5-Fluorouracil versus mitomycin C as adjuncts to conjunctival autograft in preventing pterygium recurrence

Abstract

To compare the efficacy of 5-fluorouracil (5-FU) with mitomycin C (MMC) in preventing pterygium recurrence when used as an adjuvant following pterygium excision with conjunctival autograft. Low-dose MMC combined with conjunctival autograft is an effective treatment for preventing recurrence following pterygium excision, but safety, cost, and availability limit its use in developing countries. There is a paucity of data on the efficacy of 5-FU when used in Africa as an adjuvant to conjunctival autograft following pterygium excision. This is a randomized controlled prospective trial using either 50 mg/ml 5-FU or 0.01% MMC. Eighty eyes of 80 subjects were studied. Forty-six subjects with a mean age 49.8 ± 13.8 years were treated with 5-FU (USD 13.0 per unit), while 34 patients with a mean age 51.9 ± 12.1 years were treated with MMC (USD 20.0 per unit). There was no significant difference in mean age between the two groups (p = 0.48). The ratio of male to female patients in both groups was similar at 0.92:1 for the 5-FU group and 1:1 for the MMC group (p = 0.85). Mean follow-up period was 35.2 ± 29.1 weeks. Recurrence rate in the 5-FU group was 8.7% compared to 11.8% in the MMC group (recurrence risk ratio = 0.71, 95% CI 0.17-3.1, p = 0.7). One patient from the MMC-treated group had corneoscleral melting. Other complications were mild and not sight threatening. In the prevention of pterygium recurrence, 5-FU appears to compare favorably with low-dose MMC when used as an adjuvant following pterygium excision and conjunctival autograft. Further studies are required to assess the long-term effect of using 5-FU in such cases.

Comparison of Surgical Techniques for Pterygium Using Mitomycin-C or 5-Fluorouracil as Adjuncts

“…The recurrence rates of 15%, 15.9%, 6.6%, and 5.76%, have been observed by Altay et al, Young et al, Frucht-Pery et al, and Akinci et al, respectively, when MMC (0.02%) was used with bare sclera [5,13,14,15 ] , while recurrence rates of 0%, 4.6%, 9%, and 11.8% have been observed by Frucht-Pery et al, Narsani et al, Wong et al, and Bekibele et al, respectively, when MMC (0.01% or 0.02%) was used as adjunct to CA. [14,16,17,18 ] The results in present study groups I-II, and III-IV [ Table 2] are comparable to the respective studies mentioned above.…”

“…Rahman et al, Yesim et al, and Josephine et al revealed recurrence Srates of 33.33%, 20%, and 27.8%, respectively with 5-FU (25mg/ml or 50mg/ml) as adjunct to bare sclera [2,5,19 ] , while recurrence of 8.7% has been observed by Bekibele with 5-FU (50mg/ml) as adjunct to CA. [18] The present study revealed the recurrence rates of 27.27% and 25% in 5-FU groups with bare sclera technique (Gp V and GpVI), and 8.33% and 7.69% with CA (Gp VII and GpVIII).The results of the various groups were comparable to respective studies mentioned. Moreover, success rates (χ 2 =2.82, p<0.1) with CA (Gp VII and VIII) were higher than bare sclera technique (Gp V and VI), no significant difference have been observed between low or high dose groups [Gp V versus Gp VI (χ 2 =0.01, p>0.05), and Gp VII versus Gp VIII (χ 2 =0.01, p>0.05)], carrying lesser complications with low dose (VII) against high dose group (VIII) of 5-FU with CA.…”

Management of diffuse ocular surface squamous neoplasia: efficacy and complications of topical chemotherapy

“…Following this complication, the author (JM) now reviews the patients every 3 days whilst receiving treatment in the first week and ceases the agent immediately if an epithelial defect is apparent. It is notable that this uncommon side effect has also been observed with the topical application of MMC . There were no cases of corneal endothelial failure in either the 5FU or MMC cohorts, although, endothelial cell density and morphology were not evaluated.…”

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“…Mitomycin C certainly reduced the risk of recurrence, but mitomycin C also carries its own risk of vision threatening complications. Mitomycin C can produce scleral melting, secondary glaucoma, cataract, as well as other problems [32,34,35,[44][45][46][47][48]. The known and unknown complications of mitomycin C requires cautious use despite the established lowering of recurrence rates [31][32][33]35,43].…”