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Oh and Kim: The Effect of Preoperative Subconjunctival Injection of Mitomycin C and Triamcinolone in Recurrent Pterygium
Original Article

J Korean Ophthalmol Soc 2009;50(7):1005-1014.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.7.1005

The Effect of Preoperative Subconjunctival Injection of Mitomycin C and Triamcinolone in Recurrent Pterygium

Ji Hye Oh, MD, Hong Kyun Kim, MD, PhD

Department of Ophthalmology, Kyungpook National University, School of Medicine, Daegu, Korea

Address reprint requests to Hong Kyun Kim, MD, PhD Department of Ophthalmology, Kyungpook National University Hospital #50 Samduk 2-ga, Jung-gu, Daegu 700-721, Korea Tel: 82-53-420-5816, Fax: 82-53-426-6552, E-mail: okeye@hanmir.com

Received 29 December 2008       Accepted 23 April 2009

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effect of a preoperative subconjunctival injection of mitomycin C or triamcinolone in patients with recurrent pterygium.

Methods

The records of 50 eyes of 50 patients who received excision of recurrent pterygium between June 2006 and January 2007 were reviewed. The recurrence rate and postoperative fibrovascular growth were compared in the preoperative subconjunctival mitomycin C, or triamcinolone injection group and non-treated control group. Additionally, the quantitative expression level of the transforming growth factor-β1, −β2 (TGF-β1, −β2), connective tissue growth factor (CTGF), and vascular endothelial growth factor (VEGF) in excised sample of the pterygium was assessed.

Results

There was no statistically significant difference in the recurrence rate and the relative gene expression level of growth factors in the triamcinolone group and the mitomycin group when compared with the non-treated control group. Postoperative fibrovascular proliferation was more severe in the triamcinolone group than other groups.

Conclusions

Subconjunctival mitomycin C or triamcinolone as adjunctive therapy before pterygium excision did not influence the recurrence rate of pterygium.

Keywords: Adjunctive treatment, Pterygium, Mitomycin C, Subconjunctival injection, Triamcinolone

References

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Figure 1.
(A) The preoperative slit lamp photograph captured by image capture system. (B) Converted image by computer program (Photoshop CS2®, Adobe sys, Inc. USA) to compare the vascularity of each pterygial tissue.
jkos-50-1005f1.tif
Figure 2.
Standard Photographs classified by the pterygial thickness. (A) T1, minimal elevation with definite confirmation of episcleral vessel in most of the elevated area. (B) T2, moderate elevation, episcleral vessel can be found in some of the elevated area. (C) T3, marked elevation, episcleral vessel cannot be found because of the pterygial fleshiness.
jkos-50-1005f2.tif
Figure 3.
Standard Photographs classified by the pterygial vascular proliferation. (A) V0, no directional vascular pattern. (B) V1, minimal vascularization with unidirectional pattern. (C) V2, moderate vascularization with unidirectional and enlarged vessels (D) V3, marked vascularization with unidirectional, engorged vessels.
jkos-50-1005f3.tif
Figure 4.
The mRNA expression profile (mean) relative to actin mRNA expression in pterygial tissue according to the preoperative treatment (TGF-β1, −β2=transforming growth factor-β1, β2; CTGF=connective tissue growth factor; VEGF=vascular endothelial growth factor). There were no statistical difference between groups in each parameters (Mann-Whitney U test, p>0.05).
jkos-50-1005f4.tif
Table 1.
The standard grading system of pterygium based on the photography captured by image capture system
Location (L)
L1 abnormal fibrovascular tissues were confined conjunctival area
L2 abnormal fibrovascular tissues were located in the limbal area (≤ 1.0 mm from the limbus)
L3 abnormal fibrovascular tissues were encroached over the limbal area (> 1.0 mm from the limbus)
Thickness (T)
T0 no elevation
T1 minimal elevation with definite confirmation of episcleral vessel in most of the elevated area
T2 moderate elevation, episcleral vessel can be found in some of the elevated area
T3 marked elevation, episcleral vessel cannot be found because of the pterygial fleshiness
Vascularity (V)
V0 no directional vascular pattern
V1 minimal vascularization with unidirectional pattern
V2 moderate vascularization with unidirectional and enlarged vessels
V3 Marked vascularization with unidirectional, engorged vessels
Table 2.
Demographic data and preoperative severity score
Non-treated group (A) Preoperative MMC* group (B) Preoperative TA† group (C) p value‡
A-B A-C B-C
Eye (numbers) 20 8 22
Sex (Male/Female) 6/14 4/4 8/14
Age (Years) 56.85±9.74 52.38±18.52 50.82±9.58
Severity score
Thickness 2.65±0.49 2.88±0.35 2.64±0.49 0.381 0.927 0.344
Vascularization 2.70±0.47 3.00±0.00 2.68±0.48 0.237 0.900 0.202
Location 3.00±0.00 3.00±0.00 2.95±0.21 1.000 0.340 0.872
Total 8.35±0.81 8.88±0.35 8.27±0.76 0.165 0.680 0.070

* MMC=mitomycin

† TA=triamcinolone

‡ Obtained by Mann-Whitney U test.

Table 3.
Postoperative fibrovascular proliferative score and recurrence rate
Non-treated group (A) Preoperative MMC* group (B) Preoperative TA† group (C) p value§
A-B A-C B-C
Post-op‡ score
Thickness 0.70±0.98 0.63±1.19 1.50±1.14 0.709 0.021 0.087
Vascularization 0.65±0.88 0.50±1.07 1.73±1.16 0.601 0.003 0.024
Location 0.65±0.88 0.63±1.19 1.36±1.09 0.746 0.026 0.078
Total 2.0±2.63 1.75±3.41 4.59±2.87 0.709 0.004 0.045
Post-Op‡ recurrence rate
minimal recurrence (%) 5/20 (25%) 2/8 (25%) 8/22 (36%)
Recurrence demanding 0/20 (0%) 1/8 (12.5%) 1/22 (4.5%)
reoperation (%)

* MMC=mitomycin

† TA=triamcinolone

‡ Post-op=post operation

§ Obtained by Mann-Whitney U test.

Table 4.
The mRNA expression profile (mean± SD) relative to actin mRNA expression in pterygial tissue according to the preoperative treatment
TGF-β1 TGF-β2 CTGF VEGF
Preoperative no treatment Group(A) 0.40±0.31 0.83±0.67 0.51±0.49 0.62±0.63
Preoperative mitomycin Group (B) 0.55±0.28 0.69±0.45 0.85±0.29 0.17±0.12
Preoperative triamcinolone Group (C) 0.63±0.47 0.73±0.31 0.68±0.46 0.82±0.78
p value*
A-B 0.416 0.691 0.075 0.301
A-C 0.176 0.630 0.275 0.325
B-C 0.824 0.866 0.391 0.056

* Obtained by Mann-Whitney U test.

TGF-β1, −β2=transforming growth factor-β1, β2; CTGF=connective tissue growth factor; VEGF=vascular endothelial growth factor. There were no statistical difference between groups in each parameters (Mann-Whiteny U test, p>0.05).

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