Safety and Efficacy of Intraoperative Mitomycin C During Conjunctival Autograft to Prevent Recurrence in Patients with Primary Pterygium and High Risk of Recurrence

Abstract

Abstract: : Purpose: Patients with fleshy Pterygium have high risk of recurrence. Mitomycin C (MMC) inhibits the growth of fibroblast and therefore reduces the fibrovascular tissue and might prevent recurrence of pterygium. We would like to demonstrate whether if the use of intraoperative MMC with conjunctival autograft is safe and effective to prevent recurrence in patients with primary fleshy pterygium. Methods: Fifty eight patients (58 eyes) with primary nasal pterygium and severe fibrovascular tissue (fleshy appearance) were prospectively included. Twenty eight eyes received conjunctival autograft alone and 30 eyes received MMC (0.02 % for 1 minute) with conjunctival autograft. Both groups were matched according to sex, age and severity of corneal invasion of pterygium. Pterygium invasion to cornea were graded from 1 to 3. Grade 1 were pterygium that reached less one quarter of the cornea, grade 2 the pterygium invasion were between quarter and center of the corneal and grade 3 the pterygium invasion were more than corneal central axis. Results: Twenty seven women and 31 men with mean age of 40.3 years old (ranging from 25 to 85 years old) were included. Nineteen eyes and 9 eyes had pterygium grade 1 and 2, respectively and were treated with conjunctival autograft alone. Twenty three eyes and 7 eyes had pterygium grade 1 and 2, respectively and were treated with MMC/conjunctival autograph. There were no patients with pterygium grade 3. The mean follow– up period was 12 months (ranging from 9 to 20 months). Six eyes (20%) recurred in the conjunctival autograft group and 2 eyes (6.2%) in the MMC/conjunctival autograft group, but it was not statistically significant (Fisher's exact Test, P= 0.13). All recurrences occurred before 3 months. There was no statistically difference in the grade of invasion of pterygium in both groups (Fisher's exact Test, P=0.6). In patients treated with MMC the conjunctival autograft became the invading pterygium with minimal fibrovascular tissue, compared with recurrence pterygium in cojunctival autograft alone in which the fleshy and inflamed appearance persisted. There were minimal complications in both groups such as foreign body sensation, photophobia and epithelial cyst that resolved spontaneously in less than 15 days. Conclusions: The use of MMC reduces the fibrovascular component in all primary pterygium and it was as safe and effective as conjunctival autograft alone to prevent the recurrence of pterygium.

Keywords: Pterygium • cornea: clinical science • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials