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Editor,—Mitomycin C 0.02% has been shown to be highly effective in preventing the recurrence of pterygium following its surgical removal.1 2 The safest method of application and the optimal concentration have yet to be determined.
In this retrospective study, we evaluated 45 consecutive patients who underwent surgical removal of pterygium at the Barzilai Medical Center between January 1995 and January 1996. Patients’ ages at surgery ranged from 25 to 75 years (average 51 years). A bare sclera technique was employed in each case.
Patients were divided into two groups. At the end of surgery, patients in the treatment group (n=33) were treated by the application of a Weck cell, which was soaked in a solution of mitomycin C 0.02% and applied to the sclera at the site of the surgical bed for 2 minutes, followed by thorough irrigation with saline solution. Patients in the control group (n=12) did not receive treatment with mitomycin C.
Postoperative treatment included topical application of dexamethasone 0.1% four times a day, with gradual tapering off over the first month.
Between 5 and 13 months after surgery (average 8.3 (SD 3.3) months), 24 patients from the treatment group (73%) and 11 from the control group (92%) underwent a long term follow up examination. Recurrence of pterygium, defined as any growth of blood vessels crossing the limbus onto the cornea at the previous site of pterygium, was detected in six patients (25%) in the treatment group and in nine patients (82%) in the control group (p<0.005, Student’s t test).
Closure of epithelial defects in the surgical bed was completed during the first 2 weeks after surgery in both groups. Mild punctate epithelial staining, which was found in patients in the treatment group, resolved within 2 weeks. Mild ocular discomfort lasting for 3 months was reported by six patients (25%) in the treatment group only.
This study showed that a single application of mitomycin C 0.02% for 2 minutes at the end of pterygium surgery is safe for the eye and reduces the rate of recurrence compared with untreated control eyes (25%v 81%). Even lower recurrence rates (4%) and very few complications, all of them mild, were obtained by Frucht-Pery et al using a single application of mitomycin C 0.02% for 5 minutes at the end of surgery.2