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Intraoperative mitomycin C to prevent recurrence of pterygium after excision: a 30-month follow-up study
1Prince of Wales Hospital, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin.
Objective:
The purpose of the study was to examine the efficacy of intraoperative mitomycin C (MMC) in preventing recurrence of pterygium after excision and the postoperative complications encountered.
Design:
The study design was a prospective, randomized, clinical trial.
Participants:
A total of 180 primary and recurrent pterygia were recruited for the study. They were randomized into five groups: A, control with no MMC; B, 0.02% MMC for 5 minutes; C, 0.04% MMC for 5 minutes; D, 0.02% MMC for 3 minutes; and E, 0.04% MMC for 3 minutes.
Intervention:
All patients received pterygium excision with or without the above four modes of intraoperative MMC application.
Main Outcome Measures:
Recurrence of pterygium and postoperative complications such as superficial scleral melting were measured.
Results:
At a mean follow-up of 30 (groups A-C) and 20 months (groups D and E), the respective recurrence rates in groups A through E were 75%, 8.3%, 8.6%, 42.9%, and 22.9%. There were two cases of postoperative superficial scleral melting in group C. Otherwise, no major postoperative complications were encountered.
Conclusions:
The midterm results of a single intraoperative application of MMC at the concentration of 0.02% for 5 minutes are encouraging. Its application as an adjunctive therapy for the surgical treatment of pterygium appeared to be safe and effective. However, because of the possibility of serious late complications, the authors suggest that this procedure be reserved for patients who have high probability of recurrence after excision of pterygium.
Insights
Intraoperative mitomycin C (MMC) significantly reduced pterygium recurrence after surgery. A 0.02% MMC application for 5 minutes showed promising efficacy and safety, though late complications warrant caution.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Pharmacological Adjuncts
Background:
- Pterygium recurrence after surgical excision remains a clinical challenge.
- Mitomycin C (MMC) is explored as an adjunctive therapy to prevent post-excision recurrence.
Purpose of the Study:
- To evaluate the efficacy of intraoperative mitomycin C (MMC) in preventing pterygium recurrence.
- To assess postoperative complications associated with intraoperative MMC use.
Main Methods:
- Prospective, randomized clinical trial involving 180 patients with primary or recurrent pterygia.
- Five groups were randomized: control (no MMC) and four MMC application groups (0.02% or 0.04% for 3 or 5 minutes).
- Pterygium recurrence and postoperative complications, including scleral melting, were monitored.
Main Results:
- Recurrence rates varied significantly: 75% (control), 8.3% (0.02% MMC/5 min), 8.6% (0.04% MMC/5 min), 42.9% (0.02% MMC/3 min), and 22.9% (0.04% MMC/3 min).
- The most effective regimen was 0.02% MMC applied for 5 minutes, demonstrating a substantial reduction in recurrence.
- Two cases of superficial scleral melting occurred in the 0.04% MMC/5 min group; other complications were minor.
Conclusions:
- Intraoperative application of 0.02% mitomycin C for 5 minutes is a safe and effective adjunct for pterygium surgery.
- This approach significantly reduces midterm recurrence rates.
- Due to potential late complications, its use should be considered for patients at high risk of recurrence.