Intraoperative application of 5-fluorouracil and mitomycin C aschemoadjuvants in primary pterygium surgery

Background/aim: To compare the effectiveness of intraoperative 5 fluorouracil (5-FU) and mitomycin C (MMC) application in preventing recurrence following primary pterygium excision. Materials and methods: This was a prospective clinical trial that included 93 patients with primary pterygia assigned to three treatment groups in which 29 patients received an intraoperative application of 25 mg/mL 5-FU for 5 min, 32 patients received an intraoperative application of 0.02% MMC for 5 min, and 32 patients underwent only surgical excision (the control group). Follow-up visits were done on postoperative days 1, 3, 7, 15, and 30, and then every month. Results: After a mean follow-up of 14 months, the surgical excision recurrence rates in the 5-FU, MMC, and control groups were 27.6%, 12.5%, and 43.75%, respectively. There was a statistically significant difference in the 5-FU and MMC groups when compared with the control group (chi-square; P = 0.04); however, the difference between the 5-FU and MMC groups was not significant. No serious complications were seen in the 5-FU and MMC groups. Conclusion: Intraoperative application of MMC and 5-FU is effective and safe for the prevention of recurrence. Our findings suggest that MMC is more potent for the prevention of recurrence and it causes less complaints than 5-FU.

PDF

___

1. Adamis PA, Storck T. The management of pterygium. Ophthalmology Clinics of North America 1990; 3: 611623.
2. Erda S. Primer pterjiumda tedavi. In: Tamçelik N, Doğan ÖK, Kural G, editors. XXV. Ulusal Türk Oft. Kong. Bült. cilt 1; 1991. İstanbul, Turkey: Epsilon Yayıncılık; 1991. pp. 9094 (in Turkish).
3. Chen P, Reginald G. Randomized trial comparing mitomycin-C and conjunctival autograft after excision of primary pterygium. Am J Ophthalmol 1995; 120: 151160.
4. McCoombes JA, Hirst WL. Sliding conjunctival flap for the treatment of primary pterygium. Ophthalmology 1994; 101: 170173.
5. Allan BD. Pterygium excision with conjunctival autografting: an effective and safe technique. Br J Ophthalmol 1993; 77: 698 701.
6. Demireller T, Güven H, Gürsel E. Pterjium tedavisinde mitomisin. In: Tamçelik N, Doğan ÖK, Kural G, editors. XXV. Ulusal Türk Oft. Kong. Bült. cilt 1; 1991. İstanbul, Turkey: Epsilon Yayıncılık; 1991. pp. 5557 (in Turkish).
7. Isyaku M. Treatment of pterygium. Ann Afr Med 2011; 10: 197203.
8. Altay Y, Petricli S, Ugurlu N. Intraoperative application of 5-fluorouracil and mitomycin C in primary pterygium surgery and its effect on the fibroblast counts of conjunctival biopsies. J Clin Anal Med 2014; 5: 47.
9. Cardillo J, A1ves M. Single intraoperative application versus postoperative mitomycin-C eye drops in pterygium surgery. Ophthalmology 1995; 102: 19491952.
10. Hayasaka S, Nodo S. Postoperative instillation of mitomycin-C in the treatment of recurrent pterygium. Ophthalmic Surgery 1989; 20: 580583.
11. Singh G, Wilson MR. Mitomycin eye drops as treatment for pterygium. Ophthalmology 1988; 95: 813821.
12. Kenyon K, Waganer MD. Conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 1985; 92: 14611470.
13. Lewallen S. A randomized trial of conjunctival autografting for pterygium in the tropics. Ophthalmology 1989; 96: 16121614.
14. Pherwani A, Vakil V, Eatamadi H, Singh R, Dua HS. Postoperative subconjunctival 5-Fluorouracil in the management of recurrent pterygium. Br J Ophthalmol 2007; 91: 398399.
15. Mearza AA, Aslanides IM. Uses and complications of mitomycin C in ophthalmology. Expert Opin Drug Saf 2007; 6: 2732.
16. Rubinfeld RS, Pfister RR, Stein RM. Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology 1992; 99: 16471654.
17. Fujitani A, Hayasaka S, Shibuya Y. Corneoscleral ulceration and corneal perforation after pterygium excision and topical mitomycin-C therapy. Ophthalmologica 1993; 207: 162164.
18. Dunn JP, Seamone CD. Development of scleral ulceration and calcification after pterygium excision and mitomycin therapy. AJO 1991; 112: 343344.
19. Khaw PT, Sherwood MB, MacKay SL, Rossi MJ, Schultz G. Five-minute treatments with fluorouracil, floxuridine, and mitomycin have long-term effects on human Tenons capsule fibroblasts. Arch Ophthalmol 1992; 110:11501154.
20. Kaufman SC, Jacobs DS, Lee WB, Deng SX, Rosenblatt MI, Shtein RM Options and adjuvants in surgery for pterygium. Ophthalmology 2013; 120: 201208.
21. Young AL, Leung GYS, Wong AKK, Cheng LL, Lam DSC. A randomised trial comparing 0.02% mitomycin C and limbal conjunctival autograft after excision of primary pterygium. Br J Ophthalmol 2004; 88: 995997.
22. Akinci A. Zilelioglu O. Comparison of limbal-conjunctival autograft and intraoperative 0.02% mitomycin-C for treatment of primary pterygium. Int Ophthalmol 2007; 27: 281285.
23. Abraham LM, Selva D, Casson R, Leibovitch L. The clinical applications of fluorouracil in ophthalmic practice. Drugs 2007; 67: 237255.
24. Maldonado MJ, Cono-Paro J. Inefficiency of low dose intraoperative fluorouracil in the treatment of primary pterygium. Arch Ophthalmol 1995; 113: 13561357.
25. Akarsu C, Taner P, Engin A. 5 Fluorouracil as chemoadjuvant for primary pterygium surgery: preliminary report. Cornea 2003; 22: 522526.
26. Kareem AA, Farhood QK, Alhammami HA The use of antimetabolites as adjunctive therapy in the surgical treatment of pterygium. Clinical Ophthalmology 2012; 6: 18491854.