Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C in the treatment of primary pterygium.

Purpose: To introduce a new technique of conjunctival reconstruction after primary pterygium excision, and to evaluate the efficacy of combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application in preventing recurrence of primary pterygium.

Methods: In a prospective, non-comparative case series, 43 eyes of 41 consecutive patients with primary pterygium were studied. In all patient eyes, after excision of pterygia, 0.02% mitomycin C was applied topically for 2 min over the exposed scleral surface and "symmetrical conjunctival flap transposition" was performed to reconstruct the conjunctival defect. The main outcome measures were pterygium recurrence or any complications related with surgery or mitomycin C.

Results: The mean age of the patients was 47.5 +/- 12.4 years (range 30-70 years). Among the 38 patients who were not lost to follow up, three patient eyes (7.5%) had grade 1, 24 eyes (60.0%) had grade 2 and 13 eyes (32.5%) had grade 3 pterygium. The mean follow up was 12.2 +/- 5.7 months (range 7-28 months). No recurrence or sight-threatening complications were encountered in any patient eye throughout the follow-up period.

Conclusion: Combined "symmetrical conjunctival flap transposition" and intraoperative low-dose mitomycin C application may be an effective surgical alternative in preventing recurrence of primary pterygium. Although the procedure seems to be free from severe complications, surgeons and patients should be well aware of the risk of late radiomimetic complications of mitomycin C. Comparative, randomized trials with more number of patients and longer follow up are required to further establish the safety and efficacy of this treatment strategy.