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Yin XF, Wu MH, Jin CJ, Zhou SY. Comparison of photodynamic therapy with two different parameters combined with subconjunctival injection of bevacizumab for corneal neovascularization. Photodiagnosis Photodyn Ther 2024; 46:104067. [PMID: 38548042 DOI: 10.1016/j.pdpdt.2024.104067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND To the best of our knowledge, no studies have been performed to determine the optimal parameters of photodynamic therapy (PDT) combined with subconjunctival injection of bevacizumab for corneal neovascularization. This study aimed to compare the effect of photodynamic therapy with two different sets of parameters combined with subconjunctival injection of bevacizumab for corneal neovascularization. METHODS Patients with stable corneal neovascularization (CNV) unresponsive to conventional treatment (topical steroid) were included in this study. Patients were divided into two groups, receiving PDT with two different sets of parameters (group 1 receiving fluence of 50 J/cm2 at 15 min after intravenous injection of verteporfin with, group 2 receiving fluence of 150 J/cm2 at 60 min after intravenous injection of verteporfin with). Subconjunctival injection of bevacizumab was performed immediately after PDT. All patients were followed for 6 months. Best-corrected visual acuity and intraocular pressure were evaluated, and slit-lamp biomicroscopy as well as digital photography were performed. Average diameter and cumulative length of corneal neovascular were measured to evaluate the corneal neovascularization. RESULTS Seventeen patients (20 eyes) were included in this study. At the last visit, the vision was improved in 12 eyes (60 %), steady in 4 eyes (20 %) and worsen in 4 eyes (20 %). The intraocular pressure (IOP) of all patients remained in normal range. A significant decrease in corneal neovascularization was showed in all the eyes after treatment. At 6 months after the combined treatment, the average diameter and cumulative length of vessels significantly decreased to 0.041 ± 0.023 mm (P < 0.05) and 18.78 ± 17.73 mm (P < 0.05), respectively, compared with the pretreatment data (0.062 ± 0.015 mm, 31.48 ± 18.21 mm). The reduction was more remarkable in group 2 compared to group 1.In group 1, the average diameter was 0.062 ± 0.013mm before and 0.056 ± 0.017mm after, the cumulative length of vessels was 38.66 ± 22.55mm before and 31.21 ± 17.30 after. In group 2, the date were 0.061 ± 0.016mm before and 0.029 ± 0.020mm after, 25.60 ± 8.95 mm before and 8.61 ± 8.26 mm. The reported complications included epithelial defect in four eyes, small white filaments in two eyes and corneal epithelial erosion in two eyes. CONCLUSION The PDT combined with subconjunctival injection of bevacizumab was effective for the chronic corneal neovascularization. A more promising treatment outcome was observed when PDT was performed at 60 min after intravenous injection of verteporfin with fluence of 150 J/cm2. No serious complications or systemic events were observed throughout the follow-up period.
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Affiliation(s)
- Xiao-Fang Yin
- Institute of Ophthalmology, Foshan Hospital Affiliated to Southern Medical University, The Second People's Hospital of Foshan, Foshan 528000, China
| | - Min-Hui Wu
- Institute of Ophthalmology, Foshan Hospital Affiliated to Southern Medical University, The Second People's Hospital of Foshan, Foshan 528000, China
| | - Chen-Jin Jin
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center at Sun Yat-sen University, Guangzhou 510060, China
| | - Shi-You Zhou
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center at Sun Yat-sen University, Guangzhou 510060, China.
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Peng WY, He LW, Yin XF, Zhou BB, Zhou T, Zhou SY. Successful regression of newly formed corneal neovascularization by subconjunctival injection of bevacizumab in patients with chemical burns. Front Med (Lausanne) 2023; 10:1210765. [PMID: 37425330 PMCID: PMC10324651 DOI: 10.3389/fmed.2023.1210765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To investigate the effect and timing of subconjunctival bevacizumab injection on inhibiting corneal neovascularization (CorNV) in patients after chemical burns. Methods Patients with CorNV secondary to chemical burns were involved. Two subconjunctival injections of bevacizumab (2.5 mg/0.1 mL per involved quadrant) with an interval of 4 weeks were administered, and followed up a year. The area occupied by neovascular vessels (NA), accumulative neovascular length (NL), mean neovascular diameter (ND), best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were evaluated. Complication was also recorded. Results Eleven patients with CorNV were involved. Eight patients had a history of surgery (four had amniotic grafts, one had keratoplasty, and three had amniotic grafts and keratoplasty). Decreasing in NA, NL, and ND were statistically significant at each time point compared to the baseline (p < 0.01). CorNV that developed within 1 month was considerably regressed, and vessels with fibrovascular membranes were found to be narrower and shorter than pretreatment. BCVA improved in five patients (from one to five lines), remained unchanged in five patients, and decreased in one patient compared to pretreatment. Conclusion Subconjunctival bevacizumab injection has a particular potential for the regression of CorNV, especially newly formed within 1 month in patients after chemical burns.
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Affiliation(s)
- Wen-yan Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Li-wen He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiao-fang Yin
- Department of Ophthalmology, The Second People's Hospital of Foshan, Foshan, China
| | - Bin-Bing Zhou
- Department of Ophthalmology, The Affiliated First Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Tao Zhou
- Department of Ophthalmology, First People’s Hospital of Guiyang, Guiyang, China
| | - Shi-you Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Zhang B, Dong X, Sun Y. Efficacy and safety of anti-vascular endothelial growth factor agents in the treatment of primary pterygium. Front Med (Lausanne) 2023; 10:1166957. [PMID: 37287747 PMCID: PMC10242018 DOI: 10.3389/fmed.2023.1166957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/05/2023] [Indexed: 06/09/2023] Open
Abstract
Purpose To further evaluate the efficacy and safety of anti-vascular endothelial growth factor (VEGF) agents in management of primary pterygium. Methods Randomized controlled trials (RCTs) in databases of PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 2022. Recurrences and complications were evaluated as the pooled risk ratio (RR) and 95% confidence interval (CI) using random-effects model. Results In total of 1,096 eyes in 19 RCTs were included. Anti-VEGF agents statistically decreased recurrence rate of pterygium following surgery (RR 0.47, 95% CI 0.31-0.74, P < 0.001). Subgroup analysis showed that anti-VEGF as an adjunct to bare sclera (RR 0.34, 95% CI 0.13-0.90, P = 0.03) and conjunctival autograft (RR 0.50, 95% CI 0.26-0.96, P = 0.04) statistically reduced recurrence rate, while the effect was not favorable for conjunctivo-limbo autograft (RR 0.99, 95% CI 0.36-2.68, P = 0.98). Anti-VEGF agents statistically decreased recurrence in White patients (RR 0.48, 95% CI 0.28-0.83, P = 0.008), while didn't in Yellow patients (RR 0.43, 95% CI 0.12-1.47, P = 0.18). Both topical (RR 0.19, 95% CI 0.08-0.45, P < 0.001) and subconjunctival anti-VEGF agents (RR 0.64, 95% CI 0.45-0.91, P = 0.01) had a positive influence on recurrence. There was no statistically significant difference in complications between the groups (RR 0.80, 95% CI 0.52-1.22, P = 0.29). Conclusions As adjuvant treatment, anti-VEGF agents statistically reduced the recurrence following pterygium surgery, especially among White patients. Anti-VEGF agents were well tolerated without increased complications.
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Affiliation(s)
- Bowen Zhang
- Department of Operating Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xingmei Dong
- Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Yi Sun
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Wong H, Wang JS, Du YL, Xie HT, Zhang MC. Sandwich (Amnion/Conjunctival-Limbal Autograft/Amnion) Transplantation for Recurrent Pterygium with Restrictive Strabismus. J Clin Med 2022; 11:jcm11237193. [PMID: 36498767 PMCID: PMC9737167 DOI: 10.3390/jcm11237193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: This study aimed to evaluate the clinical outcome of Sandwich (Amnion/Conjunctival-Limbal Autograft/Amnion) transplantation for recurrent pterygium with restrictive strabismus. (2) Methods: This retrospective study included 11 eyes in 11 patients diagnosed with recurrent pterygium with restrictive strabismus who received sandwich transplantation. The outcomes were measured by pterygium recurrence, best-corrected visual acuity, esotropia (prism diopters), and treatment complications. (3) Results: Eleven patients (six males, five females) had a mean age of 60.5 (range 36-80) years. The previously received pterygium excision surgery number was 1.8 ± 1.02 (range 1-4). The mean follow-up period was 19.9 ± 8.41 (range 12-36) months. All patients had a restriction of abduction in the previously operated eye, causing esotropia in the primary position. Pre-operative esotropia was 17.2 (range 10-30) prims diopter (PD). Five eyes (45.5%) had symblepharon before surgery. All patients were orthotropic until the last follow-up. Symblepharon was released in all eyes. Free ocular motility was present in all eyes. No donor site scar formation, scleral melt, or corneal ulcer was noted. (4) Conclusions: Sandwich transplantation for recurrent pterygium with restrictive strabismus is safe and effective.
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Lee BWH, Sidhu AS, Francis IC, Coroneo MT. 5-Fluorouracil in primary, impending recurrent and recurrent pterygium: Systematic review of the efficacy and safety of a surgical adjuvant and intralesional antimetabolite. Ocul Surf 2022; 26:128-141. [PMID: 35961535 DOI: 10.1016/j.jtos.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
Pterygium is an ultraviolet-related disease characterized by an aberrant, wing-shaped and active wound-healing process. There is nothing quite as disheartening for the surgeon or patient as the recurrence of pterygium, and various adjuvants have been studied to ameliorate this. This systematic review provides a comprehensive summary of the efficacy and safety of 5-Fluorouracil (5-FU) as an antimetabolite agent for pterygium management. An appraisal of electronic searches of six databases identified 34 clinical studies reporting recurrence outcomes of 5-FU use in primary, impending recurrent and recurrent pterygia. In vitro and in vivo studies of 5-FU showed dose- and duration-dependent cytostatic and cytotoxic effects in human cells. 5-FU is relatively inexpensive, available, and easy to administer, making it attractive for resource-limited scenarios. However, the published evidence demonstrates a recurrence rate of 11.4-60% with the bare scleral technique, 3.5-35.8% with conjunctival rotational flaps, 3.7-9.6% with conjunctival autografts for intraoperative topical 5-FU, and 14-35.8% for preoperative and intraoperative injections. This suboptimal efficacy brings the role of 5-FU as an adjuvant for pterygium surgery into question and the authors do not recommend its use. In contrast, postoperative intralesional injections of 5-FU to arrest progression in impending recurrent pterygium and true recurrent pterygia were more promising, with success rates of 87.2-100% and 75-100%, respectively. Furthermore, 5-FU as a treatment modality, without surgery, effectively arrested progression in 81.3-96% of primary and recurrent pterygia. Other treatments such as topical and intralesional corticosteroids, cyclosporine and anti-VEGF agents are discussed. Complications of 5-FU increase with higher doses and range from transient and reversible to severe and sight-threatening. For pterygium, 5-FU has a predilection for causing scleral thinning, corneal toxicity, and graft-related complications. Additional study with extended follow-up is needed to elucidate the optimal dose, frequency, duration, and long-term safety of 5-FU injections. If 5-FU is used in the management of pterygium, it should be with caution, in selected patients and with vigilant long-term monitoring.
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Affiliation(s)
- Brendon W H Lee
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia; University of Sydney Medical School, University of Sydney, Camperdown, Australia.
| | - Amitouj S Sidhu
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Ian C Francis
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Minas T Coroneo
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia
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Kim JH, Kim YJ, Lee YJ, Hyon JY, Han SB, Kim KG. Automated histopathological evaluation of pterygium using artificial intelligence. Br J Ophthalmol 2022; 107:627-634. [PMID: 35017158 DOI: 10.1136/bjophthalmol-2021-320141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE This study aimed to evaluate the efficacy of a new automated method for the evaluation of histopathological images of pterygium using artificial intelligence. METHODS An in-house software for automated grading of histopathological images was developed. Histopathological images of pterygium (400 images from 40 patients) were analysed using our newly developed software. Manual grading (I-IV), labelled based on an established scoring system, served as the ground truth for training the four-grade classification models. Region of interest segmentation was performed before the classification of grades, which was achieved by the combination of expectation-maximisation and k -nearest neighbours. Fifty-five radiomic features extracted from each image were analysed with feature selection methods to examine the significant features. Five classifiers were evaluated for their ability to predict quantitative grading. RESULTS Among the classifier models applied for automated grading in this study, the bagging tree showed the best performance, with a 75.9% true positive rate (TPR) and 75.8% positive predictive value (PPV) in internal validation. In external validation, the method also demonstrated reproducibility, with an 81.3% TPR and 82.0% PPV for the average of four classification grades. CONCLUSIONS Our newly developed automated method for quantitative grading of histopathological images of pterygium may be a reliable method for quantitative analysis of histopathological evaluation of pterygium.
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Affiliation(s)
- Jong Hoon Kim
- Department of Biomedical Engineering, Gachon University of Medicine and Science, Incheon, Korea (the Republic of)
| | - Young Jae Kim
- Department of Biomedical Engineering, Gachon University of Medicine and Science, Incheon, Korea (the Republic of)
| | - Yeon Jeong Lee
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Gangwon, Korea (the Republic of)
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of).,Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Sang Beom Han
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Gangwon, Korea (the Republic of)
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gachon University of Medicine and Science, Incheon, Korea (the Republic of)
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Allam WA, Alagorie AR, Nasef MH, El-Bakary MA. Safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia. Int Ophthalmol 2022; 42:2047-2053. [PMID: 34978650 DOI: 10.1007/s10792-021-02199-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia. METHODS Thirty-three eyes of 33 subjects with recurrent pterygia were enrolled in this prospective case series study. Pterygium extended removal followed by extended conjunctival transplantation was performed in all subjects. One surgeon (WA) performed all surgeries. All subjects completed follow-up for at least 12 months and were evaluated for recurrence and complications. RESULTS The mean age of the participants was 41.2 ± 10.3 years (range 22-60), 7 females (21.2%). The mean duration of follow-up was 25.64 ± 9.24 months (range 12-43). Corrected distance visual acuity (decimal notation) improved from 0.69 ± 0.22 (range 0.2-1.0) at presentation to a 1-year postoperative value of 0.83 ± 0.2 (range 0.3-1.0). No recurrence was reported in all subjects throughout the follow-up period. Transient graft swelling was recorded in 14 cases (42.4%) and resolved in all cases by the first week. All patients developed variable degrees of transient postoperative diplopia that resolved completely by the first 6 weeks. Donor site granuloma developed in 4 cases (12.1%). Spontaneous resolution was observed in 3 cases, while in one case, surgical excision was performed 2 months after the procedure. CONCLUSIONS In this study of eyes with recurrent pterygia, pterygium extended removal followed by extended conjunctival transplant was found safe and effective with no recurrence and minimal postoperative complications.
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Affiliation(s)
- Waleed A Allam
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, 31111, Egypt
- Ibn Sina Eye Center, Tanta, Egypt
| | - Ahmed Roshdy Alagorie
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, 31111, Egypt.
| | - Mohammed H Nasef
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, 31111, Egypt
- Ibn Sina Eye Center, Tanta, Egypt
| | - Molham A El-Bakary
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, 31111, Egypt
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Patel ED, Rhee MK. Surgical Techniques and Adjuvants for the Management of Pterygium. Eye Contact Lens 2022; 48:3-13. [PMID: 34686641 DOI: 10.1097/icl.0000000000000849] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide an updated review of surgical techniques and adjuvants for the management of pterygium. METHODS A literature search was conducted in PubMed for studies published since January 2011. "Pterygium surgery" and the MeSH term "Pterygium/surgery" was used. The results were filtered for randomized controlled trials in English, yielding 60 citations. RESULTS One study compared topical anesthetic agents. One study compared methods of corneal polishing of the corneoscleral bed after pterygium excision. Numerous studies evaluated the use of conjunctival autograft versus amniotic membrane, superior versus inferior conjunctival autograft, and conjunctival versus limbal-conjunctival autograft. Many studies evaluated graft fixation methods. Several studies evaluated the adjuvant use of mitomycin C, 5-fluorouracil, and bevacizumab. A few studies evaluated the adjuvant use of steroids. Eleven studies evaluated various methods of postoperative management. CONCLUSIONS Current evidence supports pterygium excision with conjunctival autograft fixation using fibrin glue, followed by patching until the first postoperative visit. Surgical adjuvants and postoperative use of artificial tears and topical cyclosporine 0.05% may further reduce recurrence. Postoperative use of topical steroids is highly variable because there is no consensus regarding the optimal dose, frequency, and duration of treatment.
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Affiliation(s)
- Ekta D Patel
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY
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Abolfathzadeh N, Ghiasian L, Samavat B, Hadi Y, Arbab M. Recurrent pterygium: A review. J Curr Ophthalmol 2021; 33:367-378. [PMID: 35128181 PMCID: PMC8772501 DOI: 10.4103/joco.joco_153_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/18/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: To summarize the recent evidence regarding different aspects of pterygium recurrence. Methods: Human-based studies from PubMed, Scopus, and Google Scholar were identified using the following keywords: conjunctival disease, pterygium, recurrent pterygium, pterygium recurrence, pterygium management/surgery, conjunctival autograft (CAU), amniotic membrane graft/transplant, and adjuvant therapy (January 2009 to February 2021). We reviewed risk factors associated with the recurrence of pterygium, timing of recurrence, medical treatments to prevent from recurrence, and nonsurgical and surgical alternatives for management of recurrence. Results: Dry eye disease, black race, and young age are considered definite risk factors for recurrence. However, fleshy appearance of the pterygium and preoperative size remain controversial. Surgical techniques such as excessive suturing, insufficient conjunctival graft size, thick conjunctival graft with remained Tenon tissue, and postoperative graft retraction are considered possible risk factors for recurrence. Using fibrin glue instead of sutures can further reduce recurrence rates. Although recurrence could occur even after many years, most recurrences happen in the first 3–6 months after surgery. Multiple kinds of adjuvant medications are used before, during, or after the operation including mitomycin C (MMC), 5-fluorouracil (5-FU), corticosteroids, and anti-vascular endothelial growth factors (anti-VEGFs). Multiple weekly subconjunctival 5-FU injections are shown to be safe and effective in halting the progression of recurrent pterygium. Although topical bevacizumab is found to inhibit the growth of impending recurrent pterygium, the effect is mostly temporary. CAU is superior to amniotic membrane transplantation in the treatment for recurrent pterygia. Conclusions: There is yet to be a panacea in treating recurrent pterygium. Currently, there is not a globally accepted recommendation for treating recurrent pterygium with anti-VEGFs or 5-FU as a nonsurgical treatment. We strongly recommend using MMC as an adjunct to surgery in recurrent cases, with consideration of its specific complications. CAU is the most effective surgical treatment for recurrent pterygium, and other new surgical therapies need further investigation.
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Xu LJ, Rong SS, Xu YS, Zheng LB, Qiu WY, Zhang X, Jiang LJ, Duan RP, Tian T, Yao YF. Anti-fibrosis potential of pirarubicin via inducing apoptotic and autophagic cell death in rabbit conjunctiva. Exp Eye Res 2020; 200:108215. [PMID: 32896532 DOI: 10.1016/j.exer.2020.108215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/26/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022]
Abstract
This study investigated the potential efficacy of pirarubicin (THP) in modulating rabbit conjunctival fibrosis both in vitro and in vivo and characterized the underlying mechanisms. Primary rabbit conjunctival fibroblasts (RCF) were cultured and treated with THP or mitomycin C (MMC) for 5 min, followed by assaying for cell viability, cell cycle distribution, apoptotic and autophagic pathways. The production of reactive oxygen species (ROS) and chemotaxis of macrophages by RCF were evaluated using 2',7'-dichlorofluorescein diacetate (DCFH-DA) labeling and transwell migration assay, respectively. Limbal stem cell excision in combination with alkali burn was performed on the rabbits to establish a model of limbal deficiency and conjunctival fibro-vascular invasion. After three months, the modeled fibro-vascular tissue was excised combined with topical subconjunctival 5-min exposure to THP compared with MMC intraoperatively. The recurrence of postoperative fibrosis and the expression of apoptosis, autophagy, and inflammation markers were evaluated by immunohistochemistry. All modeled rabbits developed conjunctival fibro-vascular lesions, which were similar to human recurrent pterygium (HRP). Both THP and MMC inhibited RCF proliferation and arrested cell cycle at the G0/G1 phase. In particular, 7.5 μmol/L THP remarkably promoted RCF autophagy by upregulating the levels of Beclin 1, Atg 5/12 conjugate, and LC3B, whereas, 15 μmol/L THP significantly triggered a cascade of mitochondrial-associated RCF apoptosis. THP induced the production of ROS and enhanced the chemoattraction of macrophages by RCF. Similar to 600 μmol/L MMC, both 7.5 μmol/L and 15 μmol/L THP attenuated postoperative conjunctival fibrosis in the models; 7.5 μmol/L THP preferentially enhanced autophagy while causing fewer side effects. THP exerted its antifibrotic action by modulating autophagy in RCF, inducing cell cycle arrest, and mitochondrial-mediated apoptosis. THP at the dose of 7.5 μmol/L prevented postoperative conjunctival fibrosis in an animal model.
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Affiliation(s)
- Li-Juan Xu
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 321006, China
| | - Shi-Song Rong
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, 02114, USA
| | - Ye-Sheng Xu
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 321006, China
| | - Li-Bin Zheng
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 321006, China
| | - Wen-Ya Qiu
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 321006, China
| | - Xia Zhang
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 321006, China
| | - Lou-Jing Jiang
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 321006, China
| | - Run-Ping Duan
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 321006, China
| | - Tian Tian
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 321006, China
| | - Yu-Feng Yao
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 321006, China.
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Yang HK, Lee YJ, Hyon JY, Kim KG, Han SB. Efficacy of bevacizumab injection after pterygium excision and limbal conjunctival autograft with limbal fixation suture. Graefes Arch Clin Exp Ophthalmol 2020; 258:1451-1457. [DOI: 10.1007/s00417-020-04704-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/02/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022] Open
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Kam KW, Young AL. 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. Graefes Arch Clin Exp Ophthalmol 2019; 257:2683-2690. [PMID: 31650270 DOI: 10.1007/s00417-019-04499-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 09/26/2019] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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Zhang J, Tian Q, Zheng T, Chen D, Wang Q, Ke M. Effect of multiple subconjunctival conbercept injections as an adjuvant to the surgical treatment of pterygium: a prospective randomised comparative 6-month follow-up study. Eye (Lond) 2019; 34:408-414. [PMID: 31554943 DOI: 10.1038/s41433-019-0596-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/12/2019] [Accepted: 08/22/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of multiple subconjunctival injections of conbercept for pterygium patients after surgery. METHODS As a prospective randomised interventional trial, 96 eyes from 96 patients with a tendency to recur were collected and divided randomly into conbercept and 5-fluorouracil groups on the 5th day after pterygium. All patients received three subconjunctival injections of conbercept (0.2 ml) or 5-fluorouracil (0.2 ml) on the 5th day (baseline), and 2 and 4 weeks post-operatively. The pterygium morphology, colour intensity, recurrence, and complications were recorded and analysed pre-1st injection and 1 day, 1 week, 1 month, 3 months, and 6 months post-3rd injection. Moreover, no patient was drop-out. RESULTS There were striking differences between the two groups on post-3rd injections 1 day, 1 week, 1 month, 3 months, and 6 months (p = 0.001, 0.002, 0.000, 0.000, and 0.002, respectively) with respect to colour intensity: the eyes in conbercept group were lighter than the 5-Fu group. On post-3rd injection 6 months, prominent disparities existed between the two groups with respect to pterygium morphology (p = 0.006) and recurrence (p = 0.002), occurred in the conbercept group prior to the 5-Fu group. Moreover, corneal abrasions were not noted in the conbercept group, which was significantly less than the 5-Fu group (17/48; p = 0.000). There was no conspicuous discrepancy between the two groups with respect to subconjunctival haemorrhage (p = 0.789) and persistent epithelial defects (p = 0.078). CONCLUSION Multiple subconjunctival conbercept injections as an adjunct therapy for pterygium surgery was shown to be safe, effective, and well-tolerated.
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Affiliation(s)
- Jing Zhang
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, No 169. Donghu Road, 430071, Wuhan, Hubei, China
| | - Quanxi Tian
- School of Information Management and statistics, Hubei University of Economics, No. 8 Yangqiaohu Road, 430205, Wuhan, Hubei, China
| | - Tian Zheng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, No 169. Donghu Road, 430071, Wuhan, Hubei, China
| | - Donglai Chen
- Department of Ophthalmology, The Second People's Hospital of Honghu, No 142. Xinjian Road, 433202, Honghu, Hubei, China
| | - Qing Wang
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, No 169. Donghu Road, 430071, Wuhan, Hubei, China
| | - Min Ke
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, No 169. Donghu Road, 430071, Wuhan, Hubei, China.
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Sun Y, Zhang B, Jia X, Ling S, Deng J. Efficacy and Safety of Bevacizumab in the Treatment of Pterygium: An Updated Meta-Analysis of Randomized Controlled Trials. J Ophthalmol 2018; 2018:4598173. [PMID: 30254755 PMCID: PMC6145151 DOI: 10.1155/2018/4598173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/10/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Studies investigating efficacy and safety of bevacizumab in pterygium have increased and reported controversial results. Thus, we updated this meta-analysis to clarify the issue. METHODS Studies were selected through search of the databases Embase, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from their inception up until June 2017. The pooled risk ratio (RR) and 95% confidence interval (CI) were calculated for recurrence and complication rates by using random effects model. RESULTS 1045 eyes in 18 randomized controlled trials (RCTs) enrolled. Overall, the pooled estimate showed a statistically significant effect of bevacizumab on the reduction of recurrence (RR 0.74, 95% CI 0.56-0.97, P=0.03). Subgroup analyses presented significant results beneficial to bevacizumab (primary pterygium group, RR 0.53, 95% CI 0.33-0.83, P=0.006; conjunctival autograft group, RR 0.48, 95% CI 0.25-0.91, P=0.02; and follow-up longer than 12 months group, RR 0.36, 95% CI 0.13-0.99, P=0.05). No statistically significant difference was observed in complication rates. CONCLUSIONS Application of bevacizumab showed a statistically significant decrease in recurrence rate following removal of primary pterygia, or in cases with conjunctival autograft, or with follow-up longer than 12 months, while complications were not increased.
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Affiliation(s)
- Yi Sun
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Bowen Zhang
- Surgical Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiuhua Jia
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Shiqi Ling
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Juan Deng
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
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Huang ST, Tian BS, Xiao O, Yang YJ, Zhou SY. Safety of antivascular endothelial growth factor administration in the ocular anterior segment in pterygium and neovascular glaucoma treatment: Systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11960. [PMID: 30142821 PMCID: PMC6112962 DOI: 10.1097/md.0000000000011960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Anti-VEGF agents has been widely used in ocular diseases, but its safety for treating anterior segment disorders, the conclusions are controversial. METHODS Several major databases, including CENTRAL, MEDLINE, and EMBASE, were searched. Safety data from 18 randomized controlled trials (RCTs) were used to compare anti-VEGF treatment in the ocular anterior segment in pterygium and neovascular glaucoma treatment with placebo/sham treatment for eye diseases. A meta-analysis for adverse events was performed. RESULTS Eighteen RCT studies with 955 eyes were included in the meta-analysis. Significant difference in conjunctival disorders (OR: 1.62; 95% CI, 1.01-2.59; P = .05) was noted among the included studies, but not in ocular intolerance (odds ratio [OR]: 0.75; 95% CI, 0.34-1.62; P = .46), corneal disorders (OR: 0.71; 95% CI, 0.37-1.37; P = .31), or the subgroup analysis of conjunctival disorders. CONCLUSIONS The administration of anti-VEGF agents in the ocular anterior segment for patients with pterygium and glaucoma was tolerable in tolerance and cornea, but was the risk factor of conjunctival disorders. The healing of corneal epithelium may be delayed in patients with primary corneal epithelial defects after anti-VEGF application. However, due to the limited evidence, further research should be performed on the safety of anti-VEGF administration in patients with different corneal disorders.
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Mohamed TA, Soliman W, Fathalla AM, El Refaie A. Effect of single subconjunctival injection of bevacizumab on primary pterygium: clinical, histopathological and immunohistochemical study. Int J Ophthalmol 2018; 11:797-801. [PMID: 29862178 DOI: 10.18240/ijo.2018.05.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/01/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effect (clinically, histopathologically and immunohistochemically) and safety of a single intra-pterygium injection of bevacizumab. METHODS Prospective interventional study comprised 40 eyes of 40 patients with primary fleshy pterygia who attended the Outpatient Clinic of Department of Ophthalmology, Assiut University Hospitals, Egypt from May 2015 to May 2016. Patients were randomly classified into 2 groups: the first group received a single intralesional injection of bevacizumab (Avastin; Genentech, San Francisco, CA, USA); the second group comprised patients who did not receive subconjunctival bevacizumab. Excision of pterygium and conjunctival auto graft was done in both groups. The excised pterygium tissues were subjected to histopathological and immunohistochemical evaluation. RESULTS The study comprised 40 eyes of 40 patients (33 men, 7 women) of age range from 31-58y. The study group included 22 eyes. The control group included 18 eyes. A decrease in the vascularity of the pterygium was noted in all injected cases. The mean vessel count was higher in non-injected pterygia than that in injected pterygia and the difference was statistically significant (P=0.001). Also, the mean vessel count in both groups was significantly higher than normal conjunctive (P=0.005 and 0.001). A statistically significant difference in vascular endothelial growth factor (VEGF) expression between injected and non-injected cases was detected in the epithelial, stromal and endothelial cells (P=0.0001, 0.016, 0.014). No serious intraoperative complications occurred in both groups. CONCLUSION The use of single intra lesional injection of Avastin in pterygium decreased vascularity and decreased VEGF expression in injected pterygium after one month. Our study proved the effect of single intra lesional injection of Avastin on pterygium. Further studies may enable limiting the need for surgery and improve quality of life for patients with pterygia.
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Affiliation(s)
- Tarek A Mohamed
- Department of Ophthalmology, Assiut University Hospital, Assiut 71111, Egypt
| | - Wael Soliman
- Department of Ophthalmology, Assiut University Hospital, Assiut 71111, Egypt
| | - Ahmed M Fathalla
- Department of Ophthalmology, Assiut University Hospital, Assiut 71111, Egypt
| | - Abeer El Refaie
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut 71111, Egypt
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García Tirado A, Boto de Los Bueis A, Rivas Jara L. Ocular surface changes in recurrent pterygium cases post-operatively treated with 5-fluorouracil subconjunctival injections. Eur J Ophthalmol 2018; 29:9-14. [PMID: 29580102 DOI: 10.1177/1120672118757428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION: To investigate the ocular surface changes occurring in eyes with recurrent pterygium post-operatively treated with 5-fluorouracil intralesional injections. METHODS: Retrospective observational study of recurrent pterygium cases treated with weekly intralesional injections of 0.1 mL (5 mg) of 5-fluorouracil (10 injections). Impression cytology samples taken from the lesion, the healthy conjunctivae (inferior, superior, and contralateral to injury), and the cornea before and after treatment were analyzed. Clinical ocular characteristics (including Schirmer's test and break-up time) were evaluated during treatment. RESULTS: A total of 15 eyes were treated, with the mean follow-up of 27 ± 8.7 months (mean ± standard deviation). Prior to treatment initiation, the ocular surface citology over the pterygium was found to be abnormal. No epithelial cells (27%) and a lower goblet cell density (73%) compared to the healthy conjunctivae (p < 0.01) were found. Squamous metaplasia was observed to some degree in the cornea (100%), pterygium (81%) and healthy conjunctivae (73%). Following treatment, pterygium composition had changed: epithelial cell number (100%) and goblet cell density (47%) had increased (p < 0.05). Goblet cell density was also increased in healthy conjunctivae (67%; p < 0.05). The degree of squamous metaplasia decreased in the cornea (67%), pterygium (45%), and healthy conjunctivae (60%; p < 0.05). No adverse effects were reported, recurrence progression was arrested, and conjunctival redness and dry-eye severity level were decreased in all cases (p < 0.01). DISCUSSION: The cytology of ocular surface in recurrent pterygium is abnormal. After weekly intralesional 5-fluorouracil injections, it tends to normalize. The 5-fluorouracil compound is a safe and effective treatment to prevent pterygium recurrence.
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Affiliation(s)
- Amanda García Tirado
- 1 Department of Ophthalmology, IdiPaz Research Institute, La Paz University Hospital, Madrid, Spain
| | - Ana Boto de Los Bueis
- 1 Department of Ophthalmology, IdiPaz Research Institute, La Paz University Hospital, Madrid, Spain
| | - Luis Rivas Jara
- 2 Department of Ophthalmology, Ramón y Cajal University Hospital, Madrid, Spain
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Lee JS, Ha SW, Yu S, Lee GJ, Park YJ. Efficacy and Safety of a Large Conjunctival Autograft for Recurrent Pterygium. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:469-478. [PMID: 29230976 PMCID: PMC5726981 DOI: 10.3341/kjo.2016.0135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/03/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of pterygium excision using a large conjunctival autograft for the treatment of recurrent pterygium. METHODS The medical records of 120 patients (126 eyes) with recurrent pterygium were reviewed. For each affected eye, pterygium excision with a large conjunctival autograft was performed. The graft was harvested from the superior bulbar area and measured more than 8 × 10 mm in size. Only patients who completed at least six months of follow-up were included. Postoperative clinical outcomes, recurrence rate, and complications were analyzed. Patients with any evidence of recurrence after surgery received a subconjunctival bevacizumab injection. RESULTS The average patient age was 56.5 ± 10.2 years, and 45 out of 120 patients were male. The mean study follow-up period was 17.7 ± 17.6 months. Most patients were satisfied with the cosmetic outcome. Postoperative visual acuity improved from 0.69 to 0.75 (p < 0.05). Postoperative refractive astigmatism and corneal astigmatism decreased by 0.55 and 2.73 diopters, respectively (p < 0.05). The postoperative recurrence rate was 4.0%, and the average recurrence period was 7.4 ± 0.6 weeks. A subconjunctival injection of 5 mg bevacizumab was performed in cases of recurrence; no progression of the pterygium was observed following the injection. Postoperative complications included 2 cases of conjunctival graft edema in 2 eyes, 5 donor site scars in 5 eyes, 13 pyogenic granulomas in 13 eyes, and a conjunctival epithelial inclusion cyst in 7 eyes. CONCLUSIONS Pterygium excision with a large conjunctival autograft for the treatment of recurrent pterygium produced an excellent cosmetic outcome, a low recurrence rate, and minimal complications. A subconjunctival bevacizumab injection given in cases of recurrence following surgery might be effective in preventing progression of the pterygium.
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Affiliation(s)
| | | | - Sung Yu
- Cheil Eye Hospital, Daegu, Korea
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Zeng W, Liu Z, Dai H, Yan M, Luo H, Ke M, Cai X. Anti-fibrotic, anti-VEGF or radiotherapy treatments as adjuvants for pterygium excision: a systematic review and network meta-analysis. BMC Ophthalmol 2017; 17:211. [PMID: 29178848 PMCID: PMC5702200 DOI: 10.1186/s12886-017-0601-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/09/2017] [Indexed: 12/03/2022] Open
Abstract
Background Anti-fibrotic, anti-VEGF (vascular endothelial growth factor) medications, or radiotherapy, as adjuvant for pterygium surgical procedure, has been suggested for reducing recurrence, but difficulties may be experienced in deciding which treatment to use. The purpose of this study was to compare the efficacies of these different adjuvants for preventing recurrence following pterygium surgery. Methods We conducted a systematic review to identify randomized controlled trials of patients with primary or recurrent pterygium who received anti-fibrotic, anti-VEGF medication, or radiotherapy as adjuvants in combination with surgical procedure. The surgical procedure contained bare sclera technique or petrygium excision combination with tissue grafting. The primary outcome of this study was recurrence. Direct-comparison and Bayesian network meta-analyses were performed to assess direct and indirect evidence of efficacy. Results We obtained data from 34 randomized controlled trials, representing a total of 2483 patients. Adjuvants included bevacizumab, 5-FU (5-fluorouracil), MMC (mitomycin C), and β-RT (beta-radiotherapy). Compared with placebo, we found distinguishable improvement in recurrence with bevacizumab (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.18–0.80), MMC (0.12, 95% CI 0.06–0.21), and β-RT (0.17, 95% CI 0.04–0.69), but not with 5-FU (0.41, 95% CI 0.12–1.39). MMC significantly reduced recurrence when compared to bevacizumab (0.31, 95% CI 0.13–0.77) and 5-FU (0.28, 95% CI 0.08–0.99). The probability of having the most recurrences after excision was lowest for MMC, followed by bevacizumab and β-RT. Similar results were found in subgroup analyses, including for primary pterygium, and the patients receiving bare sclera technique or conjunctival autograft. Conclusions Adjuvants such as MMC, bevacizumab, and β-RT could effectively prevent recurrence following pterygium excision. However, their efficacy and acceptability require further clarification in future randomized controlled trials. Electronic supplementary material The online version of this article (10.1186/s12886-017-0601-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wen Zeng
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Zengming Liu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Hanjun Dai
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Ming Yan
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Hong Luo
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Min Ke
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Xiaojun Cai
- Department of Ophthalmology, Zhongnan hospital of Wuhan University, No 169 Donghu road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China.
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20
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Meng Q, Qin Y, Deshpande M, Kashiwabuchi F, Rodrigues M, Lu Q, Ren H, Elisseeff JH, Semenza GL, Montaner SV, Sodhi A. Hypoxia-Inducible Factor-Dependent Expression of Angiopoietin-Like 4 by Conjunctival Epithelial Cells Promotes the Angiogenic Phenotype of Pterygia. Invest Ophthalmol Vis Sci 2017; 58:4514-4523. [PMID: 28873177 PMCID: PMC5584708 DOI: 10.1167/iovs.17-21974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose Disappointing results from clinical studies assessing the efficacy of therapies targeting vascular endothelial growth factor (VEGF) for the treatment of pterygia suggest that other angiogenic mediators may also play a role in its development. We therefore explore the relative contribution of VEGF, hypoxia-inducible factor (HIF)-1α (the transcription factor that regulates VEGF expression in ocular neovascular disease), and a second HIF-regulated mediator, angiopoietin-like 4 (ANGPTL4), to the angiogenic phenotype of pterygia. Methods Expression of HIF-1α, VEGF, and ANGPTL4 were examined in surgically excised pterygia, and in immortalized human (ih) and primary rabbit (pr) conjunctival epithelial cells (CjECs). Endothelial cell (EC) tubule formation assays using media conditioned by ihCjECs in the presence or absence of inducers/inhibitors of HIF-1 or RNA interference (RNAi) targeting VEGF, ANGPTL4, or both were used to assess their relative contribution to the angiogenic potential of these cells. Results HIF-1α and VEGF expression were detected in 6/6 surgically excised pterygia and localized to CjECs. Accumulation of HIF-1α in was confirmed in ihCjECs and prCjECs, including stratified prCjECs grown on collagen vitrigel, and resulted in expression of VEGF and the promotion of EC tubule formation; the latter effect was partially blocked using RNAi targeting VEGF mRNA expression. We demonstrate expression of a second HIF-regulated angiogenic mediator, ANGPTL4, in CjECs in culture and in surgically excised pterygia. RNAi targeting ANGPTL4 inhibited EC tubule formation and was additive to RNAi targeting VEGF. Conclusions Our results support the development of therapies targeting both ANGPTL4 and VEGF for the treatment of patients with pterygia.
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Affiliation(s)
- Qianli Meng
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Guangdong Eye Institute, Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou Guangdong, China
| | - Yaowu Qin
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,EENT Hospital, Fudan University, Shanghai, China
| | - Monika Deshpande
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Fabiana Kashiwabuchi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Murilo Rodrigues
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Qiaozhi Lu
- Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Hui Ren
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,EENT Hospital, Fudan University, Shanghai, China
| | - Jennifer H. Elisseeff
- Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Gregg L. Semenza
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Silvia V. Montaner
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, Maryland, United States
,Department of Pathology, School of Medicine, University of Maryland, Baltimore, Maryland, United States
,Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland, United States
| | - Akrit Sodhi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Liu J, Xu JH, Xu W, Liang GL, Lou JX, Wang Y, Wen JQ, Cao YB. Bevacizumab as adjuvant therapy in the management of pterygium: a systematic review and Meta-analysis. Int J Ophthalmol 2017; 10:1126-1133. [PMID: 28730117 DOI: 10.18240/ijo.2017.07.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 04/04/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the clinical effect of bevacizumab in pterygium treatment. METHODS A systematic review and quantitative Meta-analysis was performed. PubMed, EMBASE, Web of Science and Cochrane database were searched for eligible literatures published in English until June 2016. The endpoint was recurrence rate and pooled risk ratio (RR) was calculated. RESULTS Nine eligible studies were included and Meta-analysis results showed no significantly difference in patients treated with bevacizumab in short term follow-up [3mo: RR=0.70 (0.34, 1.45); 6mo: RR=0.55 (0.23, 1.32)] compared with control groups. No significant effects were observed in favor of bevacizumab in subgroup analyses: patients with subconjunctival injection of bevacizumab [3mo: RR=0.95 (0.70, 1.29); 6mo: RR=0.83 (0.55, 1.28)], primary pterygium [3mo: RR=0.59 (0.23, 1.54; 6mo: RR=0.59 (0.23, 1.53)], simple pterygium excision [3mo: 0.32 (0.05, 2.04), P=0.23; 6mo: 0.27 (0.05, 1.53)] and excision with conjunctival autograft [3mo: 1.51 (0.25, 9.15); 6mo: 1.11 (0.06, 21.69)]. CONCLUSION In this Meta-analysis, we did not found the significant effect of bevacizumab in pterygium treatment, at least in short term follow-up (3mo and 6mo).
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Affiliation(s)
- Jian Liu
- Department of Ophthalmology, Zhejiang Hospital, Hangzhou 310012, Zhejiang Province, China
| | - Jie-Hui Xu
- Department of Ophthalmology, Zhejiang Hospital, Hangzhou 310012, Zhejiang Province, China
| | - Wen Xu
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Guan-Lu Liang
- Department of Ophthalmology, Zhejiang Hospital, Hangzhou 310012, Zhejiang Province, China
| | - Ji-Xian Lou
- Department of Ophthalmology, Zhejiang Hospital, Hangzhou 310012, Zhejiang Province, China
| | - Yi Wang
- Department of Ophthalmology, Zhejiang Hospital, Hangzhou 310012, Zhejiang Province, China
| | - Ji-Quan Wen
- Department of Ophthalmology, Zhejiang Hospital, Hangzhou 310012, Zhejiang Province, China
| | - Yong-Bao Cao
- Department of Ophthalmology, Zhejiang Hospital, Hangzhou 310012, Zhejiang Province, China
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Topical bevacizumab treatment in aniridia. Int Ophthalmol 2017; 38:1741-1746. [PMID: 28620705 DOI: 10.1007/s10792-017-0605-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 06/08/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE To report the results of long-term topical treatment with bevacizumab (Avastin) 5 mg/mL eyedrops in a case of aniridia-related neovacularization of the cornea. METHODS Interventional case report. A female patient with aniridia had a decrease in the best corrected visual acuity from 0.32 to 0.02 in the OS over the course of 4 years, secondary to central corneal neovascularization and epithelial breakdown. Vision in the OD was 0.2. In 2008, at age 28, a shared decision was made to start off-label treatment with bevacizumab eyedrops 0.5% in both eyes. After 9 years, the visual acuity in the OD remained stable, with stability of the macropannus and maintenance of central corneal clarity. In the OS, the central corneal neovascularization regressed, the epithelium regained its clarity, and after cataract surgery visual acuity was regained to 0.32. RESULTS After 9 years of treatment with topical bevacizumab, vision acuity is comparable to the situation of 12 years previously: Visual acuity remained stable in the ODS. CONCLUSION In a young patient with progressive corneal neovascularization secondary to aniridia, stability of central corneal neovascularization was obtained and corneal clarity was preserved by adding a daily drop of bevacizumab 5 mg/mL. No adverse events occurred. Vessel growth was inhibited, and as such, the progression of the natural history of the patient's disease was halted. More clinical study with longer follow-up is needed to investigate the applicability of treatment with topical VEGF inhibitors in aniridia.
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Abstract
PURPOSE Intralesional single low-dose vascular endothelial growth factor antagonists have traditionally failed in causing regression of pterygia. The current pilot study investigates the role of high-dose repeated intralesional ziv-aflibercept in causing regression of inflamed or recurring pterygia. METHODS This prospective study from January 2015 to April 2017 consisted of using high dose of ziv-aflibercept between 0.1 mL (2.5 mg) and 0.3 mL (7.5 mg), depending on the pterygium size and the degree of inflammation. The injection was deep after tunneling the 30-gauge needle away from the injection site to avoid reflux. Reinjection was done at the first sign of recurrence of inflammation. The main outcome measure was regression of pterygial vessels by central retraction as documented by slit-lamp photography and anterior optical coherence tomography. RESULTS Four subjects, one with bilateral pterygia, were treated. Regression of new vessels and retraction of the leading edge of pterygial vessels occurred in all treated eyes (5 eyes) with dramatic visual gain in 1 eye from counting fingers to 6/9 (20/30). Numbers of injections were 9 (1 eye; 18 mo), 3 (2 eyes; 12 and 18 mo), and 1 (2 eyes; 2.5 and 7 mo). CONCLUSIONS Frequent high-dose intralesional ziv-aflibercept can lead to regression and/or retraction of inflamed pterygia in this pilot study. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov, NCT02486484.
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Kampitak K, Leelawongtawun W, Leeamornsiri S, Suphachearaphan W. Role of artificial tears in reducing the recurrence of pterygium after surgery: a prospective randomized controlled trial. Acta Ophthalmol 2017; 95:e227-e229. [PMID: 27520087 DOI: 10.1111/aos.13176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 05/26/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether artificial tears can reduce recurrence of pterygium after surgery. METHODS A total of 128 primary pterygium cases after excision were randomized into two groups according to postoperative drugs: 64 cases received topical dexamethasone (control group), and 64 cases received topical dexamethasone and hydroxypropyl methylcellulose (treatment group). The pterygium was removed with amniotic membrane graft technique in all cases. Recurrence was observed within 6 months after surgery, and survival analysis was used to evaluate the difference between groups. RESULTS There were no significant differences in age and gender of patients, size of pterygium, Schirmer's test results and tear breakup time between both groups (p > 0.05). Recurrence rate in the treatment group (16%) was significantly less than the control group (33%), p = 0.018 (log-rank test). CONCLUSION Using artificial tears as an adjunctive drug could lower pterygium recurrence after excision.
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Affiliation(s)
- Kosol Kampitak
- Department of Ophthalmology; Faculty of Medicine; Thammasat University; Pathumthani Thailand
| | - Wichai Leelawongtawun
- Department of Ophthalmology; Faculty of Medicine; Thammasat University; Pathumthani Thailand
| | - Supinda Leeamornsiri
- Department of Ophthalmology; Faculty of Medicine; Thammasat University; Pathumthani Thailand
| | - Wannisa Suphachearaphan
- Department of Ophthalmology; Faculty of Medicine; Thammasat University; Pathumthani Thailand
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Mak RK, Chan TCY, Marcet MM, Choy BNK, Shum JWH, Shih KC, Wong IYH, Ng ALK. Use of anti-vascular endothelial growth factor in the management of pterygium. Acta Ophthalmol 2017; 95:20-27. [PMID: 27473792 DOI: 10.1111/aos.13178] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/26/2016] [Indexed: 12/29/2022]
Abstract
The rising success of anti-vascular endothelial growth factor (VEGF) therapies in ocular disease has stimulated the use of such treatments in the surgical management of pterygium. We reviewed the literature to better understand the safety and efficacy of the adjunctive role of anti-VEGF treatments for pterygium excision. Without surgery, anti-VEGF alone may favourably alter symptoms and vascularity, but does not cause pterygium regression. Some evidence supports the use of anti-VEGF as an adjuvant therapy to surgery, especially when using a higher dose and a more frequent dosing regimen. Overall, anti-VEGF is generally safe and well tolerated in patients with pterygium. Currently, the evidence does not conclusively support the use of anti-VEGF in pterygium surgery. However, further research may guide unanswered questions regarding the interaction between VEGF and other factors responsible for pterygium growth. In addition, the optimal route and dosage of anti-VEGF administration is not yet known.
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Affiliation(s)
| | - Tommy Chung Yan Chan
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong
- Hong Kong Eye Hospital; Kowloon Hong Kong
| | - Marcus M Marcet
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong
| | - Jennifer Wei Huen Shum
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong
| | - Kendrick Co Shih
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong
| | - Ian Yat Hin Wong
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong
| | - Alex Lap Ki Ng
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong
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Kim YH, Jung JC, Gum SI, Park SB, Ma JY, Kim YI, Lee KW, Park YJ. Inhibition of Pterygium Fibroblast Migration and Outgrowth by Bevacizumab and Cyclosporine A Involves Down-Regulation of Matrix Metalloproteinases-3 and -13. PLoS One 2017; 12:e0169675. [PMID: 28068383 PMCID: PMC5221804 DOI: 10.1371/journal.pone.0169675] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/20/2016] [Indexed: 02/05/2023] Open
Abstract
We examined the connection between matrix metalloproteinase (MMP) expression/activity and pterygium fibroblast migration, and how these were affected by bevacizumab and/or cyclosporine A (CsA). Fibroblasts were obtained from 20 pterygia and 6 normal conjunctival specimens. Expression levels of MMP-3 and MMP-13 were examined after bevacizumab administration. Immunofluorescence staining was used to examine expression of both MMPs in fibroblasts migrating out from explanted pterygium tissues. Rates of cell migration from explant-cultured pterygia tissues and scratch-wounded confluent pterygium fibroblasts were examined in the presence of MMP-3 or MMP-13 inhibitors, as well as bevacizumab and/or CsA. A scratch wound healing migration assay was performed to determine the effects of bevacizumab and/or CsA. Protein expression of both MMPs in pterygium tissues and in cells migrating from organ-cultured pterygium tissues was greater than that observed in normal cells. Inhibition of the activities of both MMPs decreased their expression levels; these were also significantly reduced in bevacizumab-injected pterygium tissues. Bevacizumab significantly reduced the expression of both MMPs and cell migration. Pretreatment with CsA prior to bevacizumab exposure markedly inhibited cell migration and the expression of both MMPs. CsA enhanced the inhibitory effects of bevacizumab on pterygium fibroblast migration in vitro, possibly by inhibiting expression of both MMPs. These findings suggest that combined CsA and bevacizumab treatment may provide a potential therapeutic strategy for reducing the rate of pterygium recurrence.
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Affiliation(s)
- Yeoun-Hee Kim
- Cheil Eye Research Institute, Cheil Eye Hospital, 1 Ayang-Ro, Dong-Gu, Daegu, Republic of Korea
- Korean Medicine (KM)-Application Center, Korea Institute of Oriental Medicine (KIOM), Cheomdan-ro Dong-gu, Daegu, Republic of Korea
| | - Jae-Chang Jung
- Department of Biology, College of Natural Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Sang Il Gum
- Cheil Eye Research Institute, Cheil Eye Hospital, 1 Ayang-Ro, Dong-Gu, Daegu, Republic of Korea
| | - Su-Bin Park
- Department of Biology, College of Natural Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Jin Yeul Ma
- Korean Medicine (KM)-Application Center, Korea Institute of Oriental Medicine (KIOM), Cheomdan-ro Dong-gu, Daegu, Republic of Korea
| | - Yong Il Kim
- Cheil Eye Research Institute, Cheil Eye Hospital, 1 Ayang-Ro, Dong-Gu, Daegu, Republic of Korea
| | - Kyoo Won Lee
- Cheil Eye Research Institute, Cheil Eye Hospital, 1 Ayang-Ro, Dong-Gu, Daegu, Republic of Korea
| | - Young Jeung Park
- Cheil Eye Research Institute, Cheil Eye Hospital, 1 Ayang-Ro, Dong-Gu, Daegu, Republic of Korea
- * E-mail:
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Abstract
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.
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Affiliation(s)
- S A Malozhen
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - S V Trufanov
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - D A Krakhmaleva
- Research Institute of Eye Diseases, 11A, B, Rossolimo St., Moscow, Russian Federation, 119021
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Abstract
IMPORTANCE Currently the only treatment for recurrent pterygium is surgery. This is a phase 1 trial investigating ranibizumab as a medical treatment for recurrent pterygium. OBJECTIVE To assess the safety and efficacy of subtenon Ranibizimab for recurrent pterygia. DESIGN Subjects with recurrent pterygium received subtenon ranibizumab and were followed for 1 year. Safety parameters were measured. Photographs were taken and quantitatively analyzed to measure the short-term (2 months) and long-term (5-26 months) response to treatment. SETTING University of New Mexico Eye Clinic. PARTICIPANTS Eight subjects with recurrent pterygia. INTERVENTIONS Subtenon delivery of 0.5 to 2 mg of ranibizumab, at day 0, month 1, and month 2. MAIN OUTCOME MEASURES Safety parameters included visual acuity, intraocular pressure, and assessment of ocular surface. Efficacy was assessed by comparing photographs taken at day 0 with a short-term follow-up photograph taken at month 2 and a long-term follow-up image taken at the final patient visit (range 5-26 months). Quantitative analysis of photographs was performed to measure vascularity in the treated zone. RESULTS Four subjects had an arrest of pterygium growth with a visual reduction in vascularity and a quantitative reduction in the area of vascularization (average vascularized area in short-term follow-up images was 51% of the baseline photos at day 0, and in the long-term photos was 36% of day 0). The other four subjects had a less marked reduction in their vascularity in the short-term photos (69% of their baseline photos). This resulted in two subjects withdrawing from the study early. Long-term quantitative analysis for the two remaining "nonresponders," who completed the study, showed an average vascularized area that was 71% of that in their baseline photos. The long-term photos in these subjects did not appear to have a clinically relevant difference from the short-term photos. CONCLUSIONS In half of the subjects, subtenon ranibizumab appeared to arrest growth. Although the response is variable, this may warrant the drug's use when attempting to control growth of recurrent pterygia, and may prevent consecutive surgery for some patients.
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Kim SY, Ko SJ. The Effect of Inferior Conjunctival Transposition Flap for Recurrent Pterygium. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.12.1866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Yeop Kim
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
| | - Sang Jun Ko
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
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Viveiros MMH, Kakizaki FY, Hércules LA, Padovani CR, Candeias JMG, Schellini SA. In vitro study of cyclosporine A 0.05 % on primary and recurrent pterygium fibroblasts. Int Ophthalmol 2015; 36:237-42. [PMID: 26260358 DOI: 10.1007/s10792-015-0106-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 07/30/2015] [Indexed: 02/06/2023]
Abstract
To compare the cyclosporine 0.05 % exposure effect on fibroblasts from primary and recurrent pterygium. Primary culture of fibroblasts from primary and recurrent pterygium was performed until the third passage, which was exposed to cyclosporine 0.05 % in a group and the other remaining unexposed (control group), in triplicates. After 3, 6, 12, and 17 days of exposure the viable cell counting was performed by hemocytometer. The results were statistically analyzed using the technique of analysis of non-parametric variance model for repeated measures with three factors. There was a significant reduction in both fibroblast proliferation, in primary as in the recurrent pterygium cultures exposed to cyclosporine when compared not exposed cultures, with statistical significance (P < 0.05). Comparing primary and recurrent pterygium that received the drug, there was no significant difference in cell proliferation in relation to primary or recurrent pterygium. Cyclosporine 0.05 % is effective in inhibiting fibroblast proliferation in culture, both in primary and as in recurrent pterygium.
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Affiliation(s)
- Magda Massae Hata Viveiros
- Post-Doctoral of the General Basis of Surgery Post Graduation Program of Botucatu Medical School, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil. .,Department of Ophthalmology, Botucatu Medical School, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil.
| | - Fabiano Yutaka Kakizaki
- Department of Ophthalmology, Botucatu Medical School, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil
| | - Laura Almeida Hércules
- Department of Ophthalmology, Botucatu Medical School, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil
| | - Carlos Roberto Padovani
- Department of Biostatistic, Biosciences Institute, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil
| | - João Manuel Grisi Candeias
- Department of Microbiology and Immunology, Biosciences Institute, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil
| | - Silvana Artioli Schellini
- Department of Ophthalmology, Botucatu Medical School, Universidade Estadual Paulista - UNESP de Botucatu, São Paulo, Brazil
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Park YM, Kim CD, Lee JS. Effect of Bevacizumab on Human Tenon's Fibroblasts Cultured from Primary and Recurrent Pterygium. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2015; 19:357-63. [PMID: 26170740 PMCID: PMC4499648 DOI: 10.4196/kjpp.2015.19.4.357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/15/2015] [Accepted: 06/02/2015] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to compare the inhibitory effect of bevacizumab on human Tenon's fibroblasts (HTFs) cultured from primary and recurrent pterygium. Cultured HTFs were exposed to 2.0, 5.0, 7.5, and 15.0 mg/mL concentration of bevacizumab for 24 hours. The 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide and lactate dehydrogenase leakage assays were then performed to assess fibroblast metabolism and viability. The matrix metalloproteinase (MMP), procollagen type I C terminal propeptide (PIP), and laminin immunoassays were performed to examine extracellular matrix production. Changes in cellular morphology were examined by phase-contrast and transmission electron microscopy. Both metabolic activity and viability of primary and recurrent pterygium HTFs were inhibited by bevacizumab in a dose-dependent manner, especially at concentrations greater than 7.5 mg/mL. Both types of HTFs had significant decreases in MMP-1, PIP, and laminin levels. Distinctly, the inhibitory effect of bevacizumab on MMP-1 level related with collagenase in primary pterygium HTFs was significantly higher than that of recurrent pterygium. Significant changes in cellular density and morphology both occurred at bevacizumab concentrations greater than 7.5 mg/mL. Only primary pterygium HTFs had a reduction in cellular density at a bevacizumab concentration of 5.0 mg/mL. Bevacizumab inhibits primary and recurrent pterygium HTFs in a dose-dependent manner, especially at concentrations greater than 7.5 mg/mL. As the primary HTFs produces larger amounts of MMP-1 compared to recurrent HTFs, significant reduction in MMP-1 level in primary pterygium HTFs after exposure to bevacizumab is likely to be related to the faster cellular density changes in primary pterygium HTFs.
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Affiliation(s)
- Young Min Park
- Department of Ophthalmology, Pusan National University School of Medicine & Medical Research Institute, Yangsan Pusan National University Hospital, Yangsan 626-770, Korea
| | - Chi Dae Kim
- Department of Pharmacology, Pusan National University College of Medicine, and MRC for Ischemic Tissue Regeneration, Yangsan 626-870, Korea
| | - Jong Soo Lee
- Department of Ophthalmology, School of Medicine, Pusan National University & Medical Research Institute, Pusan National University Hospital, Pusan 602-739, Korea
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Nava-Castañeda A, Ulloa-Orozco I, Garnica-Hayashi L, Hernandez-Orgaz J, Jimenez-Martinez MC, Garfias Y. Triple subconjunctival bevacizumab injection for early corneal recurrent pterygium: one-year follow-up. J Ocul Pharmacol Ther 2014; 31:106-13. [PMID: 25369364 DOI: 10.1089/jop.2014.0060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The aim of the study was to evaluate the effect of 3 subconjunctival bevacizumab injections in patients with an early corneal pterygium recurrence. METHODS This study was a nonrandomized single center trial. Patients with an early corneal pterygium recurrence were selected. All patients received 3 subconjunctival bevacizumab (2.5 mg/0.1 mL) injections (basal, 2 and 4 weeks) in the recurrence area of the pterygium. The corneal and corneal-conjunctival neovascularization areas and the corneal opacification area of each pterygium were determined using digital slit lamp pictures. RESULTS Thirty-eight patients were enrolled into the study; all patients were injected within 3 months of the diagnosed pterygium recurrence. Interestingly, the bevacizumab injections had a significant effect (P<0.05) on the reduction of corneal, corneal-conjunctival area of neovascularization determined as pixels and on the corneal opacification area determined as mm(2) when comparing the basal values, to the values obtained after 15 days, 1 month, 3 months, 6 months, and 12 months after injections. CONCLUSIONS The vascularized area in all recurrent pterygia and the corneal opacification area with this triple regimen of subconjunctival bevacizumab injections were reduced, which remained until the end of the study. These results suggest that bevacizumab subconjunctival injections could be useful to treat recurrent pterygium.
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Affiliation(s)
- Angel Nava-Castañeda
- 1 Research Unit, Institute of Ophthalmology Conde de Valenciana Foundation, Colonia Obrera, Mexico City, Mexico
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Poenaru Sava MG, Raica ML, Cimpean AMG. VEGF mRNA assessment in human pterygium: a new 'scope' for a future hope. Ophthalmic Res 2014; 52:130-5. [PMID: 25300614 DOI: 10.1159/000363142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/18/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE The lack of powerful evidence to support the efficacy of anti-vascular endothelial growth factor (VEGF) therapy in human pterygium can be attributed to incomplete VEGF expression assessment by restrictive use of immunohistochemistry only and failure to use the molecular methods able to confirm immunohistochemical findings. By adding at least one more sensitive method to assess human pterygium VEGF expression, a more accurate selection of patients for bevacizumab therapy could be done and this would improve the efficacy of anti-VEGF therapy in human pterygium. METHODS We assessed VEGF mRNA amplification on paraffin-embedded specimens by applying the RNAscope method for the first time in human pterygium, an in situ hybridization-based technique able to detect VEGF mRNA as a single gene copy on paraffin-embedded samples. RESULTS Heterogeneous VEGF mRNA distribution and amplification inside the epithelial compartment of human pterygium were observed. Despite previous reports concerning the immunohistochemical expression of VEGF in the human pterygium fibrovascular compartment, no stromal components were characterized by VEGF mRNA amplification assessed by in situ hybridization in our study. A higher amplification score was observed in epithelium from recurrent pterygium, especially located in the basal and suprabasal epithelial cells. CONCLUSIONS Based on our findings we consider that in situ hybridization assessment of VEGF for human pterygium specimens can be a useful tool for reconsidering the selection of pterygium patients to be enrolled in anti-VEGF therapy.
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Affiliation(s)
- Mihai G Poenaru Sava
- Department of Ophthalmology, Angiogenesis Research Center, Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania
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Uso de terapia antifactor de crecimiento vascular endotelial en patología corneal. REVISTA MEXICANA DE OFTALMOLOGÍA 2014. [DOI: 10.1016/j.mexoft.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Karalezli A, Kucukerdonmez C, Akova YA, Koktekir BE. Does topical bevacizumab prevent postoperative recurrence after pterygium surgery with conjunctival autografting? Int J Ophthalmol 2014; 7:512-6. [PMID: 24967201 DOI: 10.3980/j.issn.2222-3959.2014.03.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 09/02/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To assess the effect of topical bevacizumab use on postoperative pterygium recurrence in eyes who underwent pterygium excision with limbal-conjunctival autograft transplantation (LCAT). METHODS Eighty-eight eyes of 88 patients with primary pterygium were included. Pterygia were graded preoperatively from type 1 to type 3 (type 1 atrophic, type 3 inflamed) according to the inflammatory status. The eyes were preoperatively randomized to receive topical steroid and antibiotic treatment (group 1, 46 eyes) and additional topical bevacizumab (5 mg/mL; group 2, 42 eyes) in the postoperative period. All eyes underwent pterygium excision and LCAT. Medications were tapered and discontinued at one month. Postoperative complications and recurrence rates were recorded. RESULTS The mean follow-up duration was 29.3±4.2mo (24-52mo) and 28.5±3.4 (24-48mo) in group 1 and 2, respectively (P>0.05). There were no statistically significant differences regarding the age or gender between groups (P>0.05). Also, the difference between groups with respect to pterygium type was not significant. During the follow-up period, recurrence developed in 2 eyes (4.3%) in group 1, whereas in one eye (2.4%) in group 2. No statistically significant difference between groups was found in recurrence rates (P>0.05). No re-operation for recurrence was necessary during the follow-up period in both groups. CONCLUSION Topical bevacizumab seems to have no additonal effect on pterygium recurrence after LCAT.
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Affiliation(s)
- Aylin Karalezli
- Department of Ophthalmology, School of Medicine, Baskent University, Konya 42080 Turkey
| | - Cem Kucukerdonmez
- Department of Ophthalmology, School of Medicine, Izmir University, Izmir 35530, Turkey
| | - Yonca A Akova
- Department of Ophthalmology, Bayındır Hospital, Ankara 06520 Turkey
| | - Bengu Ekinci Koktekir
- Department of Ophthalmology Selçuk University Faculty of Medicine, Konya 42050 Turkey
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Sha X, Wen Y, Liu Z, Song L, Peng J, Xie L. Inhibition of α-Smooth Muscle Actin Expression and Migration of Pterygium Fibroblasts by Coculture with Amniotic Mesenchymal Stem Cells. Curr Eye Res 2014; 39:1081-9. [DOI: 10.3109/02713683.2014.900806] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Bayar SA, Kucukerdonmez C, Oner O, Akova YA. Subconjunctival bevacizumab in the impending recurrent pterygia. Int Ophthalmol 2013; 34:541-7. [PMID: 24026871 DOI: 10.1007/s10792-013-9852-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 08/29/2013] [Indexed: 11/26/2022]
Abstract
The aim of this study is to evaluate the efficacy and safety of subconjunctival bevacizumab injection(s) in the treatment of impending recurrent pterygia. Twenty-three eyes of 23 patients who developed impending recurrence after pterygium surgery with conjunctival autografting and were treated with subconjunctival bevacizumab injection(s) (2.5 mg/0.1 mL) were included in the study. Anterior segment photographs were taken prior to and at 1 week, 1, 3 and 6 months after the injection, and at the end of the follow-up period. Image analysis was performed using an image processing and analysis software program. Recurrence rate and complications were recorded. The mean age and follow-up time of the patients were 51.2 ± 6.2 (31-60 years) and 16.8 ± 3.1 (12-22 months), respectively. The average number of injections was 2 ± 0.78 (1-3). Sixteen eyes required re-injection (two injections in nine eyes, three injections in seven eyes), due to progression of vascularization. There were significant differences between size percentage of lesions before injection and at 1 week, 1, 3 and 6 months after the injection (p < 0.05 for all). Corneal recurrence developed in only one patient and no ocular or systemic side-effects of bevacizumab were observed. Repeated injections of bevacizumab may help to prevent the high recurrence rate of residual impending pterygium, due to its adjuvant role in decreasing lesion size, especially in the first year after surgery.
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Affiliation(s)
- Sezin Akca Bayar
- Department of Ophthalmology, Faculty of Medicine, Baskent University, Fevzi Cakmak Cad. 10. Sokak, 06490, Bahcelievler, Ankara, Turkey,
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Lee S, Go J, Rhiu S, Stulting RD, Lee M, Jang S, Lee S, Kim HJ, Chung ES, Kim S, Seo KY. Cosmetic regional conjunctivectomy with postoperative mitomycin C application with or without bevacizumab injection. Am J Ophthalmol 2013; 156:616-622.e3. [PMID: 23570698 DOI: 10.1016/j.ajo.2013.01.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/25/2013] [Accepted: 01/29/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the complications of cosmetic wide conjunctivectomy and postoperative topical mitomycin C application with or without bevacizumab injection. DESIGN Cross-sectional cohort study. METHODS Medical records of 1713 consecutive subjects who received cosmetic wide conjunctivectomy plus postoperative topical mitomycin C by a single surgeon at a single center with or without bevacizumab injection from November 2007 to May 2010 were reviewed. A telephone interview was conducted with 557 of the subjects who could be contacted and agreed to participate in the study. Complications, recurrences, and patient satisfaction were the main outcome measures. RESULTS A total of 1713 consecutive patients underwent cosmetic wide conjunctivectomy to treat conjunctival hyperemia. Ocular diagnoses in the medical records at the time of surgery included hyperemia (8.8%), pterygium (14.0%), dry eye (3.5%), pinguecula (1.5%), and conjunctival disorder (23.3%). For the remaining 48.9% of subjects, the diagnosis was not mentioned, or the surgical procedure was for cosmetic purposes. Patients were followed for a mean of 10.9 months (range, 0-30.3 months). The overall complication rate was 82.9%, of which 55.6% were considered severe (fibrovascular conjunctival tissue proliferation, 43.8%; scleral thinning, 4.4%; scleral thinning with calcified plaques, 6.2%; intraocular pressure elevation, 13.1%; diplopia, 3.6%; and recurrence of hyperemic conjunctiva, 28.1%). CONCLUSIONS Cosmetic wide conjunctivectomy plus postoperative topical mitomycin C with or without bevacizumab injection has a high rate of complications and reoperations.
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Affiliation(s)
- Seonheui Lee
- Department of New Health Technology Assessment, National Evidence-Based Healthcare Collaboration Agency, Seoul, South Korea
| | - Jeongae Go
- Department of New Health Technology Assessment, National Evidence-Based Healthcare Collaboration Agency, Seoul, South Korea
| | - Soolienah Rhiu
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - R Doyle Stulting
- Stulting Research Center, Woolfson Eye Institute, Atlanta, Georgia
| | - Min Lee
- Department of New Health Technology Assessment, National Evidence-Based Healthcare Collaboration Agency, Seoul, South Korea
| | - Sunyoung Jang
- Department of New Health Technology Assessment, National Evidence-Based Healthcare Collaboration Agency, Seoul, South Korea
| | - Sangmoo Lee
- Department of New Health Technology Assessment, National Evidence-Based Healthcare Collaboration Agency, Seoul, South Korea
| | - Hyung Joon Kim
- Department of Ophthalmology, Daegu Catholic University Medical Center, Seoul, South Korea
| | - Eui Sang Chung
- Division of Cornea, Department of Ophthalmology, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sooyoung Kim
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea.
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Nava-Castañeda A, Olvera-Morales O, Ramos-Castellon C, Garnica-Hayashi L, Garfias Y. Randomized, controlled trial of conjunctival autografting combined with subconjunctival bevacizumab for primary pterygium treatment: 1-year follow-up. Clin Exp Ophthalmol 2013; 42:235-41. [PMID: 23777441 DOI: 10.1111/ceo.12140] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 06/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate the efficacy and safety of subconjunctival bevacizumab application as an adjuvant therapy for primary pterygium. DESIGN This study was a clinical randomized trial performed at the Institute of Ophthalmology 'Conde de Valenciana'. PARTICIPANTS Forty-nine patients with primary pterygium were enrolled in the study. METHODS Each primary pterygium patient was randomized after pterygium excision and a conjunctival autograft to receive either a single 2.5 mg/0.1 mL dose of subconjunctival bevacizumab immediately after surgery (group 1); a double 2.5 mg/0.1 mL injection of subconjunctival bevacizumab, one immediately after surgery and the second 15 days after surgery (group 2); or no injection (group 3). MAIN OUTCOME MEASURES Autoconjunctival graft presence or absence of ischaemia, necrosis, infection or detachment; surgical bed appearance; and pterygium recurrence at 1-year follow-up period were determined. RESULTS Forty-nine eyes of 49 patients were included. Sixteen patients were assigned to group 1, 17 to group 2 and 16 to group 3. Patients from groups 1 and 2 showed conjunctival autograft ischaemia at 24 h postoperative (37.5% and 58.8%, respectively, P > 0.05), which disappeared by the first postoperative month. No significant difference in the main outcome measures was found among single versus double-dose of subconjunctival bevacizumab injection patients. At the end of the study, pterygium recurrences were observed only in group 3 (P < 0.04). CONCLUSIONS A single 2.5 mg/mL subconjunctival bevacizumab injection in conjunction with primary pterygium surgery accomplishing a conjunctival autograft procedure is safe and well tolerated, and is capable of preventing pterygium recurrences when compared with a control group.
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Affiliation(s)
- Angel Nava-Castañeda
- Research Unit, Institute of Ophthalmology Conde de Valenciana, Mexico City, Mexico; Oculoplastics Department, Institute of Ophthalmology Conde de Valenciana, Mexico City, Mexico
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Intra-lesional 5 fluorouracil for the management of recurrent pterygium. Eye (Lond) 2013; 27:1123-9. [PMID: 23807385 DOI: 10.1038/eye.2013.135] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 05/17/2013] [Indexed: 11/08/2022] Open
Abstract
AIM Recurrence is the most common complication arising from pterygium surgery. The aim of this study was to investigate the effectiveness of 5 fluorouracil (5FU) in halting the recurrence of pterygium after surgical excision. METHODS A retrospective review of patients treated for pterygium recurrence was carried out. Patients with recurrent (secondary) pterygium were treated with multiple weekly intra-lesional injections of 0.1-0.2 ml (2.5-5 mg) 5FU post-operatively depending on the size of the recurrence. The treatment was started within 1 month from the date of recurrence. The time from surgery to start of recurrence, previous treatment modalities, and number of recurrences were documented. The number of injections required to induce arrest of progression and/or regression of vascularity and fleshiness of the pterygium and any complications related to 5FU treatment were examined. RESULTS Fifteen eyes from 14 patients with recurrent pterygium treated with intra-lesional 5FU injections were analysed. Three of the 15 eyes had undergone a secondary excision and 12 had undergone a primary excision. In all, 93.3% of patients showed regression of the fibrovascular tissue (thickness and vascularity) and arrest of progression following a dose of 0.1-0.2 ml (2.5-5 mg) 5FU. Twelve eyes required three injections or fewer, whereas one patient required eight injections. This beneficial effect was maintained over an average follow-up period of 17 months. No complications from 5FU were observed. CONCLUSION The use of weekly intra-lesional 5FU injections for the treatment of recurrent pterygium is safe and effective in limiting the progression and inducing the regression of recurrent pterygium. The number of injections can be tailored according to clinical need.
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Hurmeric V, Vaddavalli P, Galor A, Perez VL, Roman JS, Yoo SH. Single and multiple injections of subconjunctival ranibizumab for early, recurrent pterygium. Clin Ophthalmol 2013; 7:467-73. [PMID: 23486999 PMCID: PMC3592556 DOI: 10.2147/opth.s40400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose To assess the effect of single versus multiple subconjunctival ranibizumab injections in patients with an early pterygium recurrence. Setting Single-center, academic practice. Study population Nine patients with early pterygium recurrence. Observational procedure Subconjunctival ranibizumab (0.5 mg/0.05 mL) was administered adjacent to pterygium recurrence. Group 1 (n = 5) received one injection; group 2 (n = 4) received three injections (time points 0, 2, and 4 weeks) with the ability to retreat as needed. Main outcome measures Effect of ranibizumab on conjunctival hyperemia and corneal neovascular area over a 6-month follow-up period. Results In the single injection group, a decrease in conjunctival hyperemia was noted in all patients on postinjection day 1. At follow up, hyperemia grade fluctuated, although all patients had less hyperemia than at baseline. In the recurrent injection group, the median number of injections was 8.5 (range 7 to 9) over the 6 months. In spite of the repeated injections, the pattern of conjunctival hyperemia was similar to that of the single injection group. In group 1, corneal neovascularization remained relatively unchanged over the 6-month period in four patients and decreased in one patient by 24%. In group 2, corneal neovascularization increased in one patient by 39%, remained stable in one patient, and decreased in two patients by 34% and 44%. Conclusion This is the first study to evaluate the role of ranibizumab in the treatment of an early pterygium recurrence and the first to compare multiple versus single injections. Recurrent injections did not appear to be superior to a single injection with regards to conjunctival hyperemia.
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Affiliation(s)
- Volkan Hurmeric
- Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
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Bock F, Maruyama K, Regenfuss B, Hos D, Steven P, Heindl LM, Cursiefen C. Novel anti(lymph)angiogenic treatment strategies for corneal and ocular surface diseases. Prog Retin Eye Res 2013; 34:89-124. [PMID: 23348581 DOI: 10.1016/j.preteyeres.2013.01.001] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 12/17/2012] [Accepted: 01/04/2013] [Indexed: 12/21/2022]
Abstract
The cornea is one of the few tissues which actively maintain an avascular state, i.e. the absence of blood and lymphatic vessels (corneal [lymph]angiogenic privilege). Nonetheless do several diseases interfere with this privilege and cause pathologic corneal hem- and lymphangiogenesis. The ingrowths of pathologic blood and lymphatic vessels into the cornea not only reduce transparency and thereby visual acuity up to blindness, but also significantly increases the rate of graft rejections after subsequent corneal transplantation. Therefore great interest exists in new strategies to target pathologic corneal (lymph)angiogenesis to promote graft survival. This review gives an overview on the vascular anatomy of the normal ocular surface, on the molecular mechanisms contributing to the corneal (lymph)angiogenic privilege and on the cellular and molecular mechanisms occurring during pathological neovascularization of the cornea. In addition we summarize the current preclinical and clinical evidence for three novel treatment strategies against ocular surface diseases based on targeting pathologic (lymph)angiogenesis: (a) modulation of the immune responses after (corneal) transplantation by targeting pathologic (lymph)angiogenesis prior to and after transplantation, (b) novel concepts against metastasis and recurrence of ocular surface tumors such as malignant melanoma of the conjunctiva by anti(lymph)angiogenic therapy and (c) new ideas on how to target ocular surface inflammatory diseases such as dry eye by targeting conjunctival and corneal lymphatic vessels. Based on compelling preclinical evidence and early data from clinical trials the novel therapeutic concepts of promoting graft survival, inhibiting tumor metastasis and dampening ocular surface inflammation and dry eye disease by targeting (lymph)angiogenesis are on their way to translation into the clinic.
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Affiliation(s)
- Felix Bock
- Department of Ophthalmology, University of Cologne, Cologne, Germany
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