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Use of mitomycin C with conjunctival autograft in pterygium surgery in Asian-Canadians
1Department of Ophthalmology, University of British Columbia, Vancouver, Canada. anthonyw@unixg.ubc.ca
Objective:
To determine whether using mitomycin C (MMC) before applying conjunctival autograft is better than conjunctival autograft alone in preventing the recurrence of pterygia in an Asian-Canadian population.
Design:
Nonrandomized, retrospective, comparative case series.
Participants:
A total of 159 patients were included in the study. Seventy patients (76 eyes) received MMC (0.25 mg/ml for 1 minute) with conjunctival autograft; 89 patients (98 eyes) received conjunctival autograft alone.
Intervention:
All patients had primary (first-occurrence) pterygia excised and conjunctival autograft applied with or without MMC adjunct.
Main Outcome Measures:
Recurrence of pterygia was monitored for up to 1 year after the operation. Any complications (e.g., scleral thinning and necrosis) were documented.
Results:
Patients' pterygia were examined on presentation and were graded 1 through 3. Grade 1 pterygia were fibrovascular proliferations extending up to one quarter the diameter of the cornea; grade 2 extended between one quarter to one half the distance across the cornea; and grade 3 extended beyond the visual axis. In the more severe pterygia group (grades 2 and 3 combined), there was significantly less pterygium recurrence in the MMC/autograft group (7%) compared with the autograft alone-treated group (26%). There was no significant difference in recurrence between groups for less severe grade pterygia (grade 1). The recurrence rate of all pterygia in the MMC/autograft group was 9% compared with 18% for the conjunctival autograft group. This difference was not statistically significant, however, because of a small sample size. There were no significant complications in either group and no difference between groups in complication rates.
Conclusions:
The authors suggest using MMC in patients with more severe pterygia as an adjunct to conjunctival autograft to lower the recurrence rate. Combining the use of MMC with conjunctival autograft allows for decreased dosage and time of intraoperative exposure of mitomycin, thereby making it safer for application.
Insights
Adding mitomycin C (MMC) to conjunctival autograft surgery significantly reduces pterygium recurrence in severe cases. This combination therapy offers a safer approach for managing recurrent pterygia.
Area of Science:
- Ophthalmology
- Surgical Techniques
- Medical Treatments
Background:
- Pterygia are fibrovascular growths that can affect vision.
- Conjunctival autograft is a common surgical treatment for pterygia.
- Recurrence after pterygium surgery remains a clinical challenge.
Purpose of the Study:
- To evaluate the efficacy of mitomycin C (MMC) as an adjunct to conjunctival autograft in preventing pterygium recurrence.
- To compare outcomes between conjunctival autograft with MMC versus conjunctival autograft alone in an Asian-Canadian population.
Main Methods:
- A retrospective, comparative case series involving 159 patients with primary pterygia.
- Patients underwent pterygium excision with either conjunctival autograft plus MMC or conjunctival autograft alone.
- Pterygium recurrence and complications were monitored for up to one year post-surgery.
Main Results:
- For severe pterygia (grades 2 and 3), recurrence was significantly lower with MMC/autograft (7%) compared to autograft alone (26%).
- No significant difference in recurrence was observed for less severe pterygia (grade 1).
- Overall recurrence rates were 9% for MMC/autograft and 18% for autograft alone, though not statistically significant due to sample size. No significant complications were noted in either group.
Conclusions:
- Mitomycin C (MMC) as an adjunct to conjunctival autograft is recommended for patients with more severe pterygia to reduce recurrence rates.
- The combined approach allows for reduced MMC dosage and exposure time, enhancing safety.
- This strategy provides an effective method for managing pterygium recurrence.
