Underscoring the importance of MMC to the procedure, Dr. Anduze—who developed the Anduze bare scleral approach in the 1990s—reported that of 870 cases who underwent scleral conjunctival flap excision with one application of 0.1 cc of 0.4 mg/mL of MMC to the subconjunctival space, only 3 pterygia recurred (Anduze AL. Pterygium surgery with mitomycin-C: ten-year results. Ophthalmic Surg Lasers. 2001;32:341-345).
Dr. Trattler begins the procedure with a subconjunctival injection of 2% lidocaine with epinephrine into the lesion. He creates a linear incision to isolate the head of the pterygium and elevate it. The head is removed and the cornea is polished with a diamond burr. The subconjunctival fibrovascular tissue is removed, which is important to preventing recurrences, before MMC is injected.
MMC 0.02% (0.1 cc) is injected into the subconjunctival tissue using a 30-gauge needle with care taken to protect the bare sclera. MMC remains in the tissue at the end of surgery. The area is rinsed with balanced saline solution.
At the conclusion of the surgery, no cautery is performed or glue applied, Dr. Trattler emphasized.
Dr. Trattler and colleagues conducted a retrospective case study to evaluate the effectiveness of the subconjunctival injection of MMC after pterygium removal. Patients were included in this study who had either primary or recurrent pterygia and underwent bare sclera excision with injection of 0.1 ccs of 0.02% MMC into the subconjunctival tissue.
Importantly, no cautery was applied, MMC was not applied to the bare sclera, and no sutures or tissue glue was used.