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    Strategies for handling complex pterygium surgery, complications

    Spotlighting aggressive pterygia, recurrent pterygia, symblepharon, corneal scars, scleral melts


    Given the unique nature of my practice with a large number of patients referred for cosmetic outcomes, their expectations need to be addressed because doing a mediocre job on a case in which the pterygium/pinguecula was primary and small but with a resultant scar is less tolerable and more agonizing than a recurrence in a complex pterygium case.

    This is very similar to present-day premium cataract surgery where patients with 20/60 vision and easily extractable cataracts expect perfection as opposed to patients with 20/400 vision even if the latter may have a mature, hard, and complex cataracts.

    This is the price we must pay for our desire to excel for our patients by undertaking this level of commitment as long as the patients are educated about the fact that complications can occur.

    Mastering the art of pterygium and pinguecula surgery to treat emerging cases as well as complications and side effects empowers the surgeon to become a full-spectrum ocular surface surgeon who relentlessly follows the goals of raising the bar on ocular surface surgery to cosmetic outcomes along with enhancing vision simultaneously.

    In an upcoming “Gloves Off with Gulani” column, I look forward to discussing “Designer Cataract Surgery: Beyond Premium Technology; The Time Is Now.”



    Arun C. Gulani, MD, is founding director and chief surgeon of the Gulani Vision Institute, Jacksonville, FL. Dr. Gulani has no financial interests to declare.




    1.      Gulani AC. Sutureless amniotic surgery for pterygium: cosmetic outcomes for ocular surface surgery. Techniques in Ophthalmology. 2008;6:41-4.

    2.      Gulani AC. No-stitch pterygium surgery: next day cosmetic outcomes. Video Journal of Ophthalmology. 2009.

    3.      Gulani AC. Corneoplastique. Video Journal of Cataract and Refractive Surgery. 2006;22:3.

    4.      Gulani A, Gulani A. pterygium surgery: raising ocular surface surgery to cosmetic outcomes. Mastering corneal surgery: recent advances and current techniques. Thorofare, NJ: SLACK Incorporated. 2015;25:269-276.

    5.      Gulani AC. Gulani Iceberg Technique. Cataract & Refractive Surgery Today Europe. 2014;9:48-49.

    6.      Gulani, AC. A cornea-friendly pterygium procedure. Rev Ophthalmol. 2012;52-56.

    7.      Gulani AC. Shaping the future and reshaping the past: the art of vision surgery. Chapter 98. In: Copeland and Afshari’s Principles and Practice of Cornea. New Delhi, India: Jaypee Brothers Medical Publishers 2013;2: 1252-1273.

    8.      Gulani AC. Corneoplastique. Ind J Ophthalmol. 2014;62:3-11.

    9.      Gulani, AC. Competencies in oculoplastics: anatomy, trauma, involutions, and exam preparation. New Retina MD. 2013;1-2.




    Arun C. Gulani, MD
    Dr. Gulani is director of refractive surgery and chief, cornea & external disease, as well as assistant professor, department of ...

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