Pterygium surgery with mitomycin and tarsorrhaphy

Purpose: To determine if a pterygium surgical procedure consisting of minimal conjunctival removal, excision of the hypertrophic subconjunctival fibrovascular tissue, application of mitomycin 0.25 mg/mL for 1 minute combined with temporary nasal tarsorrhaphy, and use of postoperative dexamethasone/ antibiotic drops achieves the following: safely simplifies pterygium removal, controls the early side effects of mitomycin, reduces the rate of recurrence, and lessens the need for conjunctival transplantation. Methods: Twenty eyes in 19 patients underwent the procedure with use of mitomycin; 15 eyes had primary and 5 had recurrent pterygia. These were compared with a previous group of 28 eyes in 26 patients that underwent pterygium/tarsorrhaphy surgery without use of mitomycin; 20 eyes had primary and 8 had recurrent pterygia. Postoperatively, all eyes in both groups were treated with dexamethasone/antibiotic drops. Results: In the mitomycin group, with an average follow-up of 12.1 months, 19 eyes healed uneventfully; there have been no recurrences. The nonmitomycin group, with an average follow-up of 42.6 months, has had nine recurrences (32%); four required a second procedure. Recurrence was significantly lower in the mitomycin group (P = .006). Conjunctival healing, as reflected in the time from surgery until tarsorrhaphy opening, was significantly delayed in the mitomycin group, 36.7 versus 17 days (P = .001). The delay in conjunctival healing may explain the complications associated with the use of mitomycin in pterygium surgery. Conclusion: Minimal conjunctival removal, extensive fibrovascular tissue excision, 1-minute application of mitomycin 0.25 mg/mL, temporary nasal tarsorrhaphy, and frequent application of dexamethasone/antibiotic drops postoperatively provided a safe and successful approach to pterygium management in this series.