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Indications for and complications of mitomycin-C in pterygium surgery
1St. Croix Vision Center, Virgin Islands.
Background And Objective:
The purposes of this study are to examine the complications and results of a novel approach to the use of mitomycin-C in pterygium surgery; to identify the lowest effective dosage required to prevent recurrence; and to select those high-risk pterygia that could benefit from mitomycin-C use.
Patients And Methods:
One hundred thirty-five eyes of 128 patients considered at high risk for recurrence of pterygium were treated with a single, intraoperative, subconjunctival injection of mitomycin-C at the site of excision. Three different dosages-0.2, 0.1, and 0.05 ml-at a strength of 0.5 mg/ml were used. The eyes were observed for 10 months to 3 years.
Results:
There were only two recurrences (1.5%); both occurred in eyes that had undergone previous pterygium surgery. One recurrence happened with the 0.2-ml dosage, and the other with the 0.1-ml dosage. These recurrences occurred in association with early wound dehiscence, which essentially became a bare sclera susceptible to pterygium regrowth. Complications included temporary and prolonged discomfort, tearing, hyperemia, subconjunctival hemorrhage, wound dehiscence, and pigment accumulation. No vision-threatening side effects were noted.
Conclusions:
The persistence and intensity of discomfort noted at the higher dosage has prompted these authors to suggest that only high-risk pterygia should receive mitomycin-C. Conjunctival flaps should always be used to cover the sclera up to the limbus and to localize the mitomycin-C to prevent its migration. A single dose of not more than 0.05 ml at a strength of 0.5 mg/ml subconjunctivally gives the same results as multiple drops, but with far less morbidity.
Insights
A single, low dose of mitomycin-C (0.05 ml) effectively prevents pterygium recurrence with minimal complications. This approach is recommended for high-risk cases, offering better outcomes than multiple drops.
Area of Science:
- Ophthalmology
- Surgical Innovation
Background:
- Pterygium surgery recurrence remains a challenge.
- Mitomycin-C is used to prevent recurrence, but optimal dosage and application are debated.
Purpose of the Study:
- Evaluate a novel mitomycin-C approach in pterygium surgery.
- Determine the minimum effective mitomycin-C dosage for recurrence prevention.
- Identify high-risk pterygia suitable for mitomycin-C treatment.
Main Methods:
- 135 eyes of 128 high-risk patients received intraoperative subconjunctival mitomycin-C.
- Dosages tested: 0.2 ml, 0.1 ml, and 0.05 ml (0.5 mg/ml strength).
- Observation period: 10 months to 3 years.
Main Results:
- Only 1.5% recurrence rate (2 eyes), both in previously operated eyes.
- Recurrences associated with wound dehiscence.
- Complications included discomfort, tearing, hyperemia, hemorrhage, wound dehiscence, and pigment accumulation.
- No vision-threatening side effects observed.
Conclusions:
- A single, low-dose (≤0.05 ml) subconjunctival mitomycin-C is effective and reduces morbidity.
- Recommend mitomycin-C for high-risk pterygia only.
- Use conjunctival flaps to localize mitomycin-C and prevent migration.