Intraoperative application versus postoperative mitomycin C eye drops in pterygium surgery

Postoperative recurrence of pterygium occurs in many patients. Intraoperative and postoperative mitomycin therapy are two adjuvant treatment methods shown to lessen the high pterygium recurrence rate seen with simple excision alone. The authors designed a prospective, randomized study to explore the recurrence rate of pterygium after a single dosage of mitomycin C at the completion of pterygium excision, comparing it to postoperative mitomycin C therapy.

Thirty-six patients with 40 primary and recurrent pterygia were randomized to 1 of 2 treatment groups: intraoperative mitomycin 0.2 mg/ml for 5 minutes (group 1) and postoperative mitomycin 0.2 mg/ml four times a day for 7 days (group 2). The mean follow-up time was 15 months (range, 6 to 24 months).

The pterygium recurred in 3 (15%) of 20 eyes in group 1 and in 4 (20%) of 20 eyes in group 2 (p=0.41). One patient in group 1 had a mild scleral melting (1 x 1 mm) and a delay of reepithelialization for three weeks. Moderate superficial punctate keratitis (two eyes) and mild anterior chamber reaction (one eye) developed in group 2.

This study indicates possible advantages of administration of a single dosage of 0.02% mitomycin C over postoperative mitomycin therapy. If the decision is made to use adjunctive mitomycin, the authors recommend intraoperative over postoperative administration.