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Abstract
Purpose
To evaluate the effectiveness of Mitomycin C used as a combined therapy along with limbal-conjunctival autograft for primary pterygium.
Methods
Thirty eyes of 29 patients received Mitomycin C (0.02% MMC 3 minutes) with limbal-conjunctival autograft, and 30 eyes of 28 patients received limbal-conjunctival autograft alone. Recurrence and complications were evaluated in the patients at 2 weeks, 1, 3, 6 and 12 months postoperatively.
Results
Mean follow-up periods were 13.4±2.1 and 13.9±2.9 months, respectively. Between the two groups, recurrence in the conjunctiva or the cornea was not observed during the follow-up period. In the Mitomycin C use group, complications included a granuloma at the donor site (1 eye, 3.3%), wound dehiscence (2 eyes, 6.7%), and subgraft hemorrhage (2 eyes, 6.7%). In comparison, in the group treated with limbal-conjunctival autograft alone, complications included granuloma at the donor site (1 eye, 3.3%), pseudopterygium at the donor site (1 eye, 3.3%), wound dehiscence (3 eyes, 10%), and subgraft hemorrhage (2 eyes, 6.7%).
References
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Figure 1.
Dashed line is extensive excision profiles of a pterygium. The extensive excision was designed to resect the maximum surface of pterygium, while preserving the conjunctiva.
Figure 2.
The photograph of the anterior segment on day 1 after pterygium excision and superior limbal conjunctival autograft transplantation with temporary amniotic membrane patch. Under the temporary amniotic membrane transplantation, notice the relatively low inflammatory appearance of the eye, well-positioned graft and reestablishment of the normal limbal architecture.
Figure 3.
Left column (A, B: Limbal-conjunctival autograft without 0.02% MMC, C, D: Limbal-conjunctival autograft with 0.02% MMC) Images of preoperative fleshy grade 3 nasal primary pterygium. Right column (E, F: Limbal-conjunctival autograft without 0.02% MMC, G, H: Limbal-conjunctival autograft with 0.02% MMC) Images of the LCAT of the same patients 6 months after the surgery. Well-positioned graft and reestablishment of the normal limbal architecture are observed with no signs of recurrences in all subjects. Notice: The lack of scar on the donor and recipient conjunctiva due to the use of bioadhesives, and the cosmetic advantage due to appropriate size of conjuctival flap after extensive pterygium excision are apparent.
Figure 4.
Postoperative complications. (A) Granuloma at donor site. (B) Wound dehiscence (arrowhead). (C) Excessive fibrovascular tissue proliferation at donor site (similar to pseudopterygium). (D) Subgraft hemorrhage.
Table 1.
Previous reports of conjunctival autografts combined MMC
| Author (s) | Pterygium type | Number of Eyes | Type of surgery (MMC%, minutes) | Recurrence Rate (%) | Mean follow-up (months) | Donor Site of CAT* |
|---|---|---|---|---|---|---|
| Wong et al32 | Primary | 98 | CAT | 18% | 12 | Superior |
| | | 76 | CAT&MMC† | 9% | 12 | |
| | | | (0.025%, 1 min) | | | |
| Mutlu et al33 | Recurrent | 41 | LCAT‡ | 14.6% | 16±1.9 | Superotemporal |
| | | 40 | CAT&MMC | 12.5% | 15.5±1.5 | Superior |
| | | | (0.02%, 3 min) | | | |
| Frucht-Pery | Primary | 30 | CAT&MMC | 0% | 21.3±2.4 | Superior |
| et al34 | | | (0.02%, 1 min) | | | |
| | | 30 | MMC (0.02%, 3 min) | 6.6% | 31.5±3.4 | |
| | | 30 | CAT | 13.3% | 29.3±2.5 | Superior |
| | | 30 | Bare sclera | 46.6% | 36.2±2.8 | |
| This study | Primary | 30 | LCAT&MMC | 0% | 13.4±2.1 | Superior |
| | | | (0.02%, 3 min) | | | |
| | | | + TAMP§ | | | |
| | | 30 | LCAT+TAMP | 0% | 13.9±2.9 | Superior |
Table 2.
Demographic data of patients in the two study groups
| | LCAT*+MMC† group‡ | LCAT group | p |
|---|---|---|---|
| No. of eyes (patients) | 30 (29) | 30 (28) | |
| Age (years) | 56.9±7.8 | 59.6±8.5 | 0.217§ |
| Range | (44–71) | (45–72) | |
| Gender | | | 0.559Π |
| Male | 9 (32.0%) | 7 (30.8%) | |
| Female | 21 (68.0%) | 23 (69.2%) | |
| Follow-up (months) | 13.4±2.1 | 13.9±2.9 | 0.487§ |
| Grade# | | | 0.194Π |
| T1 / T2 / T3 | 0 / 11 / 19 | 0 / 17 / 13 | |
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