TOPICAL MITOMYCIN-C FOR PTERYGIA - IS SINGLE APPLICATION APPROPRIATE

BACKGROUND AND OBJECTIVE: Mitomycin-C has been shown to dramatically r educe pterygium recurrence rates; however, its use has been associated with serious complications, especially in higher cumulative doses. Th e authors investigated the safety and efficacy of progressively reduci ng dosages of mitomycin-C as an adjunct to pterygium surgery. PATIENTS AND METHODS: Four hundred eighty-one consecutive primary and recurren t pterygia were surgically excised in a prospective nonrandomized tria l using five different mitomycin-C dosages. Recurrence was defined as fibrovascular tissue over the corneoscleral limbus onto clear cornea i n the area of previous pterygium excision. RESULTS: Seventy-seven pati ents in a control group without mitomycin-C had a recurrence rate of 6 5% with a mean follow-up of 33 months. A group of 77 patients treated with 0.4 mg/ml of mitomycin-C, four times per day for 2 weeks, had a r ecurrence rate of 2.5% with 6 (10%) serious complications (mean follow -up 34 months). A group of 22 patients treated with 0.2 mg/ml of mitom ycin-C, four times per day for 10 days, had a recurrence rate of 55% w ith 3 (7.3%) non-vision-threatening complications (mean follow-up 32 m onths). A group of 16 patients treated with 0.2 mg/ml of mitomycin-C i ntraoperatively for 3 minutes without conjunctival closure had a recur rence rate of 44% with no complications (mean follow-up 35 months). Fi nally, a group of 289 patients treated with 0.2 mg/ml of mitomycin-C i ntraoperatively for 3 minutes with conjunctival closure had a recurren ce rate of 2.7% and no complications (mean follow-up 26 months). CONCL USION: Although the authors' results with single application are encou raging, the use of mitomycin for pterygia remains controversial. The b iologic potency of this agent, the duration of its action, and the dea rth of large-scale controlled, randomized trials demand cautious indiv idual judgment by the surgeon when considering the use of this potent drug.