Manning C A, Kloess P M, Diaz M D, Yee R W
Wilford Hall Medical Center, San Antonio, Texas, USA.
Ophthalmology. 1997 May;104(5):844-8. doi: 10.1016/s0161-6420(97)30224-3.
Conjunctival autograft transplantation and postoperative mitomycin therapy are two adjuvant treatment methods shown to lessen the high pterygium recurrence rate seen with simple excision alone. The authors conducted a prospective, randomized study comparing these two techniques with a relatively new treatment method using intraoperative mitomycin application.
Fifty patients with 56 primary pterygia were randomized to 1 of 3 treatment groups: conjunctival autograft (group 1), postoperative mitomycin 0.2 mg/ml four times a day x 7 days (group 2), and intraoperative mitomycin 0.4 mg/ml x 3 minutes (group 3). The mean follow-up time was 16 months (range, 6 to 28 months).
Recurrences developed in 4 (22.2%) of 18 eyes in group 1, 4 (21.1%) of 19 eyes in group 2, and 2 (10.5%) of 19 eyes in group 3. Complications developed in two, patients from group 2, scleral thinning managed successfully with a scleral patch graft, and epithelial toxicity that resolved on discontinuation of mitomycin on postoperative day 6. There were no complications in the other two groups.
Intraoperative mitomycin is a simple and effective alternative to postoperative mitomycin therapy, showing the lowest recurrence rate in their series with no toxicity during the study period. If the decision is made to use adjunctive mitomycin, the authors recommend intraoperative application over postoperative administration.
结膜自体移植术和术后丝裂霉素治疗是两种辅助治疗方法，已证明可降低单纯切除术后翼状胬肉的高复发率。作者进行了一项前瞻性随机研究，将这两种技术与一种使用术中丝裂霉素的相对较新的治疗方法进行比较。
50例患有56处原发性翼状胬肉的患者被随机分为3个治疗组中的1组：结膜自体移植组（第1组）、术后使用0.2mg/ml丝裂霉素，每天4次，共7天（第2组）、术中使用0.4mg/ml丝裂霉素，持续3分钟（第3组）。平均随访时间为16个月（范围6至28个月）。
第1组18眼中有4眼（22.2%）复发，第2组19眼中有4眼（21.1%）复发，第3组19眼中有2眼（10.5%）复发。第2组有2例患者出现并发症，巩膜变薄通过巩膜补片移植成功处理，上皮毒性在术后第6天停用丝裂霉素后消退。其他两组无并发症。
术中丝裂霉素是术后丝裂霉素治疗的一种简单有效的替代方法，在他们的系列研究中显示出最低的复发率，且在研究期间无毒性。如果决定使用辅助性丝裂霉素，作者建议术中应用而非术后给药。
