Prevention of recurrence of pterygium after surgery

Pterygium often recurs after excision. Corneal autocraft or mitomycin C may reduce the recurrence rate.

A systematic review including 5 RCTs with a total of 286 eyes was abstracted in DARE. OR for postoperative pterygium recurrence with bare sclera resection as compared to sclera resection with mitomycin C was 25.4 (95% CI 9.02 to 66.69). Bare sclera resection compared to conjunctival autograft replacement: OR 6.1 (95% CI 1.82 to 18.75).

A prospective, controlled clinical trial was performed in which 123 primary and 34 recurrent pterygia were randomized to 2 separate groups to undergo either bare sclera excision or conjunctival autografting . In the group with primary pterygium (mean follow-up, 15.1 months), 38 (61%) of the 62 cases of bare sclera excision showed recurrence of pterygium in contrast to 1 (2%) of the 61 cases of conjunctival autograft (P < 0.001, likelihood ratio X² test). Non-translucency, or fleshiness of the pterygium was a significant risk factor for recurrence in the bare sclera group (P < 0.001, likelihood ratio X² test). In the group with recurrent pterygium (mean follow-up, 13.2 months), 14 (82%) of the 17 bare sclera group showed recurrence of pterygium, while no recurrences occurred among the 17 cases in the conjunctival autograft group. Non-translucency was again a highly significant factor for recurrence (P < 0.001, likelihood ratio X² test).

In a prospective randomized and double-blind study of 50 eyes (50 patients) with primary progressive pterygium, mitomycin C at a concentration of 0.02 mg/mL soaked in a sterile 5 x 5 mm sponge and applied over the bare sclera intraoperatively was compared with gentamicin solution (0.3%) . Three eyes (12%) in the mitomycin C group showed recurrence within 7 months of surgery compared with eight eyes (32%) in the gentamicin control group within 3 to 5 months.

In a retrospective analysis of fifty eyes in forty-nine patients who underwent pterygium excision by the same surgeon topical mitomycin C (0.05%) applied to pterygium and adjacent areas after undermining and separation from sclera but prior to excision for three minutes . Postoperative follow up time was 12 months. The pterygium recurred in 4 (8%) eyes. Another four eyes (8%) had a cosmetically acceptable recurrence of < 2.0 mm. The only complication was a corneal dellen in one eye.

Ədəbiyyat

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