Indications for and complications of mitomycin-C in pterygium surgery

Ophthalmic Surg Lasers. 1996 Aug;27(8):667-73.

Abstract

Background and objective: The purposes of this study are to examine the complications and results of a novel approach to the use of mitomycin-C in pterygium surgery; to identify the lowest effective dosage required to prevent recurrence; and to select those high-risk pterygia that could benefit from mitomycin-C use.

Patients and methods: One hundred thirty-five eyes of 128 patients considered at high risk for recurrence of pterygium were treated with a single, intraoperative, subconjunctival injection of mitomycin-C at the site of excision. Three different dosages-0.2, 0.1, and 0.05 ml-at a strength of 0.5 mg/ml were used. The eyes were observed for 10 months to 3 years.

Results: There were only two recurrences (1.5%); both occurred in eyes that had undergone previous pterygium surgery. One recurrence happened with the 0.2-ml dosage, and the other with the 0.1-ml dosage. These recurrences occurred in association with early wound dehiscence, which essentially became a bare sclera susceptible to pterygium regrowth. Complications included temporary and prolonged discomfort, tearing, hyperemia, subconjunctival hemorrhage, wound dehiscence, and pigment accumulation. No vision-threatening side effects were noted.

Conclusions: The persistence and intensity of discomfort noted at the higher dosage has prompted these authors to suggest that only high-risk pterygia should receive mitomycin-C. Conjunctival flaps should always be used to cover the sclera up to the limbus and to localize the mitomycin-C to prevent its migration. A single dose of not more than 0.05 ml at a strength of 0.5 mg/ml subconjunctivally gives the same results as multiple drops, but with far less morbidity.

MeSH terms

  • Adolescent
  • Antibiotics, Antineoplastic / administration & dosage
  • Antibiotics, Antineoplastic / adverse effects*
  • Chemotherapy, Adjuvant
  • Combined Modality Therapy
  • Conjunctiva
  • Dose-Response Relationship, Drug
  • Drug Administration Routes
  • Follow-Up Studies
  • Humans
  • Injections
  • Intraoperative Period
  • Mitomycin / administration & dosage
  • Mitomycin / adverse effects*
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / pathology
  • Pterygium / drug therapy*
  • Pterygium / etiology
  • Pterygium / surgery*
  • Recurrence

Substances

  • Antibiotics, Antineoplastic
  • Mitomycin