Anatomy

The normal anatomy of the conjunctiva, or the skin of the nasal portion of the human eye, is a key element in the successful removal of pterygium and pinguecula. When examined carefully, the nasal corner of the eye contains two important structures, the “plica semilunaris” and the “caruncle.”
The caruncle is a fleshy mound of tissue whose actual function is to hold the lids slightly apart at the conclusion of blinking. It is quite vascular and susceptible to swelling from allergies and infection.
The plica semilunaris is a thick fold of tissue in the corner of the eye that at first glance seems to be part of the caruncle. This tissue allows the eye the freedom to move laterally without restriction. This extra fold of tissue is essential for proper sideways movement of the eye and if damaged, can cause double vision due to restriction of movement.

“Old” Surgery

Even though a pterygium looks like a growth of tissue, the true nature of the problem must be understood to obtain a good outcome with a quiet eye and no re-growth. Through his years of research and practice, Dr. Buzard has established that a pterygium is not actually a growth, but is instead a movement of tissue. This simple statement has important implications with respect to the proper removal of pterygium. As the tissue migrates onto the cornea, the plica semilunaris migrates as well. Most physicians in the past and in fact today, make it a practice to remove the entire red portion of the lesion without any real justification. In fact, when this approach is used there is almost a 60% recurrence rate due to cutting of the plica semilunaris, which subsequently bleeds and causes scarring (as shown in the example below). Because the plica semilunaris is damaged, movement of the eye is restricted, sometimes causing double vision in side view and continually causing redness and irritation of the affected area.

“New” Surgery: Conjunctival Flaps

Three important features separate Dr. Buzzard's new approach to pterygium surgery as detailed in his authoritative book on astigmatism.

First, the minimum amount of tissue is removed, essentially removing only the tissue on the cornea, or over the “colored” part of the eye. This prevents inadvertent incision of the plica semilunaris and the scarring that can result from it.

Second, the tissue is dissected from the cornea with “blunt dissection” rather than with a knife, preventing overly deep removal of corneal tissue and subsequent thinning.

Finally, a free portion of conjunctiva is transplanted from under the lid to the area left bare by the retraction of the lesion, thus preventing re-growth.

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