COMPARISON OF SURGICAL TECHNIQUES FOR PTERYGIUM USING MITOMYCIN-C OR 5-FLUOROURACIL AS ADJUNCTS

CORRESPONDING AUTHOR:
Dr. Yogesh Kumar,
Assistant Professor,
Department of Ophthalmology,
Shri Guru Ram Rai Institute of Health & Medical Sciences, Dehradun, Uttarakhand, India.
Email – eyeologist@gmail.com

ABSTRACT: AIM: To compare surgical techniques for pterygium using mitomycin-C/5-fluorouracil as adjunct to surgery. SETTINGS AND DESIGN: A randomized, interventional, prospective, comparative study was conducted in Department of Ophthalmology, S.N Medical College, Agra for 2 years. MATERIALS AND METHODS: Patients underwent complete preoperative evaluation (complete history and ophthalmological examination). Ninety-eight eyes of 98 selected cases were divided into eight groups depending upon treatment protocol:

I–Mitomycin-C (0.02%) with bare sclera

II– Mitomycin-C (0.04%) with bare sclera

III– Mitomycin-C (0.02%) with conjunctival autograft

IV– Mitomycin-C (0.04%) with conjunctival autograft

V–5-fluorouracil (10mg/ml) with bare sclera

VI–5-fluorouracil (20mg/ml) with bare sclera

VII–5-fluorouracil (10mg/ml) with conjunctival autograft

VIII–5-fluorouracil (20mg/ml) with conjunctival autograft

STATISTICAL ANALYSIS: Chi-square test was used to compare the outcome. RESULTS: Of 98 cases, 61 (62.24%) were male, 37 (37.75%) were female. The age ranged 18‒66 years, with mean age of 44.6 years. Maximum cases were in age group 41‒50 (48.98%). Seventy-nine (80.61%) had primary pterygium while 19 (19.39%) cases had recurrence. 74.49% were from rural area and 25.51%  from urban background. 75.51% were outdoor workers while 24.49% were indoor workers. Involvement was bilateral in 71 (72.45%) cases. Ninety-five (96.94%) cases had nasal pterygium and 3 (3.06%) had both nasal and temporal. Most patients (73.47%) presented with complaint of ʿgrowth in eyeʾ, followed by redness/congestion (16.33%). At reporting, corneal involvement in majority (64.28%) was 1–3 mm, and most patients (53.06%) consulted between 6–12 months of onset. The success rates, recurrence rates and ocular complications varied in various groups. The success rate was maximum (100%) in group-IV and minimum (72.73%) in group-V. Within mitomycin-C groups, conjunctival autograft revealed better results against bare sclera technique. No significant difference existed between low and high concentration groups with mitomycin-C or 5-fluorouracil, and even the mitomycin-C versus 5-fluorouracil groups. Groups IV and VIII revealed higher rate of complications including graft-injection and retraction (46.15% and 23.07% in Group-IV, and 61.54% and 23.07% in group-VIII), hematoma (23.07% and 30.77% in group-IV and VIII respectively), dry-eye (15.38% and 7.69% in group-IV and VIII ), granulation-tissue formation (7.69% in both), and scleral-thinning (7.69% in group-IV).

KEY WORDS: Bare sclera technique, Conjunctival autograft, 5-Fluorouracil, mitomycin-C, Pterygium.