Pterygium surgery with mitomycin C: how much sclera should be left bare?

Area of Science:

• Ophthalmology
• Surgical Techniques
• Ocular Surface Disease

Background:

• Pterygium is a common ocular condition requiring surgical intervention.
• The bare sclera technique is a standard surgical approach for pterygium excision.
• Postoperative management, including conjunctival coverage, may influence outcomes.

Purpose of the Study:

• To compare the impact of different conjunctival coverage techniques after pterygium excision.
• To evaluate the effects on postoperative complications, cosmetic results, and pterygium recurrence.
• To determine the optimal surgical strategy for pterygium treatment.

Main Methods:

• A prospective comparative study involving 371 patients with primary advanced pterygium.
• Surgical groups included: conjunctiva sutured 2 mm from limbus (Group A), conjunctiva sutured at limbus (Group B), and bare sclera (Group C).
• Topical mitomycin C was applied post-excision; patients were followed for 26 months.

Main Results:

• Recurrence rates were 6.35% (Group A), 6.85% (Group B), and 25% (Group C).
• Complications like dellen occurred in 1.05% (A), 1.36% (B), and 25% (C).
• Cosmetic appearance was significantly better in Group A compared to Groups B and C.

Conclusions:

• Leaving the entire sclera bare after pterygium surgery significantly increases complication and recurrence risks.
• No significant difference in complications or recurrence was found between suturing conjunctiva 2 mm from the limbus versus covering the entire sclera.
• Suturing conjunctiva 2 mm from the limbus offers a more favorable cosmetic outcome without compromising safety or efficacy.