Pterygium excision with modified bare sclera technique combined with mitomycin C
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CLINICAL INVESTIGATION
Pterygium excision with modified bare sclera technique combined with mitomycin C Yulia Aziza1,2 · Tsutomu Inatomi1,3 · Chie Sotozono1 · Shigeru Kinoshita4 Received: 7 January 2020 / Accepted: 20 August 2020 © Japanese Ophthalmological Society 2020
Abstract Purpose Numerous surgical methods, with varying rates of recurrence, have been applied for the treatment of pterygium. Adjuvant mitomycin C (MMC) application has shown promising results in the prevention of recurrence. Here we propose and describe modified bare sclera technique combined with the intraoperative application of MMC for pterygium excision. Study design Retrospective study. Methods Primary pterygium patients who underwent pterygium excision via the bare sclera combined with 0.04% MMC technique from January 2014 to December 2016 were reviewed. In all patients, the subconjunctival pterygium strand was exposed and then sufficiently excised in combination with the safe use of MMC; i.e., the prevention of MMC dilution and diffusion to surrounding tissue. Surgical complications, recurrence rates, and recurrence onset were recorded. Results This study involved 32 primary pterygium eyes (grade T1 = 22 eyes; 68.7%). The mean postoperative follow-up period was 26.4 ± 14.5 months (range: 12–60 months). MMC was applied for 1–3 min. The mean complete epithelialization was 12.6 ± 7.6 days and no surgical complications were observed. In 1 patient with double-head primary pterygium, recurrence occurred at 15-months postoperative. Conclusions The modified bare sclera technique combined with MMC application was found to be safe, effective, and presents good cosmetic appearance for the treatment of primary pterygium when safety points are strictly applied. Keywords Bare sclera with MMC · Recurrence rate · Safety profile
Introduction Pterygium is a triangular, wing-like, benign fibrovascular tissue growth located at the nasal side of the eye that involves the conjunctiva and superficial cornea [1]. It is most prevalent in countries with elevated sun exposure; i.e., located in Corresponding Author: Tsutomu Inatomi * Tsutomu Inatomi [email protected]‑m.ac.jp 1
Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii‑cho, Hirokoji‑agaru, Kawaramachi‑dori, Kamigyo‑ku, Kyoto 602‑0841, Japan
2
Department of Ophthalmology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
3
Department of Ophthalmology, National Center for Geriatrics and Gerontology, Aichi, Japan
4
Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
the tropics and the equatorial zone between the latitudes of 30° North and 30° South [2]. The prevalence of pterygium in Asia reportedly ranges between 9.84% in China, 12.3% in Singapore, 30.8% in Kumejima, Japan and 36.4% in Bali, Indonesia [3–6]. The incidence of the disorder is reportedly higher in direct association with chronic ultraviolet exposure, older age, male sex, and elevated work and general
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