CLINICAL SCENARIO A 30-year-old overseas contract worker consulted the outpatient department for a noninflamed, large, slightly vascularized, fleshy mass that encroached on the limbus of the right eye and reached the paracentral area of the cornea. The mass gradually increased in size over the past 3 years, associated with occasional redness that spontaneously resolved without any medication. The vision in the right eye degenerated over the last year. There were no other ocular or systemic signs and symptoms, and no surgery was ever done in that eye. Visual acuity was 20/40 (correctable to 20/20) in the right eye (OD) and 20/20 uncorrected in the left eye (OS). Manifest refraction revealed an against the-rule astigmatism of -2.0 diopters OD and plano OS. The rest of the ophthalmic examination was normal. His agency instructed him to have the mass removed prior to departure for Dubai in about 4 months. Since the mass was already causing astigmatism and reduced uncorrected visual acuity, surgery was contemplated. The ophthalmologist on duty wants to know whether the traditional bare-sclera technique is still the best method to use in treating this disease and preventing recurrence CLINICAL QUESTION: Pertinent data presented include a noninflamed, fleshy mass that over a period of 3 years gradually crossed the limbal border into the paracentral area of the cornea causing a two-diopter against-the-rule astigmatism. In the absence of any previous eye surgery, this picture is compatible with a primary pterygium After identifying the ocular condition in the clinical scenario, a clinical question can now be formulated as follows: Among patients with primary pterygia, how effective is bare-sclera technique compared to adjuvant treatment with mitomycin C (MMC) or conjunctival autografting (CA) in minimizing pterygium recurrence? (Author)
MITOMYCIN