Pterygium excision after LASIK
Pterygium is a highly prevalent ocular degenerative condition that manifests as a fleshy triangular growth of fibrovascular tissue onto the cornea and can result in irritating dry eye symptoms or astigmatism, necessitating its excision.

Here presents the case of a 45-year-old female presented with irritation and foreign body sensation in the right eye. Her ocular history was remarkable for an uneventful LASIK surgery on both eyes a number of years back. Examination revealed a pterygium temporally in the right eye extending approximately 4mm into the cornea and involving the LASIK flap. There was no evidence of a pterygium in the left eye. Conservative treatment was incrementally started with artificial tears, loteprednol, cyclosporine A 0.05%, and punctal occlusion with no improvement in her symptoms.

Pterygium excision was performed in a standard fashion in the operating room. After administration of a retrobulbar block, the head of the pterygium was grasped with 0.12mm forceps and gently peeled off the LASIK flap. Although a surgical plane was sometimes present, areas of deeper adhesions were often noted necessitating frequent use of a crescent blade to sever these adhesions and reduce traction on the LASIK flap. A diamond bur was then used to smooth the cornea. The conjunctival portion of the pterygium and surrounding tenon were excised, and the resulting defect covered with a similarly sized conjunctival autograft, affixed with fibrin glue.

Postoperatively, the patient maintained her 20/20 vision and was relieved from her ocular symptoms. Significant improvement on topographic indices was noted with resolution of the irregular astigmatism induced by the pterygium. Pathologic examination showed the typical elastotic degeneration and no corneal tissue was identified at the edges, indicating that the flap remained intact after surgery. The postoperative course was complicated by the formation of a pyogenic granuloma on the second postoperative month which responded well to steroid eye drops.

In conclusion, Pterygia are highly prevalent, and with the increasing prevalence of LASIK surgery, the coexistence of these 2 conditions is expected to be increasingly more likely. Optimizing the management of this condition can result in a good functional and cosmetic outcome.