Efficacy of bevacizumab in the treatment of pterygium: An updated meta-analysis of randomized controlled trials.

Recurrence is the most common problem following pterygium surgery. Whether bevacizumab can prevent pterygium recurrence is controversial. To address this point, we carried out a meta-analysis of randomized controlled trials evaluating the efficacy and safety of bevacizumab in the treatment of pterygium. We searched the PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature, China National Knowledge Infrastructure, and Wan fang databases up to September 20, 2020 for relevant articles. We used the Cochrane assessment tool to evaluate the methodologic quality of the included studies, and calculated the relative risk (RR) and 95% confidence interval (CI) of the reported recurrence and complication rates. A total of 17 studies including 1124 patients with 1144 eyes were included in the meta-analysis. The combined results showed that bevacizumab significantly reduced the recurrence rate of pterygium after surgery (RR = 0.652, 95% CI: 0.504-0.845, Z = 3.24, P = 0.001) and was not significantly associated with the occurrence of postoperative complications compared to control treatments (RR = 0.832, 95% CI: 0.604-1.145, Z = 1.13, P = 0.259). A subgroup analysis showed that the rate of pterygium recurrence was significantly lower with bevacizumab than in the control group at a dose of 2.5 mg (RR = 0.47, 95% CI: 0.24-0.91) administered by subconjunctival injection (RR = 0.54, 95% CI: 0.39-0.75) after a follow-up time of ≤ 6 months (RR = 0.63, 95% CI: 0.45-0.88). Thus, bevacizumab can reduce the risk of pterygium recurrence after surgery, and does not differ from placebo or other drug treatments in terms of the risk of complications.

Activation of LncRNA FOXD2-AS1 by H3K27 acetylation regulates VEGF-A expression by sponging miR-205-5p in recurrent pterygium.

LncRNA FOXD2-AS1 is abnormally expressed in many diseases. However, the molecular mechanisms whereby FOXD2-AS1 is involved in recurrent pterygium remain unknown. Here, qRT-PCR was performed to quantify FOXD2-AS1 expression, while CCK-8, flow cytometer and neoplasm xenograft assays were used to investigate its function. Dual-luciferase reporter, RIP and RNA pull-down assays were conducted to address the relationship between FOXD2-AS1, miR-205-5p and VEGF-A, while ChIP assays were used to detect H3K27 acetylation at the FOXD2-AS1 promoter. FOXD2-AS1 expression was up-regulated in recurrent pterygium tissues. Moreover, a high FOXD2-AS1 expression was associated with advanced stages, increased microvessel density and shorter recurrent-free survival. In addition, ROC analysis showed that FOXD2-AS1 is a valid predictor of recurrent pterygium. Furthermore, we show that FOXD2-AS1 induced proliferation and inhibited apoptosis in a cell line derived from recurrent pterygia (HPF-R) at least partially through the regulation of the miR-205-VEGF pathway. In addition, the up-regulation of FOXD2-AS1 was attributed to the H3K27 acetylation at the promoter region. In conclusion, FOXD2-AS1 is activated via its H3K27 acetylation and regulates VEGF-A expression by sponging miR-205-5p in recurrent pterygium. Our results may provide a basis for the development of new therapeutic targets and biomarkers for recurrent pterygium.

Clinical profile of pterygium in patients seeking eye care in India: electronic medical records-driven big data analytics report III.

OBJECTIVE: To describe the clinical profile of pterygium in patients presenting to a multi-tier ophthalmology hospital network in India. METHODS: This cross-sectional hospital-based study included 1,610,843 new patients presenting between 2010 and 2019. Patients with a clinical diagnosis of pterygium in at least one eye were included as cases. The data were collected using an electronic medical record system. Multiple logistic regression analysis with odds ratios (OR) was performed to identify the associated risk factors. RESULTS: Overall, 168,807 (10.5%) new patients were diagnosed with pterygium, of which 43,692 (26%) patients complained about the lesion. The prevalence rates were 0.7% in children and 12.6% in adults. Majority of patients were female (54.5%) and had unilateral (57%) affliction. Among the 241,631 affected eyes, the pterygia were primary in 99.6%, nasally located in 94%, and were grade I-II in 84.8%. Four in 5 eyes did not have any cylindrical refractive error, and 44% had coexistent cataract. Pterygium surgery was indicated in 10.3% eyes. Female sex (OR 1.37), increasing age (OR 19.5), rural residence (OR 1.21), agriculture work (OR 2.19), manual labor (OR 2.05), low socioeconomic status (OR 2.14) and geographical location closer to the equator (OR 3.4) were identified as the risk factors for developing pterygium. CONCLUSION: About one-tenth of individuals seeking eye care in India have pterygium in at least one eye. It rarely impacts vision, is commonly unilateral and nasal and usually does not require surgery. It is associated with increasing age, females, outdoor work, low income and geographical location closer to the equator.

Fifteen-year results of a randomized controlled trial comparing 0.02% mitomycin C, limbal conjunctival autograft, and combined mitomycin C with limbal conjunctival autograft in recurrent pterygium surgery.

PURPOSE: To compare the long-term outcomes of recurrent pterygium surgery between three different techniques. METHODS: We performed a 15-year follow-up study of a randomized controlled study on surgical management of recurrent pterygium. Group 1 received limbal conjunctival autograft (LCAU); group 2 received intraoperative mitomycin C (MMC) 0.02% for 5 min; and group 3 received combined LCAU + MMC 0.02% for 5 min. Consecutive patients enrolled in the original study (from April 2001 to March 2003) were invited back for a detailed clinical examination to document the long-term outcomes. The main outcome measures included the recurrence rate, residual conjunctival bed status, and complications from any of the surgical methods. RESULTS: Sixty-two patients were recruited in the original study. Eight patients had passed away and 12 patients were uncontactable or not responded. One patient who had bilateral operations refused to return for follow-up and one eye had insufficient data for analysis. Finally, 40 eyes of 40 patients were included for analyses. One eye developed a recurrence over 15 years and none required a tertiary pterygium operation. The patient received LCAU for a temporal recurrent pterygium developed a 2.2-mm recurrence. CONCLUSIONS: All three techniques yielded favorable outcomes for patients with recurrent pterygium. The use of LCAU was associated with better cosmetic outcome.

Interferon Alpha-2b Eye Drops Prevent Recurrence of Pterygium After the Bare Sclera Technique: A Single-Center, Sequential, and Controlled Study.

PURPOSE: To investigate the efficacy and safety of interferon (IFN) alpha-2b eye drops in preventing pterygium recurrence after the bare sclera technique. METHODS: Sixty eyes in 53 patients who underwent treatment for primary pterygium (the length of corneal invasion ranged from 2 to 4 mm) were enrolled in this prospective study. All patients were divided in chronological sequence into 2 groups. The control group included the first 30 eyes, whereas the treatment group included the next 30 eyes. After treatment with the bare sclera technique, levofloxacin and 0.1% fluorometholone eye drops were used 4 times a day for 3 months after surgical excision in both groups. In addition, IFN alpha-2b eye drops were applied in the treatment group 4 times a day for 3 months. Throughout an 18-month follow-up period, all patients in both groups were examined 1 day, 10 days, 1 month, 3 months, 6 months, 12 months, and 18 months after surgery. The main outcome measures were pterygium recurrence, conjunctival redness and thickness, and neovascularization and complications (ie, delayed conjunctival healing, persistent corneal epithelial defection, conjunctival granuloma, and scleral melting and necrosis). RESULTS: The recurrence rates in the control group and the treatment group at the end of the sixth month were 29.2% and 3.7%, respectively, and the rates were significantly different between the 2 groups (P = 0.019). Up to 12 months after surgeries, the recurrence rate was 33.3% in the control group and 7.4% in the treatment group, and the difference between the 2 groups was statistically significant (P = 0.048). The rates at the end of 18 months were the same. During the follow-up period, no complications were observed except for 1 conjunctival granuloma (in the treatment group) and 2 corneal epithelial defects (one in the control group and the other in the treatment group). CONCLUSIONS: Administration of IFN alpha-2b eye drops after the bare sclera technique appear safe and effective in reducing the recurrence of pterygium.

Signaling roadmap to epithelial-mesenchymal transition in pterygium, TWIST1 centralized.

Pterygium as a complex disease shares common features with other malignant cells in its onset recurrence and especially epithelial-mesenchymal transition (EMT) transition. Although using different approaches including conjunctival autografts, amniotic membrane, radiotherapy, mitomycin C (MMC) has shown promising insights in the inhibition of pterygium recurrence, it needs to be investigated in more details in molecular pathways to present adjuvant target therapy. In this study, we aimed to evaluate the expression of and then illustrate the role of signaling pathways on EMT in pterygium. Using real-time polymerase chain reaction, the twist-related protein 1 (TWIST1) expression was compared in primary pterygium and normal conjunctiva. This study assessed the mRNA expression, as well as the association between the clinicopathological indices and the gene expression level. The expression level of TWIST1 was overexpressed in 36% of our cohort ( n = 76). There was a significant positive correlation between recurrence with grade T, grade V and a significant negative correlation with growth activity. Our vast literature review on different signaling pathways in pterygium showed that EMT has centralization role in recurrence of this disease. Our data confirmed that EMT is important in the recurrence of pterygium samples and different signaling pathways end up activating the EMT markers. It is suggested to evaluate the environmental factors and their correlation with molecular markers to select favorable treatment for this kind of diseases.

Barriers between community screening for visual problems and treatments in a tertiary center.

OBJECTIVE: To evaluate the effectiveness of mobile ophthalmic unit screenings and to investigate barriers between community care and resolution of the problem at a tertiary center. METHODS: This prospective study evaluated a convenience sample from 10 municipalities in São Paulo State, Brazil. Patients were assessed in the municipality by a mobile ophthalmic unit and underwent a complete ophthalmic consultation. Patients were referred as warranted to a tertiary hospital. RESULTS: The mobile ophthalmic unit screened 1,928 individuals and 714 (37%) were referred. The mean age of the referred patients was 57.12 (SD = 19.5) years with best corrected visual acuity of 0.37 (SD = 0.36) logMAR. Forty-seven (6.6%) patients were blind and 185 (26.5%) were visually impaired. Cataracts (44.7%) and pterygium (14.7%) accounted for most referrals. Of those referred, 67.1% presented to the tertiary center. The diagnosis by the mobile ophthalmic unit corresponded to the one by the tertiary center in 88.5% of the cases. There were a significantly higher number of blind and visually impaired persons among those who presented to the hospital. There was a significantly greater attendance among patients living in more distant municipalities from the reference center with a higher number of inhabitants and a greater number of ophthalmologists in the cities of origin (p < 0.05, all comparisons). Complete treatment was performed in 65.6% of patients, and loss to follow-up was the main cause of incomplete treatment in 50.7% of patients. A total of 313 cataract surgeries were performed, which reduced the number of blind patients from 20 to 2 and of visually impaired individuals from 87 to 2 (p < 0.001). CONCLUSIONS: Only 37% of the patients assessed by a mobile ophthalmic unit required referral to a tertiary hospital. Among the referred patients, 67.1% presented to the hospital, and complete resolution after treatment was approximately 65.5%. There was a significant improvement in visual acuity and a reduction in the prevalence of blindness and visual impairment postoperatively.

Barriers between community screening for visual problems and treatments in a tertiary center

ABSTRACT OBJECTIVE To evaluate the effectiveness of mobile ophthalmic unit screenings and to investigate barriers between community care and resolution of the problem at a tertiary center. METHODS This prospective study evaluated a convenience sample from 10 municipalities in São Paulo State, Brazil. Patients were assessed in the municipality by a mobile ophthalmic unit and underwent a complete ophthalmic consultation. Patients were referred as warranted to a tertiary hospital. RESULTS The mobile ophthalmic unit screened 1,928 individuals and 714 (37%) were referred. The mean age of the referred patients was 57.12 (SD = 19.5) years with best corrected visual acuity of 0.37 (SD = 0.36) logMAR. Forty-seven (6.6%) patients were blind and 185 (26.5%) were visually impaired. Cataracts (44.7%) and pterygium (14.7%) accounted for most referrals. Of those referred, 67.1% presented to the tertiary center. The diagnosis by the mobile ophthalmic unit corresponded to the one by the tertiary center in 88.5% of the cases. There were a significantly higher number of blind and visually impaired persons among those who presented to the hospital. There was a significantly greater attendance among patients living in more distant municipalities from the reference center with a higher number of inhabitants and a greater number of ophthalmologists in the cities of origin (p < 0.05, all comparisons). Complete treatment was performed in 65.6% of patients, and loss to follow-up was the main cause of incomplete treatment in 50.7% of patients. A total of 313 cataract surgeries were performed, which reduced the number of blind patients from 20 to 2 and of visually impaired individuals from 87 to 2 (p < 0.001). CONCLUSIONS Only 37% of the patients assessed by a mobile ophthalmic unit required referral to a tertiary hospital. Among the referred patients, 67.1% presented to the hospital, and complete resolution after treatment was approximately 65.5%. There was a significant improvement in visual acuity and a reduction in the prevalence of blindness and visual impairment postoperatively.

[Pterygium: etiology, pathogenesis, treatment]. / Pterigium: étiologiia, patogenez, lechenie.

Pterygium is a degenerative condition characterized by fibrovascular outgrowth of conjunctiva over the cornea. Many theories exist that try to explain its pathogenesis. The current belief is that this disease is multifactorial with ultraviolet radiation being the most important trigger. Attention is also paid to such factors as tear film changes, cytokines and growth factors disbalance, immunologic disturbances, genetic mutations, and viral infections. Modern classifications consider the rate of fibrovascular growth, its progressive potential, and histological features. In the beginning pterygium is usually asymptomatic, however, dry eye manifestations may be present, such as burning, itching, and/or tearing. As the lesion grows toward the optical zone, visual acuity gets compromised, and thus, surgical treatment is required. Because of recurrences and repeated surgeries, the growth of the lesion may become more aggressive and cause irregular astigmatism. Comprehensive surgery of pterygium is aimed at not only removing the lesion, but also preventing recurrences. Advisable are modified bare sclera techniques with subsequent transposition of the conjunctival flap, conjunctival autotransplantation, amniotic membrane transplantation, and peripheral lamellar keratoplasty (in cases of significant ingrowth). In some cases, antirecurrent adjuvant therapy may be considered that involves the use of mitomycin C, 5-fluoruracil, and VEGF inhibitors. However, the search for the best treatment for pterygium, i.e. an easy to perform, cosmetically-friendly method associated with minimal risk of recurrences and/or complications, remains an interest of modern ophthalmology.

Cultivation and characterization of pterygium as an ex vivo study model for disease and therapy.

PURPOSE: Development of ex vivo model to study pathogenesis, inflammation and treatment modalities for pterygium. METHODS: Pterygium obtained from surgery was cultivated (3 months). Gravitational attachment method using viscoelastic facilitated adherence of graft and outgrowing cells. Medium contained serum as the only growth supplement with no use of scaffolds. Surface profiling of the multi-layered cells for hematopoietic- and mesenchymal stem cell markers was performed. Examination of cells by immunohistochemistry using pluripotency, oxidative stress, stemness, migration and proliferation, epithelial and secretory markers was performed. The effect of anti-proliferative agent Mitomycin C upon secretion of pro-inflammatory cytokines IL-6 and IL-8 was assessed. RESULTS: Cells showed high expression of migration- (CXCR4), secretory- (MUC1, MUC4) and oxidative damage- (8-OHdG) markers, and low expression of hypoxia- (HIF-1α) and proliferation- (Ki-67) markers. Moderate and low expression of the pluripotency markers (Vimentin and ΔNp63) was present, respectively, while the putative markers of stemness (Sox2, Oct4, ABCG-2) and epithelial cell markers- (CK19, CK8-18) were weak. The surface marker profile of the outgrowing cells revealed high expression of the hematopoietic marker CD47, mesenchymal markers CD90 and CD73, minor or less positivity for the hematopoietic marker CD34, mesenchymal marker CD105, progenitor marker CD117 and attachment protein markers while low levels of IL-6 and IL-8 secretion ex vivo, were inhibited upon Mitomycin C treatment. CONCLUSION: Ex vivo tissue engineered pterygium consists of a mixture of cells of different lineage origin, suitable for use as a disease model for studying pathogenesis ex vivo, while opening possibilities for new treatment and prevention modalities.

Developments and current approaches in the treatment of pterygium.

PURPOSE: To assess and compare the studies conducted in the literature with recurrence rates and the summary of the justified treatment approaches be presented. METHOD: Pterygium, a fibrovascular tissue that proceeds from the bulbar conjunctiva towards the cornea, is quite a commonly seen ocular surface deterioration. The treatment is performed through a surgical excision, and the frequent recurrence of this disorder, despite the developments of today, is the major problem experienced in the wake of the surgery. There are various treatment methods applied for the prevention of recurrence; yet, there is no definite view as to what treatment is the most effective one. Since the recurrent pterygium cases are more aggressive than the primary pterygium, it is of great importance to determine the treatment method in which recurrence rate is the lowest. In different studies seen in the literature, there is difficulty in comparing the results due to the fact that the follow-up periods, recurrence criteria and the doses and durations of the medications administered differ from one another. CONCLUSION: When the literature is reviewed, the bare sclera technique is not used due to the high rate of recurrence, whereas successful results can be achieved through the conjunctival autograft technique. Lower recurrence rates have been reported along with the administration of mitomycin C, 5-FU and other agents that were used as an adjuvant treatment.

5-Fluorouracil vs avastin as adjunct to conjunctival autograft in the surgical treatment of pterygium.

BACKGROUND: The use of adjunct antimetabolite therapy along with conjunctiva autograft has been shown to be effective in preventing pterygium recurrence. There has however been fewer reports on the effect of anti-vascular endothelial growth factor on pterygium recurrence. OBJECTIVE: To compare 5-fluorouracil with conjunctival autograft with bevacizumab (avastin) used along with autograft in the surgical treatment of pterygium. METHODS: A randomized controlled prospective study of outcome of pterygium treatment using 5-fluorouracil with conjunctiva autograft as adjuvant treatment compared avastin with conjunctiva autograft. RESULTS: A total of 70 eyes of 70 patients were recruited into the study with a mean age of 51.49 (±14.36) years. Thirty-five patients each were randomized into the 5-fluorouracil treatment group and into the avastin treatment group respectively. The mean follow-up was 18.35 months (18.44 for the 5-FU and 18.26 for the avastin group). Post operative, pterygium recurrence was observed in 1/27 (3.7%) eyes treated with 5-fluorouracil and 1/26 (3.9%) eyes of the avastin group. Both recurrences were observed at 1 year of follow-up and they were both female patients aged 46 and 52 years, respectively. CONCLUSIONS: Both 5-fluorouracil and avastin are comparably effective as adjunct to conjunctival autograft. However, cost, availability, and convenience are other considerations with use of avastin.

A randomized controlled prospective study to assess the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients.

BACKGROUND: Pterygium is an ocular surface disorder with prevalence rates ranges from 0.3% to 29% in different parts of the world. Vascular endothelial growth factor (VEGF) has been detected in increased amounts in pterygium epithelium, compared with normal conjunctiva. Bevacizumab is a recombinant, humanized anti-VEGF antibody suggested as a possible adjunctive therapy for pterygium excision that appears to have a role in prevention of recurrence. We conducted this study to evaluate the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients. METHODS: In this randomized prospective clinical study, the patients were randomized into two groups of 30 patients each. Study group received 1.25 mg/0.05 ml subconjunctival bevacizumab 1 week before pterygium surgery with conjunctival autograft. Control group received 1.25 mg (0.05 ml) subconjunctival normal saline 1 week prior to pterygium surgery with conjunctival autograft. Patients were followed up at day 1, day 7, 1 month and 3 months. The main outcome measures were morphology of pterygium after injection, intra-operative ease, recurrence of pterygia, and any complications. RESULTS: After giving bevacizumab, there was statistically significant improvement in grade, color intensity, size of pterygium, and symptoms of patients. Intra-operatively, less bleeding was observed by the surgeon. No statistically significant difference regarding reduction in astigmatism, improvement of visual acuity, and complications were observed in two groups. Recurrence was noted in five patients (8.33%) in total study population at the end of 3 months. It was present in two patients (6.67%) in Group A and three patients (10%) in Group B. CONCLUSION: Single preoperative administration of subconjunctival injection bevacizumab given 1 week before the pterygium excision with conjunctival autograft decreases the vascularity of newly formed blood vessels, hence may decrease recurrence rate though not in our study.

Randomized trial comparing multilayer amniotic membrane transplantation with scleral and corneal grafts for the treatment of scleral thinning after pterygium surgery associated with beta therapy.

PURPOSE: The aim of this study was to compare the use of multilayer amniotic membrane transplantation (AMT) with lamellar corneal transplantation (LCT) and lamellar scleral transplantation (LST) for the treatment of scleral thinning after pterygium surgery associated with beta therapy. METHODS: Twenty-six eyes from 26 different patients with scleral thinning as a consequence of beta therapy after pterygium surgery were evaluated at the Federal University of São Paulo, Brazil. Ophthalmologic examination and ultrasound biomicroscopy were performed to assess scleral thinning before the transplant surgery and then repeated at 30, 90, and 180 days after surgery. An increase in scleral thickness, epithelialization of the ocular surface, and preservation of the ocular globe were the main outcome measures. RESULTS: Irrespective of the surgical technique used (AMT, LCT, or LST), no clinical or statistical changes in corrected distance visual acuity were found in any of the patients during this study. The median preoperative scleral thickness was similar in all 3 groups: AMT = 0.45 mm, LST = 0.48 mm, and LCT = 0.52 mm (P = 0.257); however, 6 months after surgery, the median thickness in the AMT group (0.19) was significantly less than that of the LCT group (0.57) (P = 0.27) or the LST group (0.76) (P = 0.19). Epithelialization occurred in all the patients. CONCLUSIONS: LCT was the best option for the structural treatment of scleral thinning, followed by LST with a conjunctival flap. A high rate of reabsorption was found with AMT, which was the least effective of the 3 therapeutic options and should not be used for this condition.

S100A proteins as molecular targets in the ocular surface inflammatory diseases.

The S100 proteins are calcium-binding proteins that are exclusively expressed in vertebrates, where they interact with enzymes, cytoskeletal proteins, receptors, transcription factors, and nucleic acids to regulate proliferation, differentiation, apoptosis, inflammation, cell migration, energy metabolism, and Ca(2+) homeostasis. In this review, we focus on the S100A8 and S100A9 members of the family that are involved in the regulation of neutrophil chemotaxis and inflammation related to ocular surface diseases such as dry eye, meibomian gland dysfunction, pterygium, and corneal neovascularization. In our previous studies, we have found that the levels of S100A8 and S100A9 were elevated in these inflammatory ocular diseases. For instance, S100A8 and A9 were found to be upregulated in pterygium tissues at both transcript and protein levels. These findings are consistent with the role of S100A8 and S100A9 proteins in activating the innate immune system in the eye via Toll-like receptors (TLRs) and altering the immune tolerance of the eye-associated lymphoid system. Recently, use of S100A8-targeting antibody has shown promising results in targeting corneal neovascularization. Injection of S100A8 has been shown to inhibit eosinophilic infiltration and thus may have potential therapeutic implications in allergic diseases.

[Pterygium excision using bulbar conjunctival autograft with intraoperative mitomycin C for primary pterygium: a retrospective assessment of 1832 eyes].

PURPOSE: To retrospectively assess the efficacy of pterygium excision using bulbar conjunctival autograft with intraoperative mitomycin C (MMC) for primary pterygium. METHODS: Primary pterygium eyes of 1482 patients (1832 eyes) which had undergone excision surgery using bulbar conjunctival autograft with intraoperative MMC in Miyata Eye Hospital were studied. The patients' background and position and the size of the pterygium were reviewed. For 1188 eyes that were followed up 1 year or longer, the recurrence rate and periods were assessed. Factors such as age, occupation, sex, the size of pterygium and the skill of the surgeon were examined as risk factors for recurrence. RESULTS: Mean age was 65.0 +/- 10.0 years. The pterygium was in the nasal side in 99.0% of eyes, and the size in 55.4% of eyes was equal to the distance between one and two thirds of the radius of the cornea. The recurrence rate was 3.96% and was noted 9 months after the surgery. Significant risk factors were age of patient (p = 0.028) and the skill of the surgeon (p = 0.022). CONCLUSION: Pterygium excision using bulbar conjunctival autograft with intraoperative mitomycin C was effective in primary pterygium.

Outcome of recurrent pterygium with intraoperative 0.02% mitomycin C and free flap limbal conjunctival autograft.

OBJECTIVE: To determine the re-recurrence and the postoperative complications in recurrent pterygium cases treated by intraoperative 0.02% Mitomycin C (MMC) and conjunctival autograft (CAG). STUDY DESIGN: Quasi-experimental. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad and Chandka Medical College Hospital, Larkana, from January to December 2010. METHODOLOGY: Cases with recurrent pterygium were included in this study. Cases with history of first time pterygium and pterygium with conjunctival scarring, dry eye, glaucoma and vitreoretinal disease were excluded. After topical and subconjunctival anaesthesia, pterygium was excised in single piece. Intraoperative 0.02% MMC was applied on bare sclera for 2 minutes. CAG was excised from supero-temporal conjunctiva, and implanted on bare sclera. All cases were followed-up for 6 months. Re-recurrence was defined as postoperative fibrovascular re-growth of 1.0 mm or more crossing the corneo-scleral limbus. Data was analysed as descriptive statistics. RESULTS: A total of 65 eyes of 65 cases were studied having mean age of 43.26 ± 12.81 years. Among those, 41 (63.1%) were males and 48 (73.8%) belonged to rural area. The size of pterygium on cornea was 2-3 mm in 44 (67.7%) cases and 4-5 mm in 21 (32.3%) cases. Re-recurrence of pterygium was seen in 3 (4.6%) cases. Postoperative complications included conjunctival granuloma in 2 (3.1%) cases, graft necrosis in 2 (3.1%) cases, graft oedema in 3 (4.6%) cases and graft displacement in 3 (4.6%) cases. CONCLUSION: The intraoperative application of 0.02% MMC with CAG markedly reduces the risk of re-recurrence of pterygium and postoperative complications.

Efficacy of treatment for pterygium by autologous conjunctival transplantation and mitomycin C.

BACKGROUND: The recurrence of pterygium after surgery is high. A variety of adjunctive treatment approaches have been developed to improve the clinical efficacy and many related articles have been published. This study aimed to determine the risk for postoperative pterygium recurrence comparing autologous conjunctival transplantation (ACT) versus mitomycin C (MMC). METHODS: Relevant literature published until December 2010 in Medline, Embase, Cochrane, Cochrane library, Science Citation Index, and Google Scholar were searched. Qualified random clinical trial (RCT) studies on the comparison of recurrence rate of pterygium after ACT and MMC treatment were included in this study. RESULTS: Eight RCTs with 663 eyes entered the final analysis. The recurrent rate of pterygium was 8.7% (30/343) for ACT and 18.75% (60/320) for MMC. Using fixed-effect meta analysis, we found that the recurrence was significantly lower after ACT than MMC treatment (odds ratio (OR) = 0.40, 95% confidence index (CI), 0.25 - 0.63, P < 0.0001). In sensitivity analyses, we employed random-effects model and excluded studies of low quality or studies in which MMC was administrated after the operation. All the sensitivity analyses confirmed that ACT led to lower recurrence rates than MMC. Sub-group analysis revealed that the recurrence rate was 20.2% (20/99) and 27.65% (26/94) for conjunctival autograft (CA) and MMC respectively, and no significant difference in the recurrence rate was detected (OR = 0.65, 95%CI 0.33 - 1.28, P = 0.22). However, we found that conjunctival limbal autograft (CLA) had lower recurrence rate than MMC (OR = 0.26, 95%CI 0.14 - 0.48, P = 0.0001). CONCLUSION: CLA has better therapy efficacy against the recurrence of pterygium than MMC.

5-Fluorouracil versus mitomycin C as adjuncts to conjunctival autograft in preventing pterygium recurrence.

To compare the efficacy of 5-fluorouracil (5-FU) with mitomycin C (MMC) in preventing pterygium recurrence when used as an adjuvant following pterygium excision with conjunctival autograft. Low-dose MMC combined with conjunctival autograft is an effective treatment for preventing recurrence following pterygium excision, but safety, cost, and availability limit its use in developing countries. There is a paucity of data on the efficacy of 5-FU when used in Africa as an adjuvant to conjunctival autograft following pterygium excision. This is a randomized controlled prospective trial using either 50 mg/ml 5-FU or 0.01% MMC. Eighty eyes of 80 subjects were studied. Forty-six subjects with a mean age 49.8 ± 13.8 years were treated with 5-FU (USD 13.0 per unit), while 34 patients with a mean age 51.9 ± 12.1 years were treated with MMC (USD 20.0 per unit). There was no significant difference in mean age between the two groups (p = 0.48). The ratio of male to female patients in both groups was similar at 0.92:1 for the 5-FU group and 1:1 for the MMC group (p = 0.85). Mean follow-up period was 35.2 ± 29.1 weeks. Recurrence rate in the 5-FU group was 8.7% compared to 11.8% in the MMC group (recurrence risk ratio = 0.71, 95% CI 0.17-3.1, p = 0.7). One patient from the MMC-treated group had corneoscleral melting. Other complications were mild and not sight threatening. In the prevention of pterygium recurrence, 5-FU appears to compare favorably with low-dose MMC when used as an adjuvant following pterygium excision and conjunctival autograft. Further studies are required to assess the long-term effect of using 5-FU in such cases.