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Limbal conjunctival versus amniotic membrane in the intraoperative application of mitomycin C for recurrent pterygium: a randomized controlled trial

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Abstract

Purpose

This study compared the outcomes of a limbal conjunctival autograft (LCAG) with those of an amniotic membrane graft (AMG) followed by intraoperative 0.02 % mitomycin C (MMC) to treat recurrent pterygium.

Methods

In this randomized controlled trial, ninety-six eyes with recurrent pterygium were enrolled and randomly allocated into two groups using a computer-generated random number table. Pterygium removal was followed by intraoperative 0.02 % MMC for 3 min and then either LCAG or AMG transplantation. The major outcomes were recurrence rate, conjunctival inflammation grade, healing time of the corneal epithelial defect, eye-movement amplitude (EMA), uncorrected distance visual acuity (UDVA), and complications.

Results

A follow-up of 12 months was conducted for 93 eyes of 82 patients. Grade D (recurrence) presented in one eye of the LCAG group and five eyes of the AMG group, with no between-group difference (p = 0.196). However, Grades A, B, and C presented in 46, zero and zero eyes of the LCAG group respectively, and in 37, two and two eyes of the AMG group respectively, with the surgical bed generally showing a better appearance in the LCAG group than in the AMG group (p = 0.008). Compared with baseline values, the postoperative EMA improved significantly in both groups (p < 0.001 for the LCAG group; p = 0.001 for the AMG group), as did UDVA (p = 0.005 for the LCAG group; p = 0.012 for the AMG group). No between-group differences were found in terms of the healing time for epithelial defect, conjunctival inflammation grade, or the frequency of complications such as punctate epithelial keratitis, episcleral melting, corneal pannus, and delayed corneal epithelium healing.

Conclusions

LCAG transplantation with intraoperative 0.02 % MMC is as efficacious in treating recurrent pterygium as AMG transplantation with MMC. The former procedure results in an attractive cosmetic appearance but might result in limbal damage in some eyes. The surgeon’s familiarity with these procedures should determine the method of treatment.

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Acknowledgments

The study was supported in part by “Sun Yat-Sen University Clinical Research 5010 Program” in China (grant number: 2014015). This funding organization played no role in the design or performance of this research.

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    Authors and Affiliations

    1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China

      Rongxin Chen, Wenfang Ma, Xiaofang Yin & Shiyou Zhou

    2. The Third Affiliated Hospital of Nanchang University, Nanchang, 330000, China

      Guofu Huang

    3. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China

      Shu Liu

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    Correspondence to Shiyou Zhou.

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    Funding

    The “Sun Yat-Sen University Clinical Research 5010 Program” in China (grant number: 2014015) funded this study.

    Conflict of interest

    The authors declare no financial or non-financial conflicts of interest. The authors had full control over the primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.

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    All of the procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committees and in light of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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    Informed consent was obtained from all participants included in this study.

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    This study was registered at http://www.clinicaltrials.gov (ClinicalTrials.gov identifier: NCT01319721).

    Rongxin Chen, Guofu Huang, and Shu Liu contributed equally to this work.

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    Chen, R., Huang, G., Liu, S. et al. Limbal conjunctival versus amniotic membrane in the intraoperative application of mitomycin C for recurrent pterygium: a randomized controlled trial. Graefes Arch Clin Exp Ophthalmol 255, 375–385 (2017). https://doi.org/10.1007/s00417-016-3509-5

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