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Bae, Kim, Lee, and Park: The Effectiveness of Mitomycin C on Pterygium Surgery with Amniotic Membrane Transplantation
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(2): 200-207.

Published online: 15 February 2012

DOI: https://doi.org/10.3341/jkos.2012.53.2.200

The Effectiveness of Mitomycin C on Pterygium Surgery with Amniotic Membrane Transplantation

Sung Geun Bae, MD, Jeong Kyu Kim, MD, Jin Ki Lee, MD, PhD, Dae Jin Park, MD

Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea.

Address reprint requests to Dae Jin Park, MD. Department of Ophthalmology, Daegu Fatima Hospital, #99 Ayang-ro, Dong-gu, Daegu 701-600, Korea. Tel: 82-53-940-7140, Fax: 82-53-954-7417, djoph2540@yahoo.co.kr

Received 25 May 2011       Accepted 13 December 2011

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To compare postoperative recurrence rates of pterygium surgery with amniotic membrane transplantation with and without mitomycin C.

Methods

A retrospective analysis of 45 eyes of 43 patients who underwent pterygium surgery with amniotic membrane transplantation with a minimum of six months of follow-up. Nineteen eyes underwent mitomycin C application, while the remaining 26 eyes did not. Recurrence rates and complications were evaluated.

Results

With a minimum of six months of follow-up, fibrovascular tissue in the excised area not invading the cornea (conjunctival recurrence) was noted in two eyes (10.5%), and fibrovascular tissue invading the cornea (corneal recurrence) was noted in one eye (5.4%) in the amniotic membrane transplantation with mitomycin C group. Conjunctival recurrence was noted in six eyes (23.1%) and corneal recurrence in three eyes (11.5%) in the amniotic membrane transplantation without mitomycin C group. Recurrence rate in the amniotic membrane transplantation with mitomycin C group (15.9%) was significantly lower (p = 0.014) than that in the amniotic membrane transplantation without mitomycin C group (34.6%). Complications included sub-amniotic membrane hemorrhage in two eyes, granuloma in one eye, and wound dehiscence in one eye in each group. There were no specific complications related to usage of mitomycin C.

Conclusions

In pterygium surgery with amniotic membrane transplantation, application of mitomycin C is an effective method to reduce recurrence rates, especially conjunctival recurrences that are related to cosmetic problems. This method may also be helpful to reduce patient discomfort.

Keywords: Amniotic membrane transplantation, Mitomycin C, Pterygium, Recurrence rate

Figures and Tables

Figure 1
Classification of pterygium. (A) Grade T1 (atrophic), episcleral vessels are unobscured. (B) Grade T2 (intermediate), episcleral vessels are partially obscured. (C) Grade T3 (fleshy), episcleral vessels are totally obscured.
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Figure 2
This procedure was performed as fellows; (A) Episcleral traction sutures were placed. (B) Excision and blunt dissection of pterygium from the cornea and sclera by using conjunctival scissors. (C) Remnant pterygium of the cornea was dissected off by corneal forceps. (D) Wide excision of the subconjunctival Tenon's tissue was done by the Ellman cautery. (E) 0.02% Mitomycin C soaked cotton swabs were applied at excision site. (F) Amniotic membrane is peeled off from the carrier paper and spread over the cornea. (G) The amniotic membrane was sutured to the episclera and conjuctiva to facilitate regeneration of the conjunctiva over the amniotic membrane.
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Figure 3
These figures showed the two kinds of recurrent pterygium. (A, B) Grade 2, fibrovascular tissue in the excised area, reaching to the limbus, but not invading the cornea (conjunctival recurrence). (C, D) Grade 3, fibrovascular tissue invading the cornea (corneal recurrence).
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Figure 4
Complications of pterygium excision with amniotic membrane transplantation. (A) Sub-amniotic membrane hemorrhage. (B) Wound gapping (arrow). (C) Granuloma.
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Table 1
Comparison of recurrence rate with various previous reports
jkos-53-200-i001

Values are presented as number (%).

AMT = aniotic membrane transplantation; MMC = mitomycin C; CAU = conjunctival autograft.

*No recurrence; †Episcleral vessels without fibrovascular tissue; ‡Conjunctival recurrence; §Corneal recurrence.

Table 2
Characteristics of patients
jkos-53-200-i002

AMT = amniotic membrane transplantation; MMC = mitomycin C.

*Grading system by Tan et al.14

Table 3
Comparison of recurrence rates according to the surgical method
jkos-53-200-i003

Values are presented as number (%).

AMT = amniotic membrane transplantation; MMC = mitomycin C.

*Measured by Wilcoxon signed rank test; †No recurrence; ‡Episcleral vessels without fibrovascular tissue; §Conjunctival recurrence; ΠCorneal recurrence.

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