Jawad Humayun, et al
Treatment of pterygium includes medical and
surgical modalities. Medical treatment includes tears
substitute, topical steroids and sunglasses4. Different
surgical procedures used for the treatment are bare
sclera technique, simple conjunctival flap, conjunctival
auto-grafting, adjunctive treatment with Mitomycin C
or Beta irradiation, amniotic membrane patch grafting
and occasionally peripheral lamellar keratoplasty5,6.
Each procedure is associated with certain recurrence
rates. Multiple studies have been done comparing
different surgical procedures7.
with pterygium, both genders and age 18 – 60 years
were included in the study. Patients with recurrent
pterygium, conjunctivitis, blephritis, keratitis or any
other ocular inflammatory condition and patients
having history of chemical burns and symblepharon
were excluded from the study. All patients were
divided into two groups using non probability
consecutive sampling. Group A was treated with
surgical excision with 0.02% mitomycin–C application
for 3 minutes and group B was treated with surgical
excision and application of amniotic membrane.
Amniotic membrane was retrieved by getting placenta
from patients booked for elective C-section in the
OBS/Gynae department. The patients were sero-
negative for Hepatitis B and C. Amniotic membrane
was separated from Chorion and was scrapped to
remove debris. All the debris/blood was washed with
antibiotic cocktail in Balanced Salt solution
(Ampicillin, Streptomycin and Amphotericin-B). After
surgery, patients were given eye drops of
Moxifloxacin and Dexamethasone. Patients of both
groups were followed up for six months to detect
recurrence of pterygium on slit lamp examination.
Data was analyzed using SPSS version 20. Frequency
and percentages were calculated for categorical data
like age, gender and recurrence rate. Chi square test
was applied on the two groups to see the difference
between the two groups. P value ≤ 0.05 was
considered significant. Recurrence rate was stratified
against age and sex to see the effect modifiers.
Mitomycin C (MMC) is an alkylating agent, which
has been used during pterygium surgery to reduce
chances of recurrence. MMC causes cell death by
inhibiting DNA synthesis. It is applied directly over
the sclera using sponges during pterygium surgery. It
acts by inhibition of fibroblast proliferation in the
episcleral region and hence reduces chances of
recuirrence8.
One of the methods to cover the gap created by
pterigium excision is to use amniotic membrane graft
over the bare sclera. Amniotic membrane has also
been used in other ocular surface diseases such as
persistent corneal epithelial defects, chemical burns,
Stevens–Johnson syndrome and ocular cicatricial
pemphigoid9. Amniotic membrane grafts reduce
chances of recurrence of pterygium because of their
anti-inflammatory properties and cause suppression of
transforming growth factor β signaling and fibroblast
proliferation, hence promoting epithelial healing.
Studies have shown that recurrence rates of Pterygia
following amniotic membrane graftingis between
14.5% and 27.3%10.
RESULTS
A total of 102 patients were divided in two equal
groups; Patients in group A underwent primary
Our study intends to compare the recurrence rate
of pterygium following excision with mitomycin-c and
excision with amniotic membrane transplant.
Table 1: Age Distribution (n = 102).
Age Group
18 – 30 years
31 – 40 years
41 – 50 years
51 – 60 years
Total
Group A (n = 51)
12 (23.52%)
18 (35.29%)
11 (21.5%)
10 (19.6%)
51 (100%)
Group B (n =51)
12 (23.52%)
18 (35.29%)
11 (21.5%)
10 (19.6%)
51 (100%)
MATERIAL AND METHODS
The study was conducted at the department of
Ophthalmology, Qazi Hussain Ahmad Medical
Complex, Nowshera. Non-probability consecutive
sampling technique was used. Sample size was
calculated using WHO calculator, P1; proportion of
recurrence rate in mitomycin group = 40%6, P2;
proportion of recurrence rate in amniotic membrane
transplant group = 14.6%7, power of test = 90% and
keeping confidence interval = 95% (CI), the sample
size was 51 patients in each group. Total sample size
was 102. All those patients presenting for the first time
Mean and SD
40.35 ± 9.62
39.98 ± 9.11
Table 2: Efficacy (n = 102); Chi square test was applied in
which P value was 0.050.
Efficacy
Group A (n = 51)
Group B (n = 51)
Effective (no
recurrence)
Not effective
(recurrence)
Total
40 (78.43%)
47 (92.15%)
11 (21.5%)
51 (100%)
04 (7.84%)
51 (100%)
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Pakistan Journal of Ophthalmology, 2020, Vol. 36 (3): 267-271