Low-dose intraoperative mitomycin-C versus conjunctival autograft in primary pterygium surgery: Long term follow-up

PURPOSE: To evaluate and compare the long term safety and efficacy of low-d ose intraoperative application of mitomycin-C (0.02%) with conjunctival aut ograft in primary pterygium surgery. PATIENTS AND METHODS: Of 37 consecutive patients 41 eyes with primary ptery gium underwent pterygium excision with either intraoperative mitomycin-C (0 .02%) (Group I) or conjunctival autografts (Group II) at random. Mitomycin- C (0.2 mg/mL) was applied for 2.5 minutes on the scleral bed under the conj unctiva. Conjunctival autograft was obtained from upper temporal limbus and secured with 10-0 monofilament nylon. The follow-up period ranged from 14 to 54 months (mean 36 months) for mitomycin-C group and 13 to 58 months (me an 38 months) for conjunctival autograft group. RESULTS: Twenty-one eyes underwent pterygium excision with intraoperative m itomycin-C (0.02%) application (Group I) and 20 eyes were treated using con junctival autograft (Group II). The mean size of the pterygium was 3.80 mm (range 2.6 to 4.8 mm) in the mitomycin-C group and 3.60 mm (range 2.5 to 4. 5 mm) in the conjunctival autograft group. Two (9.52%) eyes treated with in traoperative mitomycin-C had delayed epithelial healing of corneoscleral wo und and one (4.76%) eye developed pyogenic granuloma. Three (14.3%) of the 21 eyes in Group I and one (5%) of 20 eyes in Group II had recurrence of pt erygium (P = 0.3174). All recurrences occurred in patients below 40 years o f age (P = 0.0384). CONCLUSION: We conclude that conjunctival autograft and intraoperative mito mycin-C are both equally effective adjuncts to primary pterygium surgery on long term follow-up. However, future prospective studies with larger numbe rs of subjects may be carried out to find out the optimum concentration and duration of intraoperative mitomycin-C application.