Intraoperative application versus postoperative mitomycin C eye drops in pterygium surgery

Pterygium: an update on pathophysiology, clinical features, and management

Pterygium is a relatively common ocular surface disease. The clinical aspects and the treatment options have been studied since many years ago, but many uncertainties still exist. The core pathologic pathway and the role of heredity in the development of pterygium are still attractive fields for the researchers. The role of pterygium in corneal irregularities, in addition to the refractive properties of pterygium removal, has been increasingly recognized through numerous studies. The association between pterygium and ocular surface neoplasia is challenging the traditional beliefs regarding the safe profile of the disease. The need for a comprehensive clinical classification system has encouraged homogenization of trials and prediction of the recurrence rate of the pterygium following surgical removal. Evolving surgical methods have been associated with some complications, whose diagnosis and management are necessary for ophthalmic surgeons. According to the review, the main risk factor of pterygium progression remains to be the ultraviolet exposure. A major part of the clinical evaluation should consist of differentiating between typical and atypical pterygia, where the latter may be associated with the risk of ocular surface neoplasia. The effect of pterygium on astigmatism and the aberrations of the cornea may evoke the need for an early removal with a purpose of reducing secondary refractive error. Among the surgical methods, conjunctival or conjunctival-limbal autografting seems to be the first choice for ophthalmic surgeons because the recurrence rate following the procedure has been reported to be lower, compared with other procedures. The use of adjuvant options is supported in the literature, where intraoperative and postoperative mitomycin C has been the adjuvant treatment of choice. The efficacy and safety of anti–vascular endothelial growth factor agents and cyclosporine have been postulated; however, their exact role in the treatment of the pterygium requires further studies.

How to minimize pterygium recurrence rates: clinical perspectives

The main treatment for pterygium is surgical removal. However, pterygium surgery is concerned with high rates of postoperative recurrence. Predicting factors of recurrence are not fully understood, yet, but they probably depend on a multitude of patient-related, clinical, and/or surgical factors. Several adjuvant treatments have been proposed to reduce postoperative pterygium recurrence, including different antimetabolites, antiangiogenetic factors, and radiation therapy. The purpose of this review is to collect the current evidence regarding application and limits of different therapeutic approaches for preventing postoperative recurrence of pterygium, giving insights and perspectives for better management of this disease. In the light of the current evidence, pterygium surgery cannot disregard wound coverage with conjunctival autografting or rotational flap combined with adjuvant treatments. The rotational flap technique is associated with shorter surgical time rates and prevents graft displacement and necrosis, given its vascular pedicle. Amniotic membrane may still be reserved in case of great conjunctival defects or insufficient conjunctiva. Repeated subconjunctival antivascular endothelial growth factor injections can be considered as an effective and safe adjuvant treatment. Moreover, management of postoperative pain is crucial. Innovative treatment strategies will probably target different molecular pathways, considering recent findings regarding pterygium pathogenesis, to improve better understanding and develop universally shared guidelines. Great importance shall be dedicated to the identification of novel molecular biomarkers and favoring factors of recurrence, in order to achieve a customized surgical treatment for each patient and obtain maximal reduction of postoperative recurrence.

Limbal Conjunctival Mini-Autografting for Preventing Recurrence after Pterygium Surgery

PURPOSE

The aim of the present study was to evaluate limbal conjunctival mini-autografting procedure based on recurrence rates following pterygium surgery.

METHODS

A total of 63 eyes (53 patients) with pterygium, of which 60 were primary and 3 were recurrent, underwent surgery for the removal of pterygia with limbal conjunctival mini-autograft. After the pterygium excision, the limbal portion of the graft was oriented and sutured to the limbus at the recipient bed with the epithelial surface upside. Recurrence was defined as fibrovascular tissue of more than 1 mm over the cornea in the area of previous pterygium excision. The mean follow-up period was 12.5 months (ranging between 6 and 29 months).

RESULTS

The time required for the surgery was approximately 30 minutes (range 20-40 minutes). Recurrence of pterygium was observed in 6 of 63 eyes (9.52%). No eyes with recurrent pterygium developed recurrence postoperatively. There were no severe complications during the operative and postoperative period. Most patients had temporary graft edema, lasting a few days after the operation, and they experienced and complained of foreign body sensations and epiphora.

CONCLUSIONS

Limbal conjunctival mini-autografting appears to be an effective procedure for pterygium surgery resulting in a low recurrence rate.

Mitomycin C in pterygium treatment

Pterygium is a benign lesion usually growing from the nasal side of the conjunctiva onto the cornea. Most cases of pterygium does not cause problem or requires specific treatment. The exact cause of pterygium is not clear yet, but some factors are pointed as causes, being the most important the long-term ultraviolet ray exposure. Pterygium surgery is usually considered when there are symptoms that do not respond to conservative treatment. Recurrence is the main complication of the surgery, and much has been done to avoid it. Mitomycin C (MMC) has been used as a fibroblast proliferation inhibitor during the surgery to reduce the chance of recurrence of the pterygium. This review describes the use of MMC as an adjunctive, the optimal dosage, the duration of administration of MMC and possible complications, when used during, after and before the surgery. Most studies suggest that increased exposure (dose or duration) of MMC is associated with a lower recurrence, but with higher risks of complications.

The influence of topical mitomycin-C on total fibroblasts, epithelialization, and collagenization in anoplasty wound healing in Wistar rats

PURPOSE

The purpose of this study is to analyze the influence of topical mitomycin-C on total fibroblasts, epithelialization, and collagenization in anoplasty wound healing in Wistar rats.

METHODS

In this experimental study, anoplasty procedures were performed on twelve Wistar rats that were subsequently randomly placed into two groups; i.e., control and treated groups. In the treated group, topical mitomycin-C was applied to the wound following the anoplasty procedure. All rats were sacrificed on the seventh day, and tissue samples of the wounds were obtained for histopathological evaluations. The total fibroblasts, epithelialization, and collagenization were evaluated by scoring methods. The Mann-Whitney test was used to analyze the statistical significance of differences, and p values below 0.05 were considered to be significant.

RESULTS

The mean fibroblast scores for the treated and control groups were 1.5 and 3.0. The mean epithelialization scores for the treated and control groups were 5 and 3.33. The mean collagenization scores for the treated and control groups were 5 and 3.5. Statistical evaluations revealed significant differences between the groups in total fibroblasts (p=0.006), epithelialization (p=0.022), and collagenization (p=0.022).

CONCLUSIONS

Topical mitomycin-C reduced the fibroblasts; however, the treatment did not suppress epithelialization or collagenization during anoplasty wound healing in Wistar rats.

Comparison of Two Techniques for the Treatment of Recurrent Pterygium: Amniotic Membrane vs Conjunctival Autograft Combined with Mitomycin C

PURPOSE

To compare the results of amniotic membrane transplantation (AMT) combined with mitomycin C (MMC) to the results of free conjunctival autograft (CA) combined with MMC for the treatment of patients with recurrent pterygium.

METHODS

In this prospective study, 60 eyes of 55 patients with recurrent pterygium were included and randomly assigned into group I (n = 30) who underwent AMT combined with MMC (AMT-MMC) and group II (n = 30) who underwent CA combined with MMC (CA-MMC). During a mean follow-up of 27.2 ± 20.8 months, recurrence of pterygium, change in uncorrected visual acuity and complications (including pain, corneal, conjunctival or scleral changes) were analyzed and were compared between groups.

RESULTS

Five eyes of 5 patients were lost to follow-up and were removed from analysis. The mean age (p = 0.274), the mean follow-up (p = 0.063), the number of prior pterygium excision surgeries (p = 0.641) and the mean preoperative visual acuity (p = 0.959) were similar in both groups. Recurrence was seen in 2 eyes (8%) in AMT-MMC group and 4 patients (13.3%) in CA-MMC group (p = 0.531). Postoperative visual acuity (p = 0.237), change in visual acuity (p = 0.525), severe pain (p = 0.531) and epithelial defect lasting more than 5 days (p = 0.510) were similar in both groups.

CONCLUSIONS

Amniotic membrane combined with MMC has similar recurrence rate to CA combined with MMC, in patients with recurrent pterygium. Similar outcomes and complication rates make AMT-MMC a promising method for the treatment of recurrent pterygium cases.

Intraoperative mitomycin C versus autologous conjunctival autograft in surgery of primary pterygium with four-year follow-up

PURPOSE

To compare the 4-year outcome of primary pterygium excision using intraoperative mitomycin C (MMC) with suturing a free conjunctival autograft (CA).

METHODS

A total of 115 eyes with nasal primary pterygium of 115 patients were included in the study. After randomization into two groups, the eyes were operated on by a single surgeon (GK). After excision of the pterygium, 56 eyes received 0.04% MMC intraoperatively on the bare sclera for 3 min and 59 eyes received a free CA sutured using 7-0 Vicryl. Postoperative follow-up was 4 years. Main outcome measures were recurrences, re-operations, surgery time, complications, visual acuity and astigmatism. Statistical evaluation was performed with the chi-squared test.

RESULTS

The recurrence rate was 38% in the MMC group and 15% in the CA group (p < 0.05). The re-operation rate of the recurrences was 53% in the MMC group and 29% in the CA group. Average surgery time was 13 minutes (range: 6-22 min) in the MMC group and 26 min (range: 18-32 min) in the CA group (p < 0.01). There was no significant change in best-corrected visual acuity and astigmatism. One major complication occurred in each group. The most frequently observed complication was delayed epithelial healing (40%) and mild scleral thinning (20%) in the MMC group and suture-related inflammation in the CA group (10%).

CONCLUSION

Pterygium surgery including free autologous conjunctival grafting is associated with fewer recurrences, re-operations and complications than using the bare sclera technique together with single-dose intraoperative MMC.

Preoperative subpterygial mitomycin C injection versus limbal conjunctival autograft transplantation for prevention of pterygium recurrence

PURPOSE

To evaluate postoperative outcome and recurrence rate after primary pterygium excision using preoperative Mitomycin C (MMC) injection versus limbal conjunctival autograft transplantation (LCAT).

METHODS

Ninety-one eyes with primary pterygium were divided into 2 groups. Group A eyes (included 48 eyes) were operated upon with pterygium excision 1 month after subpterygial injection of MMC 0.015%. Group B eyes (included 43 eyes) were operated upon with pterygium excision followed by LCAT technique. Pterygium regrowth over the cornea for 1 mm or more was considered as a recurrence.

RESULTS

The follow-up period was 24 months. In group A, reported recurrence was found in 2 (4.2%) eyes with a complication rate of 16.80%. While in group B, recurrence was reported in 4 (9.3%) eyes with a complication rate of 11.63%. No serious postoperative complications were reported. There was no statistically significant difference between the 2 groups regarding the recurrence rate as well as the complication rate.

CONCLUSION

Both techniques used in the current study proved to be effective in reducing the recurrence rate after excision of primary nasal pterygium with minimal postoperative complications. Preoperative MMC injection was technically easier, with shorter operative and preservation of healthy conjunctiva. However, LCAT is a one-stage procedure and independent from adjunctive pharmacological or radiation therapies with their hazards.

Inhibitory effect of PPARγ agonist on the proliferation of human pterygium fibroblasts

The effects of DK2, a peroxisome proliferator-activated receptor γ agonist, on cultured human pterygium fibroblasts (HPFs) in virto were studied. The HPFs were incubated with 0-200 μmol/L DK2 for 12-72 h. The MTT method was used to assay the bio-activity of DK2 at different doses and time. The cytotoxic effect of DK2 was measured by LDH release assay. The cell cycle distribution and apoptosis were flow cytometrically detected. The expression of proliferating cell nuclear antigen (PCNA) in each group was detected by real-time PCR (RT-PCR) and Western blotting. The results showed that administration of 1-75 μmol/L DK2 for 12-72 h could significantly inhibit HPF proliferation in a dose- and time-dependent manner. DK2-treated cells did not release significant amount of LDH as compared with rosiglitazone-treated cells. After treatment with DK2 at concentrations of 15, 25 μmol/L for 24 h, the number of HPFs in G(0)/G(1) phase was significantly increased while that in S phase was significantly decreased (P<0.05), leading to arrest at G(0)/G(1) phase. The apoptosis rates of HPF cells in drug-treated groups were significantly higher than the rate of control group (P<0.05). At the dosage range between 15-25 μmol/L, DK2 could inhibit the expression of PCNA mRNA and protein in HPFs in a dose-dependent fashion (P<0.05). It was concluded that PPARγ agonist can significantly inhibit HPF proliferation, resulting in the arrest at G(0)/G(1) phase, induce the apoptosis of HPFs, and suppress the synthesis of PCNA, in dose- and time-dependent manners.

Comparison of Three Methods for the Treatment of Pterygium: Amniotic Membrane Graft, Conjunctival Autograft and Conjunctival Autograft plus Mitomycin C

OBJECTIVE

To compare three techniques combined with excision in the treatment of primary and recurrent pterygium: amniotic membrane transplantation, conjunctival autograft, and conjunctival autograft plus mitomycin C.

MATERIALS AND METHODS

Forty-nine eyes of 49 subjects (30 primary, 19 recurrent pterygium) were included in this study. Combined with excision, 25 eyes (18 primary, 7 recurrent pterygium) were treated with conjunctival autografts (Group 1), and 16 eyes (12 primary, 4 recurrent pterygium) were treated with amniotic membrane transplantation for the closure of the defect (Group 2). In 8 eyes (all recurrent pterygium) low-dose mitomycin C (0.02%) was applied topically to the defect area and a conjunctival autograft was applied thereafter (Group 3). The three groups were compared with regard to the recurrence of pterygium and the defect area requiring treatment.

RESULTS

The number and percentages of recurrence seen in groups 1, 2 and 3 were as follows: 4 (16%), 4 (25%), and 0(-), respectively. For the treatment of primary pterygium cases, amniotic membrane closure and conjunctival autograft closure were comparable in effectiveness (p > 0.05). In the treatment of recurrent pterygium, there was no significant difference between the three techniques (p > 0.05). Amniotic membrane closure and conjunctival autografts were equally effective for the treatment of both primary and recurrent pterygium (p > 0.05). The graft size was significantly larger in the cases with recurrent pterygium (p = 0.016).

CONCLUSIONS

Amniotic membrane closure and conjunctival autografts seem to be equally effective in the prevention of recurrence of primary pterygium. Conjunctival autografts combined with mitomycin C are as effective as the above two techniques to prevent recurrence in the treatment of recurrent pterygium. Due to the larger area of subconjunctival fibrosis, a larger defect area is created after the excision of pterygium tissue and a larger graft is needed to close this defect in recurrent pterygium. This factor can guide the surgeon during the planning of the surgery to choose the most appropriate technique for closure of the defect.

The use of hyperbaric oxygen therapy in ophthalmology

Hyperbaric oxygen therapy is a primary or adjuvant therapeutic method used in treatment of various acute or chronic disorders. Currently, eye diseases are among the off-label use of hyperbaric oxygen. However, there is an increasing body of evidence showing its safety and efficacy in retinal artery occlusion, cystoid macular edema secondary to retinal vein occlusion, scleral thinning and necrosis faced after pterygium surgery, orbital rhino-cerebral mucormycosis, nonhealing corneal edema, and anterior segment ischemia. Its potential to treat some blinding disease has also been pointed out in recent studies. This article constitutes an up-to-date summary of knowledge and therapeutic use of hyperbaric oxygen, and aims to contribute understanding of current and potential use of hyperbaric oxygen therapy in ophthalmology.

Current concepts and techniques in pterygium treatment

PURPOSE OF REVIEW

Pterygium is a common ocular disorder in many parts of the world. At present, there is a wide variety of surgical methods but very few clinical guidelines on the optimal treatment of primary or recurrent pterygium. The purpose of this review is to summarize the more recent and relevant studies on pterygium treatment.

RECENT FINDINGS

The primary aim is to excise the pterygium and prevent its recurrence. As bare sclera excision is associated with a high recurrence rate, pterygium excision is often combined with conjunctival autograft, mitomycin C, beta-irradiation or other adjunctive therapies to reduce recurrence rates. There is currently, however, no consensus regarding the ideal treatment for the disease. Comparability between studies is also hampered by the various definitions of pterygium recurrence.

SUMMARY

This article reviews the current concepts and techniques used for the treatment of pterygium. Conjunctival autografting and mitomycin C application are the most commonly used methods for preventing recurrences. The use of mitomycin C and beta-irradiation should be used judiciously because of the potential long-term risk of sight-threatening complications. Additional clinical trials should be performed to evaluate the relative efficacies and long-term safety of the various treatment modalities.

Mitomycin C and conjunctival autograft for recurrent pterygium

PURPOSE

To observe the efficiency of intraoperative low-dose Mitomycin-C combined with conjunctival autograft in the treatment of recurrent pterygium.

METHODS

Fifteen eyes with recurrent pterygium were included in this study. The mean age of the patients was 51.6 +/- 11.4 (9 men, 6 women). All patients underwent excision of the pterygium tissue and subconjunctival fibrous tissue with a no cautery approach. 0.2 mg/ml Mitomycin-C (0.02%) was applied for 3 min. Conjunctival autograft was obtained from the superotemporal bulbar conjunctiva of the same eye. Eyes were followed for a mean period of 21.0 +/- 9.1 months.

RESULTS

Recurrence was seen in two eyes (13.3%) during the follow-up period. The only complication seen was graft edema (two eyes; 13.3%) which healed after pressure patching. Graft necrosis, scleral melting or failure of revascularization was not noted.

CONCLUSION

Intraoperative application of 0.2 mg/ml Mitomycin-C combined with conjunctival autograft reduces recurrence in recurrent pterygium cases, with minimal complications.

Efficacy of Subconjunctival 5-Fluorouracil and Triamcinolone Injection in Impending Recurrent Pterygium

OBJECTIVE

To study the efficacy of subconjunctival 5-fluorouracil (5-FU) and triamcinolone injection in halting the progression of impending recurrent pterygium.

DESIGN

Randomized, prospective, controlled clinical trial.

PARTICIPANTS

One hundred nine patients who had undergone pterygium excision within the previous 6 months and developed grade 3 characteristics (impending recurrent pterygium).

METHODS

A total of 109 eyes with impending recurrent pterygium were stratified randomly into 3 groups by treatment: 35 eyes served as the control group, 39 eyes received a 5-mg intralesional injection of 5-FU weekly for 2 weeks, and 35 eyes received one 20-mg intralesional injection of triamcinolone. All groups received 1% prednisolone acetate eye drops 4 times daily for 8 weeks.

MAIN OUTCOME MEASURES

Recurrence rate, success rate, and survival analysis were compared among the groups.

RESULTS

With a mean follow-up time of 10.9+/-5.5 months (range, 6-26 months), the success rates of the 5-fluorouracil and triamcinolone groups were higher than the control group (87.2%, 71.4%, and 48.6%, respectively). 5-fluorouracil was significantly (P = 0.001) more effective in inhibiting the recurrence of pterygium compared with the control group at all time points during follow-up. Kaplan-Meier survival analysis showed that the recurrence-free period of pterygium in the 5-FU group was significantly (P = 0.005) longer than that of the control group but not in the triamcinolone group compared with the controls (P = 0.063). There was no significant difference between the 5-FU group and the triamcinolone group (P = 0.362). Minimal reversible complications such as steroid-induced glaucoma and superficial punctate epitheliopathy developed during the study.

CONCLUSIONS

Intralesional injection of 5-FU and triamcinolone was more effective in inhibiting the recurrence of pterygium than topical steroid alone, with the results in the 5-FU group reaching statistical significance.

Photodynamic therapy for wound-healing modulation in pterygium surgery. A clinical pilot study

BACKGROUND

This study was performed to evaluate the safety and efficacy of photodynamic therapy with the carboxyfluorescein ester BCECF-AM as an adjunctive treatment procedure for pterygium surgery to reduce the rate of recurrence.

METHODS

In this nonrandomized prospective clinical trial, 19 eyes with nasally located primary pterygium were examined. All eyes were treated with the bare sclera surgical technique. Seven eyes received in addition treatment with BCECF-AM solution and blue light. All patients were evaluated at least after 1 day, 1 week, 1 month, 3 months, and 1 year. Postoperative fibrovascular growth from the limbus of at least 1 mm was defined as recurrence.

RESULTS

The intraoperative application of BCECF-AM solution did not cause anterior chamber flare or any other significant side effects. The bare sclera surgery rate of recurrence was 0% (zero of 12) after 3 months and 91% (11 of 12) after 1 year. The additional photodynamic therapy treatment had a rate of recurrence of 14.2% (one of seven) after 3 months and 71.4% (five of seven) after 1 year.

CONCLUSIONS

The applied PDT technique seems to be a safe procedure but is associated with a high rate of recurrence. In conclusion, the evaluated PDT treatment procedure, at this point, should not be considered. As we found a high rate of recurrence also in the control group, the bare sclera technique is not effective, even in primary pterygia.

5-Fluorouracil as chemoadjuvant for primary pterygium surgery: preliminary report

PURPOSE

To investigate the safety and efficacy of intraoperative application of 5-fluorouracil as an adjuvant in primary pterygium surgery and to evaluate the effect of postoperative subconjunctival 5-fluorouracil injections on the recurrent pterygium.

METHODS

Of 25 consecutive white patients, 28 eyes with primary pterygium underwent pterygium excision with intraoperative application of 5-fluorouracil (25 mg/mL for 3 minutes). The superior and inferior conjunctiva was approximated to cover the scleral bed within 1 mm of the limbus. Recurrence of pterygium was defined as postoperative fibrovascular growth more than 1 mm onto the cornea. Eyes with recurrence less than 2 mm were treated with subconjunctival 5-fluorouracil injections.

RESULTS

After a mean follow-up of 14.1 +/- 3.9 months (mean +/- standard deviation), 7 recurrences (25%) were observed. All recurrences were detected within 12 months. In 4 of 7 recurrences, the fibrovascular growths were less than 2 mm. We, therefore, performed subconjunctival 5-fluorouracil injections. In 3 (75%) of 4 recurrences, the fibrovascular growths became atrophic. No serious complications were observed during and after the surgery. However, superficial punctate keratitis, pain, and hyperemia were detected in all patients in the early postoperative period. As a result, of 28 eyes, 4 (14%) had unacceptable cosmetic results and growing recurrences.

CONCLUSIONS

This study suggests that intraoperative applications of 5-fluorouracil is both efficient and safe in the treatment of primary pterygium. Additionally, postoperative subconjunctival 5-fluorouracil injections may prevent the progression of fibrovascular tissue.

Pterygial derived fibroblasts express functionally active histamine and epidermal growth factor receptors

Pterygia are characterised by a fleshy outgrowth of altered conjunctival tissue over the cornea and are most common in tropical regions. Pterygial fibroblasts are characteristically distinct from normal conjunctival fibroblasts, and therefore the aim of this study was to determine the presence and functional significance of histamine and epidermal growth factor (EGF) receptors in these cells. Pterygial specimens were cultured in vitro and cellular outgrowths were phenotypically characterised as fibroblasts using vimentin and cytokeratin staining. Intracellular calcium mobilization was used to characterise the functional activity of histamine receptors on these cells. Maximal response was obtained with 100 microM histamine. However, lower concentrations of histamine also caused mobilization of calcium that were totally abolished by pre-incubation with H1 but not H2 or H3 receptor antagonists. EGF receptor was diffusely expressed over the cell surfaces. EGF stimulated receptor internalization, ERK protein phosphorylation and intracellular calcium mobilization. Therefore, fibroblasts derived from human pterygia express functionally active histamine and epidermal growth factor receptors. Controlled modification of either the receptors or the appropriate ligands could have beneficial effects in pterygia treatment.

Pterygium in Australia: a cost of illness study

PURPOSE

The aim of this report was to describe the number of Australians affected by pterygium in recent years, treatment options, number of treatment encounters and costs of treatment.

METHOD

A review of published literature was conducted to identify the prevalence of pterygium in Australian populations. Costs of primary care were based on national general practitioner (GP) survey data. Costs of surgical intervention were based on Health Insurance Commission claims data and Australian Institute of Health and Welfare National Hospital Morbidity Data.

RESULTS

Pterygium occurs in 1.1% of Australians. It is more prevalent in populations with higher exposure to ultraviolet radiation, and older men (occurring in 12% of males over 60 years). The estimated annual number of GP contacts was 58,900. Forty per cent of primary care contacts for pterygium were referred to an ophthalmologist and topical medication was prescribed by GPs in 32% of contacts. The estimated annual cost of GP visits, specialist visits and topical medication was AUD$3.2 m. There were 6997 claims for pterygium removal in 1999/2000 with 3192 conjunctival autografts. Rates of pterygium removal were highest in Queensland with 56 per 100,000 population. The annual costs of surgical intervention were estimated at AUD$4.8 m.

CONCLUSIONS

The direct medical costs of pterygium in Australia are AUD$8.3 m annually. This is likely to be an underestimate of total cost because indirect costs such as loss of work time could not be measured. More data are needed on the long-term benefits of pterygium intervention.

Tear functions in patients with pinguecula

PURPOSE

To investigate the tear flow, tear film stability and condition of mucus in patients with pinguecula.

METHODS

The Schirmer I and ferning tests were performed and break-up time (BUT) was determined in 57 patients with pinguecula [random eyes; 34 males and 23 females, 18 to 70 years of age (mean +/- SD: 39.1 +/- 13.5 years)] and in 57 age-matched subjects (control) [random eyes; 35 males and 22 females, 11 to 70 years of age (mean +/- SD: 37.8 +/- 15.2 years)], and the test results were statistically analysed.

RESULTS

The mean Schirmer test value was 22.72 +/- 12 mm in the eyes with pinguecula and 22.7 +/- 8.5 mm in the control eyes. There was no statistically significant difference (t = 0.01, p = 0.99) between the groups. The mean BUTs were 11.42 +/- 6.89 s in the eyes with pinguecula and 15.46+/-5.85 s in the control eyes. Comparison of BUTs between the groups revealed a statistically significant difference (t = 3.37, p = 0.0010). Also, ferning types were found to be significantly abnormal in the eyes with pinguecula (p < 0.01).

CONCLUSION

The alteration in the mucin layer is a possible change inducing pinguecula formation, or it may reflect an already existing pathology in the cells on the ocular surface.

Intraoperative mitomycin C in the treatment of pterygium

PURPOSE

To evaluate the effectiveness of intraoperative mitomycin C in preventing the recurrence of primary pterygium.

METHODS

In this prospective, randomized study, 38 eyes of 35 patients with primary pterygium were evaluated. In 19 eyes, the "bare sclera technique" combined with intraoperative application of 0.2 mg/mL (0.02%) mitomycin C for five minutes was performed (mitomycin C treated group). The other 19 eyes--taken as control group--underwent surgical excision alone. Statistics were analyzed using the Mann-Whitney U test and the Fischer's exact test.

RESULTS

Patients were 20-38 years of age. The mean age was 25.29 +/- 5.08 in the mitomycin C treated group and 25.00 +/- 5.19 in the control group. During the mean follow-up of 17.04 months (range, 12-36 months; SD = 5.89), 4 recurrences (21%) were observed in the mitomycin C treated group and 11 (57.8%) in the control group. The difference between the two groups was significant (p = 0.045). No postoperative complication was encountered in both groups except for recurrences.

CONCLUSION

Intraoperative mitomycin C was found to be effective in preventing the recurrence of primary pterygium.