Posters

Pterygium surgery: trap to avoid

Poster Details

First Author: H.Boui MOROCCO

Co Author(s): A. Bouzidi   A. Bouassel   S. Iferkhass   A. Laktaoui           

Abstract Details

Purpose:

Pterygium is a triangular conjunctivo-elastic neoformation with a corneal tip in the area of the palpebral fissure (especially in the nasal area). It is a relatively frequent affection, which rises in the hot and dry regions north and south of the equator. It is considered benign and its radical treatment remains purely surgical, with recurrence as the main complication. Among the differential diagnoses of pterygium we find conjunctival intraepithelial neoplasia (formerly Bowen's disease and being part of ocular surface squamous neoplasia (OSSN)).

Setting:

We report here the case of an 86-year-old man, having as antecedents: operation for pterygium twice in 2015 and 2017. The evolution was marked by a rapid recurrence with appearance of cauliflower swelling.

Methods:

The ophthalmological examination had found: Visual acuity at counting fingers at the left eye and 20/40 at the right eye. At the slit lamp we found at the level of the left eye a swelling in bouquet or in conjunctival cauliflower invading the limbus and cornea in temporal and superior with superficial punctate keratitis. In the right eye the rest of the clinical examination was unremarkable. An OCT of the previous segment has been realized. The patient was admitted to a specialized center for chemotherapy Local: Mitomycin 0.04%.

Results:

Pterygium is a reputed benign condition whose radical treatment is surgery. Different types of surgeries exist. The most frequently used is conjunctival autograft. Anatomo-pathological examination of the operative specimen is not a common practice. But in some cases it may be conjunctival intraepithelial neoplasia, a malignant conjunctival tumor that can in some cases become invasive. An excisional biopsy with pathological examination therefore appears necessary in front of any "pterygium" suspicious of malignancy, this in order to set up an adequate treatment, the rather possible (local chemotherapy) and not to delay the care, as in our case.

Conclusions:

Pterygium is a known benign condition whose radical treatment is surgical. But it should not be underestimated because it may be a differential diagnosis. In particular conjunctival intraepithelial neoplasia (formerly Bowen's disease), hence the interest of biopsy with histopathological examination, whenever the pterygium seems atypical.

Financial Disclosure:

None