Elsevier

Ophthalmology

Volume 105, Issue 5, 1 May 1998, Pages 901-905
Ophthalmology

Intraoperative mitomycin C to prevent recurrence of pterygium after excision: A 30-month follow-up study12

Presented in part at the Annual Meeting of the American Academy of Ophthalmology, Atlanta, November, 1995.
https://doi.org/10.1016/S0161-6420(98)95034-5Get rights and content

Abstract

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 paterygium 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.

Section snippets

Materials and methods

A prospective, randomized, double-masked study to assess the effectiveness and complications of a single intraoperative dose of MMC at the concentration of 0.02% and 0.04% for 5 minutes was started in September 1992. Although excellent results were obtained, there were two cases of superficial scleral melting in the 0.04% group. To titrate the minimal effective dosage, another 72 pterygia were randomized into 2 groups, 1 with 0.02% MMC for 3 minutes and the other with 0.04% MMC for 3 minutes.

Results

One hundred seventy-seven pterygia in 148 eyes of 108 patients (all ethnic Chinese) were included in this study. There were 63 males and 45 females ranging from 23 to 80 years of age (mean, 54.2 years). One hundred forty-three were primary pterygia and 34 were recurrent pterygia. One hundred fifty-two of the pterygia were located nasally, 1 temporally, and 12 both nasally and temporally.

Recurrence of pterygium was defined as corneal encroachment of 1.5 mm or more. Postoperative follow-up ranged

Discussion

The success of pterygium surgery has been limited by its high rate of recurrence. Adjunctive treatments can achieve better outcome. However, many of these adjuncts are not without risks. Our results indicated that intraoperative MMC has a narrow therapeutic range. Application of 0.02% and 0.04% intraoperative MMC for 3 minutes was ineffective (groups D and E, Table 1). Whereas intraoperative MMC of 0.04% for 5 minutes was effective (group C, Table 1), it caused superficial scleral melting. Many

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    1

    The authors have no proprietary interest in any of the materials used in this study.

    2

    The protocol was approved by the ethics committee of the Chinese University of Hong Kong.

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