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    Modified Anduze technique improves pterygium surgical outcomes

    Approach maintains low complication, low recurrence rates with change in MMC application

    Take-home message: Avoiding use of mitomycin C on the scleral bed during pterygium extraction is a modification of the Anduze bare scleral approach.

     

    Miami—A scleral melt is among the risks when using mitomycin C (MMC) during pterygium surgery.

    Most surgeons recognize the risk associated with placement of a sponge soaked in MMC directly on the scleral bed, and avoid it by placing sponges soaked with MMC under the subconjunctival tissue for 1 to 4 minutes to keep the scleral bed free of MMC.

    Alfred Anduze, MD, developed a modification to this method of MMC application in which he places a small injection of MMC directly into the subconjunctival tissue. The use of this technique appears to provide excellent safety, with a low recurrence rate.

    Though numerous surgical techniques for pterygium removal exist, some are associated with high rates of recurrence or an increased rate of complications, said William B. Trattler, MD, in private practice, Miami, and volunteer assistant professor of ophthalmology, Florida International University Wertheim College of Medicine.

    Current management strategies include various types of grafts using sutures or tissue glue and adjunctive therapies that include application of MMC, Dr. Trattler noted.

    Previous recommendations for application of MMC were found to be incorrect, and they specifically instructed that a sponge saturated with MMC be placed on the bare sclera for 1 to 3 minutes after the pterygia are removed, he offered.

    Though MMC is used by surgeons to maintain a low recurrence rate, it is critical that MMC be used properly to avoid complications, such as scleral melts. Based on work published by Dr. Anduze, Dr. Trattler injects the drug into the subconjunctival tissue to avoid the bare sclera completely.

    Inflammation plays a key role in the pathogenesis and recurrence of pterygia, Dr. Trattler noted.

    “Therefore, limiting the use of pro-inflammatory sutures or glues also can be advantageous in preventing pterygium recurrence,” he said.

    William B. Trattler, MD
    Dr. Trattler, a corneal specialist at Miami's Center for Excellence in Eye Care, Miami.

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