Long-term results after bare sclera pterygium resection with excimer smoothing and local application of mitomycin C.

To the Editor: We read with great interest the article entitled ‘‘Long-Term Results After Bare Sclera Pterygium Resection With Excimer Smoothing and Local Application of Mitomycin C’’ by Walkow et al. The authors evaluated the efficacy of pterygium surgery with bare sclera technique followed by phototherapeutic keratectomy and local application of 0.02% mitomycin eye drops to smoothen the corneal surface. They concluded that the technique is safe with excellent results and causes few minor side effects with low recurrence rate. We have performed Excimer laser phototherapeutic keratectomy (PTK) after simple excision with bare sclera technique in 14 eyes with pterygium involving the visual axis. The patients were evaluated on parameters such as uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), pachymetry, corneal topography if possible, fundus evaluation if possible after dilating the pupil, ultrasonography for posterior segment evaluation, and laser interferometry to assess potential vision. Simple excision of the pterygium with bare sclera technique was performed. The patients were evaluated 1 week after surgery. PTK was performed with a mean ablation of 75.71 6 17.01 mm 2 weeks after the initial surgery, and the patients were evaluated on similar parameters at 1 week, 4 weeks, 3 months, and 6 months after laser. The mean age of the patients was 42.28 6 7.53 years, and 9 patients (64.28%) were women. The BCVA at the time of initial presentation ranged from counting fingers close to face (CFCF) to 5/60 on a Snellen acuity chart. After the pterygium excision (1 week), the BCVA ranged from 6/60 to 6/24 (mean: 0.19 6 0.06), and 1 week after PTK, it ranged from 6/18 to 6/9 (mean: 0.52 6 0.12) on a Snellen chart. There was no recurrence of pterygium during the period of follow-up. A high recurrence rate has been reported in the literature after simple excision of pterygium by bare sclera technique. Conjunctival autograft after intraoperative application of 0.02% mitomycin E has been found to be effective. In this study, the authors performed phototherapeutic keratectomy after bare sclera pterygium excision and used topical 0.02% mitomycin C with good effect. Mitomycin C has been reported to cause scleral melting after even a single intraoperative application with a dose of 0.02% for 3 minutes. We have a similar experience and therefore we did not use mitomycin E in our patients. Another similar study reported a high recurrence rate after pterygium excision by bare sclera technique and PTK without the use of mitomycin E after a follow-up of 6 to 10 months. However, in our cases, the ocular surface after PTK was smooth and remained smooth until 6 months without any recurrence of pterygium. This may be attributed to the deeper tissue ablation in our cases. There was marked improvement in the BCVA after PTK because the pterygium was involving the visual axis, and after excision, there was leftover scar in the cornea, resulting in suboptimal visual acuity. However, we agree that the follow-up period was short, and a longer follow-up is needed to make a definite statement regarding the efficacy of the procedure to prevent recurrence of pterygium.