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Brian Tieu, Manuj Kapur; Effectiveness and safety of intralesional injection of 0.01 mg Mitomycin C one month prior to bare sclera excision for pterygium treatment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5439.
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Mitomycin C (MMC) is an anti-metabolite with radiomimetic properties that is used as an adjuvant in pterygium excisions to reduce recurrence; however, it can cause many side effects particularly at high doses. Previous studies have shown that injection of 0.15 to 0.2 mg/mL MMC one month prior to bare sclera excision results in low recurrence rates, but may result in some complications. The purpose of this study was to determine if the lowest effective concentration of 0.1 mg/ml MMC injected intralesionally can maintain low recurrence rates and be potentially safer.
A retrospective case review was performed of patients who underwent bare sclera pterygium excision one month after intralesional injection of 0.01 mg MMC. The cases were evaluated for complications including dellen, persistent corneal epithelial or conjunctival defect, intraocular pressure spikes, scleral thinning, and recurrence of disease, which was defined as re-growth of fibrovascular tissue greater than 1 mm past the limbus. Surgical specimens also were reviewed for significant changes.
Eleven patients underwent this procedure and were followed post-operatively for at least 6 months. No recurrences have been noted nor major complications. Histopathological analysis of the excised tissue showed less vascularization.
Intralesional injection of a lower dose of MMC one month prior to bare sclera excision may be as or more effective than higher doses, but possibly safer overall with exposure to less of the anti-metabolite.
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