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Fifteen-year results of a randomized controlled trial comparing 0.02% mitomycin C, limbal conjunctival autograft, and combined mitomycin C with limbal conjunctival autograft in recurrent pterygium surgery

  • Cornea
  • Published:
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Abstract

Purpose

To compare the long-term outcomes of recurrent pterygium surgery between three different techniques.

Methods

We performed a 15-year follow-up study of a randomized controlled study on surgical management of recurrent pterygium. Group 1 received limbal conjunctival autograft (LCAU); group 2 received intraoperative mitomycin C (MMC) 0.02% for 5 min; and group 3 received combined LCAU + MMC 0.02% for 5 min. Consecutive patients enrolled in the original study (from April 2001 to March 2003) were invited back for a detailed clinical examination to document the long-term outcomes. The main outcome measures included the recurrence rate, residual conjunctival bed status, and complications from any of the surgical methods.

Results

Sixty-two patients were recruited in the original study. Eight patients had passed away and 12 patients were uncontactable or not responded. One patient who had bilateral operations refused to return for follow-up and one eye had insufficient data for analysis. Finally, 40 eyes of 40 patients were included for analyses. One eye developed a recurrence over 15 years and none required a tertiary pterygium operation. The patient received LCAU for a temporal recurrent pterygium developed a 2.2-mm recurrence.

Conclusions

All three techniques yielded favorable outcomes for patients with recurrent pterygium. The use of LCAU was associated with better cosmetic outcome.

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References

  1. Young AL, Cao D, Chu WK, Ng TK, Yip YWY, Jhanji V, Pang CP (2018) The evolving story of pterygium. Cornea 37(Suppl 1):S55–S57. https://doi.org/10.1097/ICO.0000000000001744

    Article  PubMed  Google Scholar 

  2. Chen PP, Ariyasu RG, Kaza V, LaBree LD, McDonnell PJ (1995) A randomized trial comparing mitomycin C and conjunctival autograft after excision of primary pterygium. Am J Ophthalmol 120:151–160

    Article  CAS  Google Scholar 

  3. Tsim NC, Young AL, Jhanji V, Ho M, Cheng LL (2015) Combined conjunctival rotational autograft with 0.02% mitomycin C in primary pterygium surgery: a long-term follow-up study. Br J Ophthalmol 99:1396–1400. https://doi.org/10.1136/bjophthalmol-2014-305817

    Article  PubMed  Google Scholar 

  4. Young AL, Yeung JC, Leung AT, Wong AK, Cheng LL, Lam DS (2002) Pterygium excision and conjunctival mini-autograft. Eye 16:110–111. https://doi.org/10.1038/sj.eye.6700080

    Article  CAS  PubMed  Google Scholar 

  5. Misra S, Craig JP, McGhee CN, Patel DV (2014) A prospective study of pterygium excision and conjunctival autograft with human fibrin tissue adhesive: effects on vision, refraction, and corneal topography. Asia-Pac J Ophthalmol 3:202–206. https://doi.org/10.1097/APO.0000000000000006

    Article  Google Scholar 

  6. Lekhanont K, Patarakittam T, Thongphiew P, Suwan-apichon O, Hanutsaha P (2012) Randomized controlled trial of subconjunctival bevacizumab injection in impending recurrent pterygium: a pilot study. Cornea 31:155–161. https://doi.org/10.1097/ICO.0b013e3182151e0e

    Article  PubMed  Google Scholar 

  7. Altiparmak UE, Katircioglu YA, Yagci R, Yalniz Z, Duman S (2007) Mitomycin C and conjunctival autograft for recurrent pterygium. Int Ophthalmol 27:339–343. https://doi.org/10.1007/s10792-007-9085-2

    Article  PubMed  Google Scholar 

  8. Shehadeh-Mashor R, Srinivasan S, Boimer C, Lee K, Tomkins O, Slomovic AR (2011) Management of recurrent pterygium with intraoperative mitomycin C and conjunctival autograft with fibrin glue. Am J Ophthalmol 152:730–732. https://doi.org/10.1016/j.ajo.2011.04.034

    Article  CAS  PubMed  Google Scholar 

  9. Clearfield E, Hawkins BS, Kuo IC (2017) Conjunctival autograft versus amniotic membrane transplantation for treatment of pterygium: findings from a cochrane systematic review. Am J Ophthalmol 182:8–17. https://doi.org/10.1016/j.ajo.2017.07.004

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mutlu FM, Sobaci G, Tatar T, Yildirim E (1999) A comparative study of recurrent pterygium surgery: limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap. Ophthalmology 106:817–821. https://doi.org/10.1016/S0161-6420(99)90172-0

    Article  CAS  PubMed  Google Scholar 

  11. Wan Norliza WM, Raihan IS, Azwa JA, Ibrahim M (2006) Scleral melting 16 years after pterygium excision with topical Mitomycin C adjuvant therapy. Cont Lens Anterior Eye 29:165–167. https://doi.org/10.1016/j.clae.2006.08.001

    Article  CAS  PubMed  Google Scholar 

  12. Ti SE, Tan DT (2003) Tectonic corneal lamellar grafting for severe scleral melting after pterygium surgery. Ophthalmology 110:1126–1136. https://doi.org/10.1016/S0161-6420(03)00260-4

    Article  PubMed  Google Scholar 

  13. Young AL, Leung GY, Wong AK, Cheng LL, Lam DS (2004) A randomised trial comparing 0.02% mitomycin C and limbal conjunctival autograft after excision of primary pterygium. Br J Ophthalmol 88:995–997. https://doi.org/10.1136/bjo.2003.036830

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Young AL, Ho M, Jhanji V, Cheng LL (2013) Ten-year results of a randomized controlled trial comparing 0.02% mitomycin C and limbal conjunctival autograft in pterygium surgery. Ophthalmology 120:2390–2395. https://doi.org/10.1016/j.ophtha.2013.05.033

    Article  PubMed  Google Scholar 

  15. Prabhasawat P, Barton K, Burkett G, Tseng SC (1997) Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Ophthalmology 104:974–985

    Article  CAS  Google Scholar 

  16. Singh G, Wilson MR, Foster CS (1988) Mitomycin eye drops as treatment for pterygium. Ophthalmology 95:813–821

    Article  CAS  Google Scholar 

  17. Singh G, Wilson MR, Foster CS (1990) Long-term follow-up study of mitomycin eye drops as adjunctive treatment of pterygia and its comparison with conjunctival autograft transplantation. Cornea 9:331–334

    Article  CAS  Google Scholar 

  18. Mastropasqua L, Carpineto P, Ciancaglini M, Enrico Gallenga P (1996) Long term results of intraoperative mitomycin C in the treatment of recurrent pterygium. Br J Ophthalmol 80:288–291

    Article  CAS  Google Scholar 

  19. Rubinfeld RS, Pfister RR, Stein RM, Foster CS, Martin NF, Stoleru S, Talley AR, Speaker MG (1992) Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology 99:1647–1654

    Article  CAS  Google Scholar 

  20. Luanratanakorn P, Ratanapakorn T, Suwan-Apichon O, Chuck RS (2006) Randomised controlled study of conjunctival autograft versus amniotic membrane graft in pterygium excision. Br J Ophthalmol 90:1476–1480. https://doi.org/10.1136/bjo.2006.095018

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Kucukerdonmez C, Akova YA, Altinors DD (2007) Comparison of conjunctival autograft with amniotic membrane transplantation for pterygium surgery: surgical and cosmetic outcome. Cornea 26:407–413. https://doi.org/10.1097/ICO.0b013e318033b3d4

    Article  PubMed  Google Scholar 

  22. Masters JS, Harris DJ Jr (2015) Low recurrence rate of pterygium after excision with conjunctival limbal autograft: a retrospective study with long-term follow-up. Cornea 34:1569–1572. https://doi.org/10.1097/ICO.0000000000000597

    Article  PubMed  Google Scholar 

  23. Katircioglu YA, Altiparmak U, Engur Goktas S, Cakir B, Singar E, Ornek F (2015) Comparison of two techniques for the treatment of recurrent pterygium: amniotic membrane vs conjunctival autograft combined with mitomycin C. Semin Ophthalmol 30:321–327. https://doi.org/10.3109/08820538.2013.874468

    Article  PubMed  Google Scholar 

  24. Kheirkhah A, Hashemi H, Adelpour M, Nikdel M, Rajabi MB, Behrouz MJ (2012) Randomized trial of pterygium surgery with mitomycin C application using conjunctival autograft versus conjunctival-limbal autograft. Ophthalmology 119:227–232. https://doi.org/10.1016/j.ophtha.2011.08.002

    Article  PubMed  Google Scholar 

  25. Anguria P, Ntuli S, Carmichael T (2014) Young patient's age determines pterygium recurrence after surgery. Afr Health Sci 14:72–76. https://doi.org/10.4314/ahs.v14i1.11

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Rao SK, Lekha T, Mukesh BN, Sitalakshmi G, Padmanabhan P (1998) Conjunctival-limbal autografts for primary and recurrent pterygia: technique and results. Indian J Ophthalmol 46:203–209

    CAS  PubMed  Google Scholar 

  27. Ti SE, Chee SP, Dear KB, Tan DT (2000) Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium. Br J Ophthalmol 84:385–389

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Shatin, New Territories, Hong Kong

    Ka Wai Kam & Alvin L. Young

  2. Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong

    Ka Wai Kam & Alvin L. Young

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  1. Ka Wai Kam
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Correspondence to Alvin L. Young.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Joint Chinese University of Hong Kong–New Territories East Cluster Clinical Research Ethics and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Kam, K.W., Young, A.L. Fifteen-year results of a randomized controlled trial comparing 0.02% mitomycin C, limbal conjunctival autograft, and combined mitomycin C with limbal conjunctival autograft in recurrent pterygium surgery. Graefes Arch Clin Exp Ophthalmol 257, 2683–2690 (2019). https://doi.org/10.1007/s00417-019-04499-5

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  • DOI: https://doi.org/10.1007/s00417-019-04499-5

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