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The use of mitomycin C with autologous limbal-conjunctival autograft transplantation for management of recurrent pterygium  [cached]
Mohamed A Fakhry
Clinical Ophthalmology , 2011,
Abstract: Mohamed A FakhryDepartment of Ophthalmology, Kasr El Aini Hospital, Cairo University, Cairo, EgyptPurpose: The purpose of this study is to evaluate and compare recurrence rates upon using mitomycin C (MMC) with limbal-conjunctival autograft for treating recurrent pterygia.Methodology: An interventional, prospective, comparative clinical study was performed in 30 eyes (26 patients) with recurrent pterygia, allocated into two groups: Group A (19 eyes) operated by pterygium excision and limbal-conjunctival autograft transplantation (L-CAT) without MMC and Group B (20 eyes) operated with injection of 0.1 mL of MMC 0.15 mg/mL 1 month before L-CAT surgery. Exclusion criteria included patients with symblepharon, cicatricial conjunctival diseases, limbal stem cell deficiency, and other intraocular diseases.Results: A total of four cases of recurrences for Group A (P = 0.012) and one case of recurrence for Group B (P < 0.001) were recorded.Conclusions: Preoperative injection of MMC in low dose and concentration improves the results of L-CAT in recurrent pterygium.Keywords: recurrent pterygium, limbal autograft, conjunctival autograft, mitomycin C
Comparison of Amniotic Membrane Grafts and Intraoperative Mitomycin C for Primary Pterygium Excision  [PDF]
Ba?dagül Bilek,U?ur Keklik?i,Y?ld?r?m Bayaz?t ?akalar,M. Kaan ünlü
Dicle Medical Journal , 2008,
Abstract: To evaluate and compare the effectiveness and safety of the human amniotic membrane graft with intraoperative application of Mitomycin C in primary pterygium surgery.In 60 consecutive patients, 60 eyes were included in the study. The patients were randomly divided into two groups, primary pterygium excision with intraoperative Mitomycin C (0.2 mg/ml) were applied to the 30 patients and amniotic membrane grafts were applied to the other 30 patients.Recurrence was detected in two patients (%6.66) who received amniotic membrane grafts, and in five patients (%16.66) who received primary pterygium excision with intraoperative Mitomycin C. No statistical difference was observed between groups according to the reccurence (p > 0.05). Suture lysis in early postoperative period was detected in one patient (%3.33) who received amniotic membrane grafts. Scleral melting was developed in one patient (%3.33) and punctate epitheliopathy was developed in one patient (%3.33) who received primary pterygium excision with intraoperative Mitomycin C. No statistical difference was observed between groups according to the complications (p > 0.05).Although no statistical difference was observed between two groups according to complication and reccurence, amniotic membrane graft method was safer than primary pterygium excision with intraoperative Mitomycin C.
The use of mitomycin C with autologous limbal-conjunctival autograft transplantation for management of recurrent pterygium
Mohamed A Fakhry
Clinical Ophthalmology , 2011, DOI: http://dx.doi.org/10.2147/OPTH.S16474
Abstract: se of mitomycin C with autologous limbal-conjunctival autograft transplantation for management of recurrent pterygium Case Series (4650) Total Article Views Authors: Mohamed A Fakhry Published Date January 2011 Volume 2011:5 Pages 123 - 127 DOI: http://dx.doi.org/10.2147/OPTH.S16474 Mohamed A Fakhry Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, Cairo, Egypt Purpose: The purpose of this study is to evaluate and compare recurrence rates upon using mitomycin C (MMC) with limbal-conjunctival autograft for treating recurrent pterygia. Methodology: An interventional, prospective, comparative clinical study was performed in 30 eyes (26 patients) with recurrent pterygia, allocated into two groups: Group A (19 eyes) operated by pterygium excision and limbal-conjunctival autograft transplantation (L-CAT) without MMC and Group B (20 eyes) operated with injection of 0.1 mL of MMC 0.15 mg/mL 1 month before L-CAT surgery. Exclusion criteria included patients with symblepharon, cicatricial conjunctival diseases, limbal stem cell deficiency, and other intraocular diseases. Results: A total of four cases of recurrences for Group A (P = 0.012) and one case of recurrence for Group B (P < 0.001) were recorded. Conclusions: Preoperative injection of MMC in low dose and concentration improves the results of L-CAT in recurrent pterygium.
Complications following Use of Intraoperative Mitomycin-C in Pterygium Surgery.  [PDF]
Imtiyaz Ahmad, Reyaz Ahmad Untoo, Sheikh Sajjad.
JK Science : Journal of Medical Education & Research , 2004,
Abstract: This study was designed to evaluate the possible complications following the use of intraoperativemitomycin-C in patients undergoing surgery for primary pterygium. Hundred eyes of 88 patients withprimary pterygium were operated upon using ''bare sclera technique''. Intraoperatively all the patientswere applied freshly prepared mitomycin-C 0.02% (0.2 mg/ml) on the bare sclera for a period of 5 minutes,after which the eyes were thoroughly rinsed with a sterile balanced salt solution. Postoperatively, none ofthe patients recieved mitomycin-C eye drops. After a mean postoperative followup of 14 months, 4 eyes(4%) of 4 patients developed thinning of the sclera with visualization of the underlying uveal tissue. Oneeye (1%) developed extreme thinning of the sclera with ectasia of the underlying uveal tissue, requiringa scleral patch. Recurrence was seen in 2 eyes (2%) only. The study shows that although intraoperativemitomycin-C (0.02%) reduces the recurrence of pterygium, it leads to serious, cosmetically unacceptableand even sight-threatening complications.
Preoperative subconjunctival injection of mitomycin C versus intraoperative topical application as an adjunctive treatment for surgical removal of primary pterygium  [cached]
Ghoneim Ehab,Abd-El Ghny Ahmed,Gab-Allah Amro,Kamal Mohamed
Middle East African Journal of Ophthalmology , 2011,
Abstract: Purpose : To compare the efficacy of preoperative local injection of mitomycin C (MMC) to intraoperative application of MMC in the prevention of pterygium recurrence after surgical removal. Materials and Methods : Seventy eyes of 70 patients with primary pterygia were randomly allocated to two groups. The first group (Group A, 35 eyes) received 0.1 ml of 0.15 mg/ml of subconjunctival MMC injected into the head of the pterygium 24 h before surgical excision with the bare sclera technique. The second group (Group B 35 eyes) underwent surgical removal with the bare sclera technique with intraoperative application of MMC (0.15 mg/ml) over bare sclera for 3 min. The study was performed between March 2007 and December 2008, and follow up was performed for 1 year postoperatively. Differences between frequencies in both groups were compared by the Chi-square test or Fisher exact test. Differences between means in both groups were compared by Student′s t-test. P < 0.05 was considered significant. Results : The rate of pterygium recurrence was 5.70% in Group A and 8.57% in Group B at 1 year postoperatively (P>0.05). Postoperatively, scleral thinning occurred in one eye in each group that resolved by 5 months postoperatively. No serious postoperative complications occurred in either group. Conclusion : Preoperative local injection of 0.15 mg/ml MMC is as effective as intraoperative topical application of 0.15 mg/ml MMC for preventing pterygium recurrence after surgical removal.
Evaluation of epithelial cell proliferating activity and fibroblast nuclear kariometry in recurrent pterygium treated with mitomycin C
Almeida Junior, Gildasio Castello de;Frederico, Fabio Batista;Watanabe, Karina Paula;Garcia, Tatiana Vanucci;Iquejiri, ?ngela Yuri;Cury, Patrícia Maluf;Taboga, Sebasti?o Roberto;Azoubel, Reinaldo;
Arquivos Brasileiros de Oftalmologia , 2008, DOI: 10.1590/S0004-27492008000400019
Abstract: purpose: to evaluate the effectiveness of mitomycin c (mmc) in preventing recurrence of pterygium following conjunctival autograft transplantation (cat). ki-67 antigen to evaluate epithelial cell proliferation and fibroblast nuclear kariometry were used to assist treatment evaluation. methods: twenty-nine patients with recurrent pterygium were divided into three groups: group (g) 1 - cat and placebo eyedrops (ped); g2 - cat, 0.015% mmc subconjunctivally, and ped; g3 - cat and 0.02% mmc eyedrops. immunohistochemistry for the ki-67 antigen and fibroblast nuclei kariometry were performed on the excised tissue, divided into nasal and temporal sides. kariometry was evaluated in terms of volume (vl) and area (ar) using at least 50 cells/patient. results: the percentage of positive epithelial cells for the ki-67 antigen on the nasal and temporal side after treatment of the three groups were: nasal (5.39% g1, 4.49% g2, and 3.88% g3); temporal (3.30% g1, 4.46% g2, 4.14% g3), did not show significant differences. fibroblast nucleus kariometry was: nasal vl (792.1 μ3 g1, 605.1 μ3 g2, and 549.9 μ3 g3) and ar (100.58 μ2 g1, 83.13 μ2 g2, and 78.41 μ2 g3). the three groups showed significant differences: p=0.039 and p=0.035, for respectively vl and ar, on the nasal side. after a six month of treatment, the three groups presented the following recurrence rates: g1, 22.22%, g2, 18.18% and g3, 33.33%, respectively. conclusion: mmc did not reduce the number of positive epithelial cells for the ki-67 antigen in recurrent pterygium, but decreased fibroblast nucleus volume and area on the nasal side of the pterygia. the number of positive epithelial cells for the ki-67 antigen seemed not to be related to pterygium recurrence observed over a six-month post-surgery period. the role of epithelial cell proliferation in pterygium recurrence should be evaluated by further studies.
Estudio comparativo del uso de mitomicina C en el pterigium recidivante Comparative study of the use of mitomycin C in recurrent pterygium  [cached]
Belmary Aragonés Cruz,Jaime Alema?y Martorell
Revista Cubana de Oftalmolog?-a , 2008,
Abstract: INTRODUCCIóN: El pterigium constituye un problema en la práctica oftalmológica por su alta prevalencia y elevada frecuencia de recidiva. El propósito de este estudio fue el de comparar la técnica quirúrgica de injerto autólogo de conjuntiva con células límbicas más mitomicina C, con la de injerto de membrana amniótica con mitomicina C, en pterigium recidivante, en cuanto a la tasa de recidiva, complicaciones posoperatorias inmediatas, y tiempo libre de recidiva (meses). MéTODOS: Se realizó un ensayo clínico controlado prospectivo con n= 57 pacientes portadores de pterigium recidivante. Se conformaron 2 grupos: grupo 1, injerto de conjuntiva antólogo con células límbicas más mitomicina C; y el grupo 2, injerto de membrana amniótica más mitomicina C. Se comparó el comportamiento de las técnicas empleadas a partir de sus resultados. El seguimiento fue ± de 1-6 meses. RESULTADOS: La agudeza visual mejoró en 60 % de los casos. La recidiva fue de 2 % para el grupo 1 y de 6 % para el grupo 2. CONCLUSIONES: El método de injerto conjuntival con limbo resultó más efectivo para el tratamiento del pterigium recidivante. él método de membrana amniótica constituye una alternativa para el tratamiento de casos en los cuales no sea viable la aplicación de de injerto antólogo. INTRODUCTION: Pterygium is a problem in ophthalmology practice because of its high prevalence and frequency of recurrence. The objectives of this study was to compare the surgical technique of autologous conjuctival graft with limbal cells plus mitomycin C with that of amniotic membrane graft treated with mitomycin C in recurrent pterygium in terms of recurrence rates, immediate postoperative complications and recurrence-free time (months). METHODS: A prospective controlled clinical assay was carried out in 57 patients suffering recurrent pterygium. They were divided into two groups; the group 1 that had autologous conjuctival graft with limbal cells plus mitomycin C, and the group 2 with amminotic membrane graft plus mitomycin C. The used techniques were compared on the basis of their results. The follow-up period extended from one to six months. RESULTS: Visual acuity improved in 60 % of cases. Recurrence occurred in 2 % of cases in group 1 and 6 % in group 2. CONCLUSIONS: The conjunctival graft with limbal cells method was more effective for the recurrent pterygium treatment. The amniotic membrane method constitutes an alternative therapy for cases in which autologous graft is not applicable.
Comparing techniques for pterygium surgery  [cached]
Atilla Alpay,Suat Hayri Ugurbas,Berktug Erdogan
Clinical Ophthalmology , 2008,
Abstract: Atilla Alpay, Suat Hayri Ugurbas, Berktug ErdoganDepartment of Ophthalmology, Faculty of Medicine, Zonguldak, Karaelmas University, Zonguldak, TurkeyPurpose: To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique.Methods: This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia; mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia; 18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction; and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years.Results: Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were observed. There were no major complications threatening visual ability in the surgical patients.Conclusion: A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.Keywords: pterygium, comparing, techniques, mitomycin C
Comparing techniques for pterygium surgery
Atilla Alpay, Suat Hayri Ugurbas, Berktug Erdogan
Clinical Ophthalmology , 2009, DOI: http://dx.doi.org/10.2147/OPTH.S2767
Abstract: mparing techniques for pterygium surgery Original Research (7455) Total Article Views Authors: Atilla Alpay, Suat Hayri Ugurbas, Berktug Erdogan Published Date September 2008 Volume 2009:3 Pages 69 - 74 DOI: http://dx.doi.org/10.2147/OPTH.S2767 Atilla Alpay, Suat Hayri Ugurbas, Berktug Erdogan Department of Ophthalmology, Faculty of Medicine, Zonguldak, Karaelmas University, Zonguldak, Turkey Purpose: To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique. Methods: This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia; mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia; 18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction; and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years. Results: Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were observed. There were no major complications threatening visual ability in the surgical patients. Conclusion: A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.
Intraoperative Ethanol Treatment as an Adjuvant Therapy of Pterygium Excision  [cached]
Ko-Hua Chen,Ko-Hua Chen,Ko-Hua Chen,Wen-Ming Hsu
International Journal of Biomedical Science , 2006,
Abstract: Recurrence of pterygium is the main concern for ophthalmic surgeons after the excision of pterygium. To evaluate the efficacy and safety of ethanol treatment during pterygium excision in preventing the recurrence of pterygia, a prospective randomized study was performed of 78 eyes in primary pterygium patients treated by excision. Primary pterygium patients were randomly assigned to ethanol group (38 eyes given intraoperative ethanol) or mitomycin-c (MMC) group (40 eyes given intraoperative MMC). Ethanol (20%) was applied for 60 seconds to the pterygial and its adjacent corneal surfaces before pterygium excision. After excision, the excised site of sclera was soaked with 20% Ethanol for 60 seconds. In group 2, MMC (0.25 mg/ml) was applied for 60 seconds to the bare sclera after pterygium excision. The outcomes were followed for more than one year. Pterygium recurred in 2 (5.3%) of 38 eyes in ethanol group and 4(10.0%) of 40 eyes in MMC group. Final appearance of the pterygium excision area was satisfactory in 73.6% of group1 and 67.5% of group 4. No patients experienced severe complications postoperatively. In comparison with MMC treatment, intraoperative ethanol is more efficacious in preventing recurrence of pterygium and causes fewer complications. It suggests this regimen as an alternative for the treatment of pterygium, especially for those patients of high risk group for MMC treatment complications.
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