Comments To: Recurrence and Complications of Pterygium Extended Removal Followed by Extended Conjunctival Transplant for Primary Pterygia

Dear Editor,

Extended pterygium removal followed by extended conjunctival transplant was described to be an effective technique for primary pterygia and resulted in a 0% recurrence rate with minimal intraoperative and postoperative complications (1).

Surgery is proposed when the patient has eye discomfort despite the use of lubricant eyedrops, restriction of ocular motility, occlusion of the visual axis, irregular astigmatism, and aesthetic complaints (2).

An adequate surgical technique is important to prevent recurrence, and mitomycin C (MMC) can also be a good ­option as an adjunctive treatment to prevent the recurrence of pterygium after surgery (2).

Data show that the use of MMC along with the conjunctival autograft technique further reduces the recurrence of pterygium, and the use of MMC alone reduces the recurrence if an adequate surgical technique is not used (3).

Intraoperative, preoperative, and postoperative use of MMC with conjunctival transplantation demonstrated a low recurrence rate and good cosmetic results in the treatment of pterygium (3).

Most studies suggest that increased exposure (dose or duration) of MMC is associated with a lower recurrence, but with higher risks of complications. Thus, there is a need for new long-term studies to determine the optimal dosage and duration of administration of MMC; as described in the literature, many complications occur years after the procedure (3).

We conducted a study with 45 patients who underwent pterygium surgery with conjunctival transplants. Fifteen patients underwent 1 surgery, and the recurrence rate was 47% (7 patients) in 1 year. A second group of 15 patients had a preoperative MMC 0.02% injection in the pterygium 2 weeks before the surgery; the recurrence rate was then 6% (1 patient) in 1 year. A third group had a MMC 0.02% injection in the pterygium 1 month before the surgery; the recurrence was also 6% (1 patient) after a 1-year follow-up. There were no side effects observed related to the use of MMC during the 1-year follow up.

Thus, studies of new surgical techniques and adjuvant treatments will be useful for improving pterygium removal that has a high risk of recurrence even for primary pterygium.