Intraoperative mitomycin in primary pterygium excision. A prospective, randomized trial.
PURPOSE: Conjunctival autograft transplantation and postoperative mitomycin therapy are two adjuvant treatment methods shown to lessen the high pterygium recurrence rate seen with simple excision alone. The authors conducted a prospective, randomized study comparing these two techniques with a relatively new treatment method using intraoperative mitomycin application. METHODS: Fifty patients with 56 primary pterygia were randomized to 1 of 3 treatment groups: conjunctival autograft (group 1), postoperative mitomycin 0.2 mg/ml four times a day x 7 days (group 2), and intraoperative mitomycin 0.4 mg/ml x 3 minutes (group 3). The mean follow-up time was 16 months (range, 6 to 28 months). RESULTS: Recurrences developed in 4 (22.2%) of 18 eyes in group 1, 4 (21.1%) of 19 eyes in group 2, and 2 (10.5%) of 19 eyes in group 3. Complications developed in two, patients from group 2, scleral thinning managed successfully with a scleral patch graft, and epithelial toxicity that resolved on discontinuation of mitomycin on postoperative day 6. There were no complications in the other two groups. CONCLUSIONS: Intraoperative mitomycin is a simple and effective alternative to postoperative mitomycin therapy, showing the lowest recurrence rate in their series with no toxicity during the study period. If the decision is made to use adjunctive mitomycin, the authors recommend intraoperative application over postoperative administration.