Abstract
Objective
Although conjunctival autograft (CAU) and amniotic membrane grafting (AMG) with mitomycin-C
(MMC) are most effective for the treatment of primary pterygium, the optimal surgical
treatment of recurrent pterygium is not well established. We thus aimed to examine
recurrence rates after recurrent pterygium excision surgery performed with CAU or
AMG with or without MMC.
Methods
We performed a retrospective review of adult patients who underwent recurrent pterygium
excision surgery at Boston Medical Center between January 1999 and July 2019. Postoperative
recurrence rates were compared between surgical treatment groups: CAU + MMC, CAU,
AMG + MMC, and AMG. Postoperative and any intraoperative complications were recorded.
Results
We identified 41 eyes of 38 patients having undergone recurrent pterygium excision
surgery that met our criteria. The observed postoperative recurrence rates were 0%
(0 of 8 eyes) with CAU + MMC, 17.7% (3 of 17 eyes) with CAU, 45.5% (5 of 11 eyes)
with AMG + MMC, and 80.0% (4 of 5 eyes) with AMG. The postoperative recurrence rate
was significantly lower with CAU than with AMG, both with (p = 0.045) and without (p = 0.021) adjuvant MMC. There were no statistically significant differences in repeat
recurrence rates with or without MMC with CAU (p = 0.52) or with AMG (p = 0.31). There was 1 reported case of possible complication from MMC resulting in
complete amniotic membrane melt.
Conclusions
Our study suggests that CAU results in less repeat recurrence than AMG in the treatment
of recurrent pterygium. The use of intraoperative MMC may decrease the recurrence
rate, but it is not statistically significant and may be associated with complications.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of OphthalmologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pterygium: prevalence, demography and risk factors.Ophthalmic Epidemiol. 1999; 6: 219-228
- Pingueculae and pterygia.Surv Ophthalmol. 1988; 33: 41-49
- Intraoperative mitomycin C in the treatment of pterygium.Cornea. 2000; 19: 471-473
- Options and adjuvants in surgery for pterygium: a report by the American Academy of Ophthalmology.Ophthalmology. 2013; 120: 201-208
- Randomized trial of pterygium surgery with mitomycin C application using conjunctival autograft versus conjunctival–limbal autograft.Ophthalmology. 2012; 119: 227-232
- Conjunctival autograft versus amniotic membrane transplantation after double pterygium excision: a randomized trial.Cornea. 2016; 35: 823-826
- Fifteen-year results of a randomized controlled trial comparing 0.02% mitomycin C, limbal conjunctival autograft, and combined mitomycin C with limbal conjunctival autograft in recurrent pterygium surgery.Graefes Arch Clin Exp Ophthalmol. 2019; 257: 2683-2690
- Comparison of amniotic membrane graft alone or combined with intraoperative mitomycin C to prevent recurrence after excision of recurrent pterygia.Cornea. 2005; 24: 141-150
- Mitomycin C in pterygium treatment.Int J Ophthalmol. 2016; 9: 465-468
- Pterygium recurrence time.Ophthalmology. 1994; 101: 755-758
- Mitomycin C in the treatment of pterygium.Clin Exp Ophthalmol. 2006; 34: 197-198
- Mitomycin C–associated scleral stromalysis after pterygium surgery.Cornea. 2015; 34: 398-401
- Mitomycin C and conjunctival autograft for recurrent pterygium.Int Ophthalmol. 2007; 27: 339-343
- Limbal allograft, amniotic membrane transplantation, and intraoperative mitomycin C for recurrent pterygium.Ophthalmology. 2005; 112: 1263-1267
- A comparative study of recurrent pterygium surgery: limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap.Ophthalmology. 1999; 106: 817-821
Article Info
Publication History
Published online: June 21, 2022
Accepted:
May 27,
2022
Received in revised form:
May 17,
2022
Received:
November 9,
2021
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
