Effect of Combined Therapy of Mitomycin C with Beta Irradiation for Prevention of Recurrence of Primary and Recurrent Pterygium

ABSTRACT

PURPOSE: The most common problem in pterygium operation is recurrence ; recurrence rate is higher in recurrent pterygium than primary one. Effects on recurrence rate of combination therapy of intraoperative mitomycin C soaking method with postoperative beta-irradiation (strontium 90) along with its complications were investigated in primary and recurrent pterygium. Recurrence rate of the combination therapy was compared with that of the pterygium excision, postoperative beta-irradiation, and intraoperative mitomycin C soaking, respectively. METHODS: Fifty-three patients (fifty-nine eyes) with primary pterygium and twenty-three patients (twenty-four eyes) with recurrent pterygium received surgery. Mitomycin C in a concentration of 0.2 mg/ml soaked in a 2 x 2 mm Weckcel sponge was applied on the bare sclera intraoperatively after pterygium excision. Forty-five seconds of beta irradiation was done on the first and sixth postoperative days. RESULTS: During the mean follow-up period of 15 months, recurrence rate was 3.4% (2 eyes) in primary pterygium and 4.2% (1 eye) in recurrent one, respectively. Compared to the recurrence rate of 22.5% in primary and 35.0% in recurrent pterygium, respectively when removal of pterygium alone was performed and 14.3% in primary and 20.0% in recurrent, respectively with postoperative beta-irradiation and 12.8% in primary and 15.0% in recurrent, respectively with intraoperative mitomycin C soaking. These differences were statistically significant (P<0.05). One eye showed symblepharon in recurrent pterygium with combination therapy. CONCLUSION: Combination therapy of intraoperative administration of mitomycin C and postoperative beta irradiation (strontium 90) is considered an effective and safe adjunct for prevention of the recurrence of recurrent pterygium as well as primary.