Pterygium surgery with mitomycin and tarsorrhaphy.
OBJECTIVE
To determine if a pterygium surgical procedure consisting of minimal conjunctival removal, excision of the hypertrophic subconjunctival fibrovascular tissue, application of mitomycin 0.25 mg/mL for 1 minute combined with temporary nasal tarsorrhaphy, and use of postoperative dexamethasone/antibiotic drops achieves the following: safely simplifies pterygium removal, controls the early side effects of mitomycin, reduces the rate of recurrence, and lessens the need for conjunctival transplantation.


METHODS
Twenty eyes in 19 patients underwent the procedure with use of mitomycin; 15 eyes had primary and 5 had recurrent pterygia. These were compared with a previous group of 28 eyes in 26 patients that underwent pterygium/tarsorrhaphy surgery without use of mitomycin; 20 eyes had primary and 8 had recurrent pterygia. Postoperatively, all eyes in both groups were treated with dexamethasone/antibiotic drops.


RESULTS
In the mitomycin group, with an average follow-up of 12.1 months, 19 eyes healed uneventfully; there have been no recurrences. The nonmitomycin group, with an average follow-up of 42.6 months, has had nine recurrences (32%); four required a second procedure. Recurrence was significantly lower in the mitomycin group (P = .006). Conjunctival healing, as reflected in the time from surgery until tarsorrhaphy opening, was significantly delayed in the mitomycin group, 36.7 versus 17 days (P = .001). The delay in conjunctival healing may explain the complications associated with the use of mitomycin in pterygium surgery.


CONCLUSIONS
Minimal conjunctival removal, extensive fibrovascular tissue excision, 1-minute application of mitomycin 0.25 mg/mL, temporary nasal tarsorrhaphy, and frequent application of dexamethasone/antibiotic drops postoperatively provided a safe and successful approach to pterygium management in this series.
Wood
Thomas O
TO
University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Williams
Ellen E
EE
Hamilton
Danielle L
DL
Williams
Bryan L
BL
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005143:Eyelids / Q000601:surgery*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000009:adverse effects / Q000627:therapeutic use*; D019384:Nucleic Acid Synthesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects; D011182:Postoperative Care; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control; D011625:Pterygium / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D055502:Secondary Prevention
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin; D003907:Dexamethasone