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ORIGINAL ARTICLE
Year : 2013  |  Volume : 1  |  Issue : 2  |  Page : 87-90

Impression cytology to study conjunctival epithelial morphology after pterygium excision with mitomycin-c and conjunctival autograft, limbal autograft (A Pilot study)


1 Department of Ophthalmology, Padmshree Dr. D Y Patil Medical College, Pimpri, Pune, Maharashtra, India
2 Department of Pathology, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India
3 Department of Ophthalmology, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India

Correspondence Address:
Kavita R Bhatnagar
B 4/21, Brahma Aangan, Off Salunke Road, Kondhwa, Pune-411048
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3897.112176

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Purpose: To compare the conjunctival epithelial morphology after two types of pterygium excision procedures. Materials and Methods: Twenty-seven eyes of 22 patients with primary pterygium were randomly assigned to bare-sclera with intra-operative mitomycin C (MMC 0.02% for 60 seconds; group I) and pterygium excision with conjunctival autografting (group II). Controls were healthy eyes of age- and sex-matched subjects. Impression cytology was performed preoperatively, and at 2 weeks, 1, 3, 6, and 12 months after surgery. At each visit, any recurrence or complications were looked for. Result: There was no recurrence with conjunctiva lautograft. Though one eye had recurrence in MMC group, none showed any serious complications like corneal or scleral melting, glaucoma, or cataract. Pterygium excision wounds healed in a similar four-stage process in both the groups, but at different rates and with different final results. The nucleus-to-cytoplasm (N/C) ratio was highest at about 1 month postoperatively in group 1 and at 2 weeks in group 2, before gradually returning to control levels. Preoperatively, the goblet cell density (GCD) in treated eyes was almost twice than that in control eyes (P = 0.001), but fell to zero immediately postoperatively. Goblet cells first appeared (with rapidly increased density) in group II. At 12 months, the mean GCD in group II was not significantly different from those in controls, whereas the mean GCD in group I was still less than that of control (p = 0.02). Conclusion: A single application of mitomycin c after pterygium excision in the concentration of 0.02% for duration of 60 seconds is not associated with serious complications. Conjunctival autograft prevents corneal recurrence more effectively than MMC. Goblet cell density is markedly reduced by mitomycin c. Even 1 year after surgery, the ocular surface remains abnormal with respect to epithelial phenotypes in eyes treated by any of the two techniques.


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