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First Author: A.Young HONG KONG
Co Author(s): M. Ho L. Cheng
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Mitomycin C (MMC) and limbal conjunctival autograft (LCAU) are two recognised safe and effective adjuvants in the prevention of pterygial recurrence. Recently, endothelial damage has been attributed to intraoperative application of MMC. However, relative less is known regarding the long term outcome from these two treatment adjuvants. This study was thus conducted to evaluate the long term effects of these two methods.
Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong
: The cohort of a randomised controlled trial of consecutive patients from Feb 2001 to March 2002 presenting with primary pterygium excision, were randomized into two adjuvant groups: (1) intraoperative 0.02% MMC for 5 minutes or (2) LCAU. These patients were invited in 2012 to return for a detailed follow-up evaluation including specular microscopy on endothelial counts, appearance of residual bed and any other complications. Recurrence as per the original study was defined as fibrovascular tissue invading the cornea beyond 1.5mm.
115 eyes in 114 patients of the original study were randomised to receive MMC (n=63) or LCAU (n=52). In the current study of 10 year long term follow up, a total of 76 patients (47 MMC, 29 LCAU) returned and completed the full examination. There were 12 recurrences in the MMC group (25.5%), with 2 recurring in the LCAU group (6.9%). There was a statistically difference in the recurrence rate between the two treatment groups (p=0.021). The endothelial cell counts for the two groups were measured, with the mean endothelial cell count in MMC group of 2392 cells per mm2 and LCAU group was 2390 cells per mm2. There was no significant difference in the mean corneal endothelial cell count between two groups in the long term (p=0.978).
Pterygium excision followed by MMC or LCAU are both safe adjuvants for pterygium excision. As per the original cohort results, the long term outcome also favours LCAU in terms of recurrences. However, contrary to published reports, corneal endothelial cell count does not appear to be worse in comparison to LCAU over time.