METAANALYSIS ON THE RECURRENCE RATES AFTER BARE SCLERA RESECTION WITHAND WITHOUT MITOMYCIN-C USE AND CONJUNCTIVAL AUTOGRAFT PLACEMENT IN SURGERY FOR PRIMARY PTERYGIUM

Background/aims-Bare sclera resection with and without use of mitomyci n 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 po stoperative pterygium recurrence comparing the three surgical treatmen t modalities. Methods-A search through Medline for randomised controll ed clinical trials comparing at least two of the three surgical techni ques in the treatment of primary pterygium, along with a hand search o f all references in relevant papers, was conducted. All eligible clini cal trials were graded for quality utilising the Detsky score; those s tudies 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. Results-Five eligible studies with an adeq uate quality score were retrieved, three comparing bare sclera resecti on with and without mitomycin C use, one comparing bare sclera resecti on with conjunctival autograft placement, and one comparing both. The pooled odds ratio for pterygium recurrence in patients who had only ba re sclera resection was 6.1 (95% confidence intervals, 1.8 to 18.8) co mpared with the patients who had conjunctival autograft placement and 25.4 (9.0 to 66.7) compared with the patients who received mitomycin C . Conclusions-The odds for pterygium recurrence following surgical tre atment of primary pterygium are close to six and 25 times higher if no conjunctival autograft placement is performed or if no intra/postoper ative mitomycin C is used, respectively. Surgeons and clinical trialli sts should not be encouraged in the use of bare sclera resection as a surgical technique for primary pterygium.