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
a Fundación Santa Fe de Bogotá, Bogotá,
Colombia, b University of South
Florida Eye Institute, Tampa, Florida, USA
Correspondence to: Juan Camilo Sánchez-Thorin, MD, Avenida 9 No 117
20 (401),
Bogotá, Colombia.
Accepted for publication 19
January 1998
BACKGROUND/AIMS
Bare sclera resection with
and without use of mitomycin C and conjunctival autograft placement are
three surgical techniques currently in use for the treatment of primary
pterygium. The purpose of this study was to determine through a
meta-analysis the risk for postoperative pterygium recurrence comparing
the three surgical treatment modalities.
METHODSA search through Medline for randomised
controlled clinical trials comparing at least two of the three surgical
techniques in the treatment of primary pterygium, along with a hand
search of all references in relevant papers, was conducted. All
eligible clinical trials were graded for quality utilising the Detsky
score; those studies with a score of 0.5 or greater were included. The main outcome measurements were the pooled odds ratios and 95% confidence intervals for the risk of pterygium recurrence. These were
calculated utilising the Mantel-Haenszel method.
RESULTSFive eligible studies with an adequate
quality score were retrieved, three comparing bare sclera resection
with and without mitomycin C use, one comparing bare sclera resection
with conjunctival autograft placement, and one comparing both. The
pooled odds ratio for pterygium recurrence in patients who had only
bare sclera resection was 6.1 (95% confidence intervals, 1.8 to 18.8)
compared with the patients who had conjunctival autograft placement and 25.4 (9.0 to 66.7) compared with the patients who received mitomycin C.
CONCLUSIONSThe odds for pterygium recurrence
following surgical treatment of primary pterygium are close to six and
25 times higher if no conjunctival autograft placement is performed or
if no intra/postoperative mitomycin C is used, respectively. Surgeons
and clinical triallists should not be encouraged in the use of bare
sclera resection as a surgical technique for primary pterygium.
© 1998 by British Journal of Ophthalmology
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