Comparison of Surgical Techniques for Pterygium Using Mitomycin-C or 5-Fluorouracil as Adjuncts

Abstract

To compare surgical techniques for pterygium using mitomycin-C/5-fluorouracil as adjunct to surgery. SETTINGS AND DESIGN: A randomized, interventional, prospective, comparative study was conducted in Department of Ophthalmology, S.N Medical College, Agra for 2 years. MATERIALS AND METHODS: Patients underwent complete preoperative evaluation (complete history and ophthalmological examination). Ninety-eight eyes of 98 selected cases were divided into eight groups depending upon treatment protocol: I-Mitomycin-C (0.02%) with bare sclera II-Mitomycin-C (0.04%) with bare sclera III-Mitomycin-C (0.02%) with conjunctival autograft IV-Mitomycin-C (0.04%) with conjunctival autograft V-5-fluorouracil (10mg/ml) with bare sclera VI-5-fluorouracil (20mg/ml) with bare sclera VII-5-fluorouracil (10mg/ml) with conjunctival autograft VIII-5-fluorouracil (20mg/ml) with conjunctival autograft STATISTICAL ANALYSIS: Chi-square test was used to compare the outcome. RESULTS: Of 98 cases, 61 (62.24%) were male, 37 (37.75%) were female. The age ranged 18-66 years, with mean age of 44.6 years. Maximum cases were in age group 41-50 (48.98%). Seventy-nine (80.61%) had primary pterygium while 19 (19.39%) cases had recurrence. 74.49% were from rural area and 25.51% from urban background. 75.51% were outdoor workers while 24.49% were indoor workers. Involvement was bilateral in 71 (72.45%) cases. Ninety-five (96.94%) cases had nasal pterygium and 3 (3.06%) had both nasal and temporal. Most patients (73.47%) presented with complaint of ʿ growth in eyeʿ , followed by redness/congestion (16.33%). At reporting, corneal involvement in majority (64.28%) was 1-3 mm, and most patients (53.06%) consulted between 6-12 months of onset. The success rates, recurrence rates and ocular complications varied in various groups. The success rate was maximum (100%) in group-IV and minimum (72.73%) in group-V. Within mitomycin-C groups, conjunctival autograft revealed better results against bare sclera technique. No significant difference existed between low and high concentration groups with mitomycin-C or 5-fluorouracil, and even the mitomycin-C versus 5-fluorouracil groups. Groups IV and VIII revealed higher rate of complications including graft-injection and retraction (46.15% and 23.07% in Group-IV, and 61.54% and 23.07% in group-VIII), hematoma (23.07% and 30.77% in group-IV and VIII respectively), dryeye (15.38% and 7.69% in group-IV and VIII), granulation-tissue formation (7.69% in both), and scleral-thinning (7.69% in group-IV).

Two Newer Methods of Pterygium Surgery- A Comparative Study

“…Age group of 41 -50 years consists of 36.66% patients and 26.66% patients in the age group of 51-60 years. Gazzard et al 7 in their study found that prevalence rates of pterygium in subjects over 51 years were 6 times higher than of 21-30 years age group.…”

“…4,5,6 Both the agents prevents pterygium recurrence by inhibiting fibroblast proliferation and contraction at the level of episclera. 7 However intraoperative use of mitomycin-c is sometimes associated with vision threatening complications like glaucoma, corneal oedema, corneal perforation, scleral melting and cataract formation. 8 Although some studies reported conjunctival and corneal necrosis, superficial keratitis, scleral granuloma with intraoperative use of 5-FU.…”

“…8 Although some studies reported conjunctival and corneal necrosis, superficial keratitis, scleral granuloma with intraoperative use of 5-FU. 7 The newer technique, subconjunctival injection of 5-fluorouracil allows exact dose delivery directly to the activated fibroblasts in subconjunctival space, where it can work directly on cells responsible for pterygium recurrence. 9 Purpose of this study was to find out whether 1) A simpler technique like subconjunctival injection of 5-fluorouracil one day before pterygium excision with bare sclera technique gives result comparable to conjunctival autograft in terms of recurrence rate and other complications 2) Whether this technique is associated with complications like ocular surface toxicity seen with its intraoperative application and with the use of mitomycin-c in pterygium surgery.…”

"The use of Fentanyl Patches in the Management of Post- Operative Pain in Pterygium Surgery"

“…Although all techniques provide excellent intraoperative analgesia, even the long-acting agents provide limited postoperative analgesia. Adjunctive measures to reduce postoperative pain have been studied including the use of tissue glue as a fixation method, patching or bandage contact lens, or topical therapeutic agents such as lidocaine gel, cyclopentolate and bupivacaine postoperatively [15][16][17][18]. The same surgeon, surgical technique, fixation method of primary sutures and post-operative care plan was used to reduce influence of these confounding factors which studies have analysed can impact post-operative management [19][20][21].…”