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Hyunjoo Jean Lee, Yonwook Justin Kim; Comparison of Surgical Methods and the Use of Mitomycin-C for the Treatment of Recurrent Pterygium. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3539.
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© ARVO (1962-2015); The Authors (2016-present)
Many studies have compared different surgical treatments and adjuvant therapies for primary pterygium, but less is known about for the most effective way to treat recurrent pterygium. Mitomycin-C (MMC) is often used as an adjuvant when performing pterygium excision, but the risk-benefit ratio of using MMC in the treatment of recurrent pterygium is not well known. We aimed to compare the recurrence rate in cases of recurrent pterygium treated with or without MMC, as well as to compare the use of MMC to conjunctival autografting (CLAU) in the treatment of recurrent pterygium. We hypothesized that CLAU is just as effective as MMC with or without AMT for the treatment of recurrent pterygium.
We performed a retrospective chart review of patients that underwent recurrent pterygium surgery at Boston Medical Center between January 1999 and May 2015. Cases with less than 6 months of follow-up were excluded. Age, surgical method, MMC use, post-operative recurrence, and complications were recorded. The Fisher exact test was used to compare post-operative recurrence rates.
A total of 17 cases met the inclusion criteria with a mean follow up of 28 months (range: 8 - 57). MMC was used in 9 cases, in conjunction with CLAU or amniotic membrane transplantation (AMT). Eight cases were performed without MMC, but with CLAU and/or AMT. The mean age of the +MMC group and –MMC were 46.9 and 53.5 respectively (p = 0.25). In the +MMC group, there were 6 recurrences (66.7%) with mean follow up of 27.5 months (range: 6 – 42), and one reported case of complete amniotic membrane melt leading to BCL placement. In the -MMC group, there were 3 recurrences (37.5%) with mean follow up of 28.5 months (range: 11 - 57). CLAU alone was performed in 3 cases, resulting in no recurrences (0%). MMC with AMT was performed in 6 cases, which resulted in 4 recurrences (66.7%). The differences in recurrence rates between the two groups were not statistically significant (+MMC vs. –MMC p = 0.35, CLAU vs. MMC/AMT p = 0.17).
Adjuvant use of MMC was not found to decrease the recurrence rate in recurrent pterygium and may be associated with complications. In addition, CLAU alone may be at least as efficacious as, and safer than, MMC with AMT in the treatment of recurrent pterygium. However, our sample size was small, and further investigation is on-going.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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