Short term adjunctive mitomycin treatment after pterygium excision

ABSTRACT

The most common complication following pterygium excision is recurrence. Although several adjunctive therapies are available, the use of mitomycin-C, an alkylating agent that inhibits DNA synthesis, has recently been popularized due to ease of use and a low recurrence rate. With the initial recommended dosage of 1.0 mg/ml QID for two weeks, or when used in the setting of concomitant ocular surface disorders such as severe blepharitis or keratoconjunctivitis sicca, significant complications have been reported. We report the results of a clinical trial of 12 eyes of 10 patients without co-existing ocular surface disease, who underwent bare sclera pterygium excision and adjunctive therapy with low dose mitomycin-C [0.4 mg/ml TID 3 days] therapy between July 1991 and January 1992. Four were recurrent pterygia, while eight were advanced primary pterygia. In the 12-18 month follow up period there have been no recurrences, or significant complications [i.e., persistent epithelial defects, sterile corneal or scleral ulceration, glaucoma, leveitis, or cataract]. Seven out of 12 eyes [58%] developed pyogenic granulomas, all of which were excised successfully. Published reports of significant complications with topical mitomycin-C therapy mandate continued efforts to identify the lowest total dose of this adjunctive therapy that can effectively prevent recurrence of pterygia