INFORMED CONSENT FOR AN OPERATION OF PTERYGIUM

You suffer of a pterygium. As treatment for this condition, your ophthalmologist proposes surgery.

This document contains the information about the reasons, conditions, results, risks and limitations of the proposed medical act.

The pterygium

It is a benign, not cancerous, tumour of the conjunctiva that is the thin membrane that lines the surface of the eye.

It is common, especially in temperate and warm countries.

Why operate?

Without treatment, the pterygium, initially restricted to the conjunctiva, tends to cover the cornea. It becomes annoying by its unaesthetic appearance and by the chronic eye irritation it causes. The extension to the cornea may result, over the months or the years, disabling visual impairment. The longer one waits, the greater risk to keep visible scars and visual disorders.

Surgery is the only way to remove this tumour.

The operation

It is performed on the patient, while installed on the back, in a sterile environment, under surgical microscope.

* Anaesthesia: it can be done by injection of anaesthetic in the vicinity of the lesion, or only by the instillation of drops.

* Technical procedure: Its aim is the complete excision of the lesion. There is no opening of the eyeball.

Chronologically, the steps of the procedure are: Disinfection, anaesthesia with drops and injection in the area of the lesion and the graft, incision, removal of the lesional tissue, debridement of the healthy tissue, addition or not of medication reducing the risk of recurrence, reconstitution of the conjunctival plan by a graft of conjunctiva taken from the same eye, closure with absorbable sutures, disinfection, eye-pad or eye-cup or not.

Your ophthalmologist will decide the type of anaesthesia, closure and post-operative treatment depending on the location and size of the lesion.

The time spent in the operating room is 30 minutes per eye. In the operating theatre, it is of 40 minutes. In short, you leave one hour after your arrival.

If the lesion has an unusual appearance, an analysis in the laboratory of pathology can be performed to determine its exact nature. It is your responsibility to reconnect, 1 to 2 weeks later to have the results. The cost of this analysis will be billed by the laboratory.

Any residues of stitches will be removed one month later.

Usual postoperative course

The postoperative routine is: Swelling of the eyelids, redness, discharge, watery eyes with a bit of blood, sensitivity to light, sensation of sand and, depending on the sensitivity of the patient, light to heavy pain. These inconveniences are especially encountered on the first 3 post-operative days and fade gradually over a week. The sensation of sand, due to the knots of the sutures, can last several weeks, until they are absorbed or are removed by your ophthalmologist. The redness fades gradually over the weeks following the disappearance of the sutures.

The complications of the operation

Although it is perfectly standardized and followed by good results, this type of operation is no exception to the general rule that there is no surgery without risk. It is not possible for your ophthalmologist to ensure formally the success intervention.

You should be aware that

* During the anaesthesia and sometimes despite the anaesthesia, during the operation itself, there is a hazard of discomfort and, although very rarely, even pain. This risk depends on the patient’s responsiveness to the anaesthetic molecule. It is unpredictable.
* In any local anaesthesia and all surgical procedures, there is a hazard of local complications, bleeding and infection and general intolerance that can lead to a severe shock. The risk of these complications is unpredictable. It is so exceptional that it is impossible to quantify it.

* After any surgery, there is a hazard of inadequate or excessive scarring, which can lead to unaesthetic scarring.
This risk is higher on dark skinned or regularly exposed to sunlight patients. It is not quantifiable.

* After removing a tumour, there is a hazard of recurrence leading to further surgery. This risk is unpredictable, but has been estimated between 8 and 19% globally, depending on the geographic location. Sun exposure increases this risk.

To what must the patient be careful to, before, during and after the operation?

You agree to follow the precautions, treatments and appointments to be prescribed before, during and after the operation.

THE EVE OF THE OPERATION: Remove make-up; thoroughly wash your hair and face, especially the eyelids and eyelashes, and the whole body with shampoo or soap. Rinse generously and repeat the same thorough washing and rinsing. Dry yourself with a clean towel. Sleep with clean nightclothes and bedding. It is advisable not to take any aspirin the day before and the day of the operation. You may take the day after. Discuss this matter with your GP.

THE DAY OF THE OPERATION AND DURING THE WEEK FOLLOWING IT: On the morning of that day, upon awakening, re-remove make-up carefully and repeat a thorough double shower as described above. Wear clean underwear and clothes. Take your breakfast and regular medications except aspirin to be avoided that morning. Make sure you have all your medications and this document duly signed.

Then go, at the time indicated in your appointment, to Dr. SAFFIEDINE’s Cabinet to register and pay all the medical and surgical costs of that day. These fees will not be reimbursed by Social Security. They will eventually be reimbursed by your private insurance to which you should check. The Cabinet of Dr. SAFFIEDINE is not involved in these

During the operation, you are requested to keep calm and strictly follow the instructions given by your ophthalmologist.

After the operation, use the eye drops or ointment prescribed on the operated eye at noon, evening and before bed. The application of this treatment is to be continued four times a day (morning, afternoon, evening and before bedtime) during a whole week.

The presence of an aiding person is advised during the remainder day of the operation.

A light bleeding in the tears and swelling of the eye should not worry you or keep you from following the treatment.

In case of pain, take one or two, maximum three, Paracetamol tablets per day for up to three days. Avoid Aspirin.

It is always strongly advised not to rub your eyes.

If a protective eye-pad or an eye-cup is placed on the eye, it should be kept throughout sleep, nap or at night, changing the plasters for each application of ointment, all this for 7 days. The plasters stick best on a skin previously washed with soap or a gently rubbed with an alcoholic perfume.

Visual activities, professional and of leisure, are all allowed as long as there is no eye contact with dirt or dust.

Wearing sunglasses is always advisable when exposed to sunlight.

YOU SHOULD CONTACT YOUR OPHTHALMOLOGIST IMMEDIATELY IN CASE OF

• Breathing difficulties
• General malaise
• Fever
• Persistent Bleeding
• Continued strong pain lasting more than 24 hours.