How is No-Stitch Pterygium Surgery Performed?

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Video Transcript

How is no-stitch pterygium surgery performed?
Hi, I’m Dr Rylan Hayes, ophthalmologist and specialist pterygium surgeon here on the Sunshine Coast. The procedure begins with sedating twilight anesthetic from our anesthetist and a local anesthetic injection to completely numb the eye — so you feel no sharp pain during surgery. Some pressure or light sensation is possible, true pain is not. And if you are feeling any discomfort, we’ll increase the anesthetic. That said, most people are under twilight and sedate enough that they don’t even know what’s happening. I then carefully remove the pterygium from the surface of the eye, including any fibrovascular tissue that has grown onto the cornea. I take great care with this step to give the best possible cosmetic result and functional outcome. Next, I harvest a small piece of your own healthy conjunctival tissue from underneath your upper eyelid. This is the autograft, which I then position over the area the pterygium was removed from. Instead of using stitches to hold it in place, I secure the graft using Tisseel, a premium fibrin tissue adhesive made from donated blood products. This adhesive holds the graft securely in place and dissolves naturally as the healing progresses. The whole procedure typically takes around half an hour, and you go home the same day. So if you’d like to know more or want your pterygium managed, come see me in clinic for a discussion.

How is No-Stitch Pterygium Surgery Performed?

The Signature No-Stitch Pterygium Surgery by Dr Rylan Hayes is a carefully refined technique designed to achieve excellent cosmetic and functional outcomes with minimal patient discomfort. Here’s a step-by-step overview of what happens during the procedure.

Anaesthesia

The procedure is performed under twilight sedation with a numbing injection under the eye. Because of the sedation, there are fasting requirements before surgery which you will be given. Local anaesthetic eye drops are also first used, which completely numb the ocular surface before anything is done. Some sensation of pressure or light touch is possible, but sharp pain during the procedure is not expected. If at any point you feel any hint of discomfort, additional anaesthetic is applied, however it is rare for a patient to be aware of proceedings and feel any discomfort.

Step 1: Pterygium excision

The pterygium is carefully removed from the conjunctiva and cornea using precise surgical dissection. Any fibrovascular tissue that has grown onto the corneal surface is meticulously cleared. Particular attention is given to the limbal zone — the junction between the cornea and conjunctiva — as clean handling here is important for both cosmetic and recurrence outcomes. The thickened tissues growing from the whites of the eyes is trimmed back (tenonectomy) to reduce recurrence.

Step 2: Conjunctival autograft harvesting

A small piece of healthy conjunctival tissue is harvested from the upper conjunctiva — the area on the whites of the eye underneath the upper eyelid. Using your own tissue (rather than a synthetic or donor graft) is the gold standard approach. The autograft is sized to match the area created by pterygium removal, and its orientation is carefully preserved.

Step 3: Graft positioning with Tisseel

Instead of sutures, Dr Hayes uses Tisseel — a premium fibrin tissue adhesive derived from donated human blood products — to secure the autograft over the excised area. Tisseel mimics the natural clotting process and bonds the graft securely in position.

As healing progresses, the adhesive dissolves naturally. This is the step that eliminates the suture-related discomfort of traditional pterygium surgery was notorious for.

Step 4: Finishing up

Injections are performed of antibiotics and anti-inflammatory medication around the numbed eye to kickstart the healing process, then a patch is placed over the eye to remain in place until the morning.

Procedure duration and discharge

The procedure typically takes approximately 20-30 minutes. Afterwards, you are monitored briefly in recovery with a snack and a drink before being discharged home the same day. The protective eye shield is left in place until the following morning at which time you can remove it and start your eye drops. We include some eyelid wipes in case your eyelashes are a bit stuck together, but be sure to only gently wipe them, no vigorous rubbing or picking at the eye so as not to disturb the graft.

Avoid getting the eye dirty or wet for 2 weeks, though showering with the eye closed is OK. And wear your plastic eye shield at bedtime for a week so as not to rub the eye overnight.

Key Takeaways

• The procedure is performed under twilight sedation with a local anaesthetic numbing injection.
• The pterygium is excised and replaced with a conjunctival autograft (your own healthy tissue)
• Tisseel fibrin adhesive secures the graft without sutures, significantly reducing post-operative discomfort
• The procedure takes approximately 30 minutes and is performed as a day case

Want to learn more about the procedure?

Book a consultation with Dr Rylan Hayes at The Vision Surgeon, Maroochydore.

References

• Clearfield E, et al. Conjunctival autograft for pterygium. Cochrane Database Syst Rev. 2016.
• Kaufman SC, et al. Fibrin tissue adhesive vs sutures for pterygium surgery. J Cataract Refract Surg. 2003.
• American Academy of Ophthalmology. Pterygium — Preferred Practice Pattern. aao.org