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Preoperative MMC proves safe, effective for pterygium treatment
Am J Ophthalmol. 2010;150(2):193-198.
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Subconjunctival injection of mitomycin C proved safe and effective in treating primary pterygium 1 month before excision surgery, a study showed.
Investigators set out to compare two surgical approaches: preoperative MMC injection with subsequent bare scleral excision and intraoperative MMC with conjunctival rotational flap. They pointed to a dearth of conclusive data on the appropriate choice of pterygium removal method.
"We can conclude that subconjunctival injection of MMC 1 month before the bare scleral excision of pterygium is a simple and quick surgical procedure and is at least as effective as a conjunctival rotational flap with intraoperative MMC application in terms of recurrence and complication rate for primary pterygium treatment," the study authors said. "However, studies with a larger sample size, longer follow-up period, and more diverse patient population should be designed for evaluation of long-term success and potential complications in a more comprehensive clinical situation."
The prospective, randomized clinical trial included 82 eyes diagnosed with primary pterygium and assigned to two groups. The first group comprised 36 eyes that underwent subconjunctival injection of 0.02% MMC 1 month before bare scleral incision. The second group included 46 eyes that had conjunctival rotational flap with intraoperative MMC for 2 minutes.
Mean patient age was 48.48 years. Minimum follow-up was 12 months (range: 12 to 18 months).
Study results showed that at 12 months, there was no clinically significant recurrence of pterygium in the first group; two recurrences occurred in the second group. However, the between-group difference in recurrence rate was statistically insignificant.
We first described the use of subconjunctival mitomycin C for the treatment of pterygia in Ophthalmology in 2003. The concern with mitomycin C has always been toxicity and preventing damage to the epithelial stem cells. Subconjunctival mitomycin C applies the medication directly to the activated fibroblasts rather than to bare sclera and allows the exact delivery of medication rather than a non-controlled topical delivery. This study further supports the use of preoperative subconjunctival mitomycin followed by bare sclera excision as a simple and cost effective treatment of pterygia.
– Eric D. Donnenfeld, MD
OSN
Cornea/External Disease Board Member
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