Pterygium recurrence following preoperative topical Mitomycin C and 5-Fluorouracil eyedrops.

Introduction: Various adjuvant therapies have been used to prevent recurrence after pterygium excision. However, no single agent has been proven to be a gold standard for completely preventing recurrence with no associated complications.

Purpose: This study aims to compare the recurrence rate following preoperative topical mitomycin C (MMC) and 5-fluorouracil (5-FU) eye drops in pterygium excision surgery.

Methods: In this interventional longitudinal comparative study, 90 patients with primary pterygium attending the Ophthalmology Clinic were enrolled and randomized into three equal groups of 30 each. Groups A, B, and C received preoperative 0.02% MMC eye drops, 1% 5-FU eyedrops, and placebo treatment respectively for one week before surgery followed by pterygium excision with conjunctival autograft and histopathological analysis. Patients were followed for 6months to identify recurrence.

Results: At the end of the 6months, the recurrence rate in the preoperative MMC group (6.7%) was less than the 5-FU (13.3%) and placebo (20%) groups. The histopathological findings were consistent with pterygium tissues. There were high grades of inflammation, degeneration, and vascularization in both the MMC and 5-FU groups in the specimens which recurred within a period of 6months. Five patients had a novel finding of smooth muscle choristoma tissue with bundles of smooth muscle cells and fat cells clustered among the conjunctival tissue.

Conclusion: Based on our study results, we demonstrate that preoperative topical MMC and 5-FU eyedrops have efficacy in reducing recurrence in pterygium surgeries. The eyedrop route of administration has been proven to be an effective and easier alternative, enabling us to monitor for adverse effects of adjuvant drugs. Histopathological evaluation provides indices to predict features of future recurrence in pterygium specimens. This is the first study in which the efficacy of preoperative MMC and 5-FU is studied in eyedrop formulation along with histopathological correlation with recurrence.