Pterygium. Clinical course and treatment.

The author reviews the current concepts of the pathogenesis, clinical course and treatment of pterygium. This neoplasm can be considered as to be a manifestation of a chronic irritative process caused by solar radiation and repeated microtrauma and, to a lesser degree, by other aetiological factors which are studied successively. The clinical course of the disease consists of two phases: a conjunctival phase and a corneal or true pterygial phase. The anatomical and clinical forms studied in a population of 2,350 subjects in an endemic region of pterygium (Central Sahara) appear to be closely related to the severity and the duration of exposure to predisposing factors. Prevention therefore constitutes the best treatment when it can be applied in highly endemic zones. The various preoperative and postoperative medical and physical treatment modalities (radiotherapy--beta therapy--cryotherapy--laser photocoagulation--antimitotic drugs--corticosteroids) are analysed together with the three main groups of surgical techniques: deviation--excision--lamellar keratoplasties. Medical and physical treatment modalities appear to be minimally effective in the primary treatment, but are valuable and essential adjuvants to surgical treatment. Surgery is the only treatment modality indicated in the corneal phase of the disease. Recurrence remains the major risk of this surgery which means that the surgical indications must be very carefully defined. Only a small number of techniques can be considered to be valid. Lamellar keratoplasties and their variants are indicated in the great majority of cases and have demonstrated their efficacy in the prevention of postoperative recurrences.