of this technique which is becomming more commonplace as its advantages become clear.
Appropriate and limited dissection of the pterygium base to reduce complications, and post operative pain.
Some surgeon very much favour and vaunt the extenisve disection of the pterygium base with aggressive removal of a natural tissue layer called Tenon’s Layer. This has been claimed to reduce recurrence further over the routine use of an autograft. This remains contorversial with disagreement between surgeons. What is clear is that excellent results can be achieved without extensive disection and extensive disection considerably increases post operative pain and the risk of serious complications such as permanent double vision. The technique for pterygium removal that Dr Hay-Smith uses is the technique favoured by the majority of international centres of excellence, including Moorfields Eye Hospital in London where he trained.
Long lasting and deep anaesthesia to reduce post operative pain and discomfort.
Dr Hay-Smith works with his usual anaethetist, Dr Wilmott, who can induce a deep and long lasting anaethetic with effective sedation.