Prevention of Recurrence of Pterygium after Surgery

A systematic review 1 including 5 RCTs with a total of 286 eyes was abstracted in DARE. OR for postoperative pterygium recurrence with bare sclera resection as compared to sclera resection with mitomycin C was 25.4 (95% CI 9.02 to 66.69). Bare sclera resection compared to conjunctival autograft replacement: OR 6.1 (95% CI 1.82 to 18.75).

A prospective, controlled clinical trial was performed in which 123 primary and 34 recurrent pterygia were randomized to 2 separate groups to undergo either bare sclera excision or conjunctival autografting 2. In the group with primary pterygium (mean follow-up, 15.1 months), 38 (61%) of the 62 cases of bare sclera excision showed recurrence of pterygium in contrast to 1 (2%) of the 61 cases of conjunctival autograft (P < 0.001, likelihood ratio X² test). Non-translucency, or fleshiness of the pterygium was a significant risk factor for recurrence in the bare sclera group (P < 0.001, likelihood ratio X² test). In the group with recurrent pterygium (mean follow-up, 13.2 months), 14 (82%) of the 17 bare sclera group showed recurrence of pterygium, while no recurrences occurred among the 17 cases in the conjunctival autograft group. Non-translucency was again a highly significant factor for recurrence (P < 0.001, likelihood ratio X² test).

In a prospective randomized and double-blind study of 50 eyes (50 patients) with primary progressive pterygium, mitomycin C at a concentration of 0.02 mg/mL soaked in a sterile 5 x 5 mm sponge and applied over the bare sclera intraoperatively was compared with gentamicin solution (0.3%) 3. Three eyes (12%) in the mitomycin C group showed recurrence within 7 months of surgery compared with eight eyes (32%) in the gentamicin control group within 3 to 5 months.

In a retrospective analysis of fifty eyes in forty-nine patients who underwent pterygium excision by the same surgeon topical mitomycin C (0.05%) applied to pterygium and adjacent areas after undermining and separation from sclera but prior to excision for three minutes 4. Postoperative follow up time was 12 months. The pterygium recurred in 4 (8%) eyes. Another four eyes (8%) had a cosmetically acceptable recurrence of < 2.0 mm. The only complication was a corneal dellen in one eye.

References

• Sánchez-Thorin JC, Rocha G, Yelin JB. Meta-analysis on the recurrence rates after bare sclera resection with and without mitomycin C use and conjunctival autograft placement in surgery for primary pterygium. Br J Ophthalmol 1998 Jun;82(6):661-5. [PubMed] [DARE]
• Tan DT, Chee SP, Dear KB, Lim AS. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol 1997 Oct;115(10):1235-40. [PubMed]
• Panda A, Das GK, Tuli SW, Kumar A. Randomized trial of intraoperative mitomycin C in surgery for pterygium. Am J Ophthalmol 1998 Jan;125(1):59-63. [PubMed]
• Rodriguez JA, Ferrari C, Hernández GA. Intraoperative application of topical mitomycin C 0.05% for pterygium surgery. Bol Asoc Med P R 2004 Mar-Apr;96(2):100-2. [PubMed]