Abstract: The bare sclera technique alone is known to have a high recurrence rate; however, numerous studies have shown that this technique combined with mitomycin yields low recurrence rates.~-5 The selection of bare sclera versus primary conjunctival closure is a variable in pterygia surgery that remains controversial.This point is illustrated by two recently published studies exploring the use of intraoperative mitomycin.Frucht-Pery et al ~ used the bare sclera technique, resulting in a 5% recurrence in patients randomized to mitomycin 0.2 mg/ml × 5 minutes.Cardillo et al 6 elected to close the exposed sclera with a conjunctival ftap rotation, resulting in a 4% recurrence in patients randomized to mitomycin 0.4 mg/ml x 3 minutes.Both techniques were reportedly safe and effective.Our study 7 showed a 10.5% recurrence in patients randomized to mitomycin 0.4 mg/ml × 3 minutes using the bare sclera technique.Rubinfeld et al s published a case series of ten patients with severe complications from topical mitomycin following pterygium excision.A common element in nine of the ten patients in this series was a relatively large cumulative dose of mitomycin, ~often due to poor patient compliance.The only serious complication in our study was seen, likewise, in a patient randomized to the topical postoperative mitomycin group.It is unknown whether these complications would have been averted if conjunctiva was closed over the excision site, or if intraoperative mitomycin was used instead of postoperative mitomycin.We believe that the cumulative dose of mitomycin in the postoperative regimen was the primary cause of these complications.These reports strengthen our belief that topical postoperative mitomycin in pterygia surgery must be used with extreme caution, if ever, especially given that intraoperative mitomycin application appears to provide a safe and effective alternative.The purpose of our study was to compare a single intraoperative dose of mitomycin with the more established treatment modalities of conjunctival autografl transplantation and postoperative mitomycin.Dr. Sudarshan proposes an interesting combined technique using intraoperative mitomycin application with conjunctival autograft transplantation, although no data are given regarding outcomes.Covering sclera with conjunctiva may theoretically provide protection against the avascular effects of mitomycin; however, a vascularized sliding conjunctival flap seems like a better option than grafted tissue with an interrupted blood supply.Prospective, randomized studies would be helpful in comparing bare sclera to primary conjunctival closure (whether using grafted tissue or a conjunctival flap) with intraoperative mitomycin in pterygia surgery.