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Low-dose intraoperative mitomycin-C versus conjunctival autograft in primary pterygium surgery: long term follow-up
1Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. eyepgi@ch1.dot.net.in
Purpose:
To evaluate and compare the long term safety and efficacy of low-dose intraoperative application of mitomycin-C (0.02%) with conjunctival autograft in primary pterygium surgery.
Patients And Methods:
Of 37 consecutive patients 41 eyes with primary pterygium underwent pterygium excision with either intraoperative mitomycin-C (0.02%) (Group I) or conjunctival autografts (Group II) at random. Mitomycin-C (0.2 mg/mL) was applied for 2.5 minutes on the scleral bed under the conjunctiva. Conjunctival autograft was obtained from upper temporal limbus and secured with 10-0 monofilament nylon. The follow-up period ranged from 14 to 54 months (mean 36 months) for mitomycin-C group and 13 to 58 months (mean 38 months) for conjunctival autograft group.
Results:
Twenty-one eyes underwent pterygium excision with intraoperative mitomycin-C (0.02%) application (Group I) and 20 eyes were treated using conjunctival autograft (Group II). The mean size of the pterygium was 3.80 mm (range 2.6 to 4.8 mm) in the mitomycin-C group and 3.60 mm (range 2.5 to 4.5 mm) in the conjunctival autograft group. Two (9.52%) eyes treated with intraoperative mitomycin-C had delayed epithelial healing of corneoscleral wound and one (4.76%) eye developed pyogenic granuloma. Three (14.3%) of the 21 eyes in Group I and one (5%) of 20 eyes in Group II had recurrence of pterygium (P = 0.3174). All recurrences occurred in patients below 40 years of age (P = 0.0384).
Conclusion:
We conclude that conjunctival autograft and intraoperative mitomycin-C are both equally effective adjuncts to primary pterygium surgery on long term follow-up. However, future prospective studies with larger numbers of subjects may be carried out to find out the optimum concentration and duration of intraoperative mitomycin-C application.
Insights
Conjunctival autografts and low-dose mitomycin-C (0.02%) show similar long-term efficacy for primary pterygium surgery. Further studies are needed to optimize mitomycin-C application for pterygium treatment.
Area of Science:
- Ophthalmology
- Surgical Techniques
- Pharmacology
Background:
- Pterygium is a common ocular condition.
- Surgical excision is the primary treatment for pterygium.
- Adjunctive therapies aim to reduce recurrence rates.
Purpose of the Study:
- To compare the long-term safety and efficacy of low-dose intraoperative mitomycin-C (0.02%) versus conjunctival autograft in primary pterygium surgery.
Main Methods:
- 37 patients (41 eyes) with primary pterygium underwent surgery.
- Group I: Intraoperative mitomycin-C (0.02%) application.
- Group II: Conjunctival autograft transplantation.
- Follow-up ranged from 13 to 58 months.
Main Results:
- Recurrence rates were 14.3% for mitomycin-C and 5% for conjunctival autograft (P=0.3174).
- Delayed epithelial healing and pyogenic granuloma were observed with mitomycin-C.
- Recurrences were more frequent in patients under 40 years old (P=0.0384).
Conclusions:
- Both conjunctival autograft and intraoperative mitomycin-C are effective for primary pterygium surgery.
- Further research is recommended to determine optimal mitomycin-C concentration and duration.
- Conjunctival autografts may offer a slightly lower recurrence rate in this study.