Comparative study of intraoperative mitomycin C and beta irradiation in pterygium surgery

Abstract

Aims-To compare the rate of recurrence and complication after surgery for primary pterygium performed by one surgeon using either intraoperative mitomycin C or irradiation. Methods-A retrospective study was performed of 164 eyes in 164 patients who had undergone primary pterygium surgery. After the pterygium was excised, the bare sclera was covered by sliding adjacent superior conjunctiva. 103 eyes received intraoperative mitomycin C (0.04%, 150 seconds) and 61 eyes irradiation (total dose 21.6 Gy). The mean follow up period was 20.2 (SD 17.9) months (range 1-66 months). Recurrence was defined as the postoperative regrowth of fibrovascular tissue crossing the corneoscleral limbus. Results-The recurrence rate after mitomycin C and irradiation was 8.74% and 23.0% of eyes, respectively, after mean follow up of 17.9 and 31.2 months, respectively. The Kaplan-Meier survival analysis revealed a significantly better outcome for those who had intraoperative mitomycin C (Mantel-Cox log rank analysis, p=0.031). The mean interval to recurrence was not significantly diVerent between the two groups. During the follow up, none of the patients showed side eVects or reactions related to mitomycin C or irradiation. Conclusions-The intraoperative administration of 0.04% mitomycin C is more eVective than irradiation as an adjunctive treatment for pterygium surgery in the patient population examined in this study. (Br J Ophthalmol 2000;84:618-621) Since pterygium frequently recurs after simple surgical removal, numerous surgical procedures and adjunctive measures have been devised to prevent the recurrence, including a sliding conjunctival flap to cover the pterygium excisional site,

Pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft

“…However, due to high recurrence rate with simple excision which could be as high as 40% in some cases, 3 the use of adjunct therapy such as beta radiation, antimetabolites such as mitomycin-C and 5-fluorouracil (5-FU), and conjunctiva autograft have been advocated. 4,5 Both mitomycin-C and 5-FU have been shown to cause a reduction in recurrence rate of pterygium but they are both potentially toxic to ocular tissues and have been associated with some complications. 6 Conjunctiva autograft on the other hand has been said to be free of complications and although takes longer to perform is said to be associated with little or no recurrence.…”

Eficácia do uso intraoperatório de mitomicina C na cirurgia do pterígio: análise de 102 casos

“…(2,3) Outras técnicas podem evoluir com baixa recidiva pós-cirurgia de pterígio, o transplante de membrana amniótica associada ao transplante de conjuntiva autólogo no tratamento do pterígio primário pode evoluir com recidivas de 2,0 a 7,89%. (13,14) CONCLUSÃO Houve um maior acometimento do pterígio em pacientes do sexo feminino neste estudo, o que está em concordância com outros estudos.…”

Strontium Beta-Irradiation: Can it Prove Strong Enough in Curbing the Ophthalmic Hydra Called Pterygium

“…Time factor becomes very pertinent in developing countries where patient to ophthalmologist ratio is negatively skewed, incidence of pterygium is high and potentially blinding diseases account for the bulk of surgical time. Comparative data for beta radiation and mitomycin C are conflicting with Amano et al suggesting superiority of mitomycin-C while Snibson et al and Simsek et al giving verdict in favour of beta irradiation [7][8][9][10].…”