Resum
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 MMC (0.01%) plus CAG 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 MMC 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 (p = 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 CAG 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.
Keywords: Pterygium, surgery, recurrence, risk factors.
Résumé
Introduction: Pour identifier les déterminants de la récidive après l’excision de la ptérygoïde primaire combinée avec autogreffe conjonctivale (ACG) et l’utilisation peropératoire de la mitomycine C (MMC) ou le 5- fluorouracile (5-FU).
Méthodes: Un essai contrôlé randomisé clinique comparant le 5-FU (50 mg / ml) et de l’ACG par rapport MMC (0,01%) plus CAG dans la prévention des récidives de ptérygoïde primaire après l’excision.
Résultats: Un total de 80 yeux de 80 sujets ont été étudiés, avec 46 yeux dans le groupe 5-FU et 34 yeux dans le groupe de MMC.L’âge moyen était de 50,7 ± 13,1 ans avec un mâle : femelle rapport de 0.95:1. Moyenne suivi de période a été de 35,2 ± 29,1 semaines. Le taux global de récidive a été de 10 %, avec un taux de 8,7 % dans le groupe 5-FU et 11,8 % dans le groupe MMC. L’âge moyen des patients qui ont eu une récidive était de 38,1 ± 13,3 ans comparées à 52,1 ± 12,4 ans chez ceux sans récidive (P=0,003). La taille médiane de la ptérygoïde (la voile conjonctival chez les patients qui avaient une récurrence était 3,2 mm, tandis que la taille médiane chez les patients qui n’ont pas une réapparition à 3,0 mm (P= 0,8). Cinq (12,8 %) hommes avaient une réapparition comparativement à trois (7,3 %) femmes (P =0,48); alors que 10,5 % de charnue ptérygoïde réapparue comparativement à aucun (0 %) de ptérygoïdenon charnues (P =1,00).
Conclusion: Plus jeune âge demeure un facteur de risque de récidive lorsque les deux CAG et anti métabolites sont associés dans le traitement de ptérygoïde, tandis que l’effet du sexe, de la taille et de la morphologie de la ptérygoïde peut être diminué par une telle combinaison.
Correspondence: Dr. B.A. Olusanya, Department of Ophthalmology, College of Medicine, University of Ibadan, Nigeria. E-mail: bolutifeo@yahoo.com; bolusanya@comui.edu.ng
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