Risk factors for pterygium recurrence after surgical excision with combined conjunctival autograft (CAG) and intraoperative anti metabolite use

Abstract

Background: To identify the determinants of recurrence following primary pterygium excision combined with conjunctival autograft (CAG) and intraoperative use of Mitomycin C (MMC) or 5- Fluorouracil (5-FU). Methods: A randomized controlled clinical trial comparing 5-FU (50 mg/ml) plus CAG versus M MC (0.01%) plus C AG in preventing recurrence of primary pterygium following excision. Results: A total of 80 eyes of 80 subjects were studied, with 46 eyes in the 5-FU group and 34 eyes in the MMC group. The mean age was 50.7 ±13.1 years with a male: female ratio of 0.95:1. Mean follow up period was 35.2 ± 29.1 weeks. The overall recurrence rate was 10%, with a rate of 8.7% in the 5-FU group and 11.8% in the M MC group. The mean age of the patients who had a recurrence was 38.1 ± 13.3 years compared to 52.1 ± 12.4 years in those without a recurrence (p = 0.003). The median size of the pterygium in patients who had a recurrence was 3.2mm, while the median size in patients who did not have a recurrence was 3.0mm (p = 0.8). Five (12.8%) males had a recurrence compared to three (7.3%) females (/; = 0.48); while 10.5% of fleshy pterygia recurred compared to none (0%) of the non-fleshy pterygia (p = 1.00). Conclusion: Younger age remains a risk factor for recurrence when both C AG and antimetabolites are combined in the treatment of pterygium, while the effect of gender, size and morphology of the pterygium may be diminished by such combination.