Low-dose intraoperative mitomycin-C versus conjunctival autograft in primary pterygium surgery: long term follow-up.
OBJECTIVE
To evaluate and compare the long term safety and efficacy of low-dose intraoperative application of mitomycin-C (0.02%) with conjunctival autograft in primary pterygium surgery.


METHODS
Of 37 consecutive patients 41 eyes with primary pterygium underwent pterygium excision with either intraoperative mitomycin-C (0.02%) (Group I) or conjunctival autografts (Group II) at random. Mitomycin-C (0.2 mg/mL) was applied for 2.5 minutes on the scleral bed under the conjunctiva. Conjunctival autograft was obtained from upper temporal limbus and secured with 10-0 monofilament nylon. The follow-up period ranged from 14 to 54 months (mean 36 months) for mitomycin-C group and 13 to 58 months (mean 38 months) for conjunctival autograft group.


RESULTS
Twenty-one eyes underwent pterygium excision with intraoperative mitomycin-C (0.02%) application (Group I) and 20 eyes were treated using conjunctival autograft (Group II). The mean size of the pterygium was 3.80 mm (range 2.6 to 4.8 mm) in the mitomycin-C group and 3.60 mm (range 2.5 to 4.5 mm) in the conjunctival autograft group. Two (9.52%) eyes treated with intraoperative mitomycin-C had delayed epithelial healing of corneoscleral wound and one (4.76%) eye developed pyogenic granuloma. Three (14.3%) of the 21 eyes in Group I and one (5%) of 20 eyes in Group II had recurrence of pterygium (P = 0.3174). All recurrences occurred in patients below 40 years of age (P = 0.0384).


CONCLUSIONS
We conclude that conjunctival autograft and intraoperative mitomycin-C are both equally effective adjuncts to primary pterygium surgery on long term follow-up. However, future prospective studies with larger numbers of subjects may be carried out to find out the optimum concentration and duration of intraoperative mitomycin-C application.
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. eyepgi@ch1.dot.net.in
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Sharma
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Gupta
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Ram
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Gupta
D000328:Adult; D000477:Alkylating Agents / Q000008:administration & dosage*; D003228:Conjunctiva / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D011625:Pterygium / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D012449:Safety; D055502:Secondary Prevention; D014182:Transplantation, Autologous; D014945:Wound Healing / Q000187:drug effects
D000477:Alkylating Agents; D009883:Ophthalmic Solutions; D016685:Mitomycin