Pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft

Department of Ophthalmology, University college Hospital Ibadanu, Oyo, Nigeria.
Eye (Impact Factor: 2.08). 01/2008; 22(1):31-4. DOI: 10.1038/sj.eye.6702480
Source: PubMed


The use of conjunctiva autograft, adjunct antimetabolite therapy has been shown to be effective in preventing pterygium recurrence.
To compare 5 fluorouracil (5-FU) to conjunctival autograft in the treatment of large, fleshy pterygium.
A randomised controlled prospective study of outcome of pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft. Thirty-five eyes with large pterygium treated with bare sclera conjunctival excision plus 5-FU were compared with 33 eyes treated with excision and conjunctival autograft alone.
Post-operative pterygium recurrence was observed in four (11.4%) eyes treated with 5-FU and 4 (12.1%) eyes treated with conjunctiva autograft (P>0.05). The post-operative complications included, granuloma formation 11.4% for 5-FU and 3.0% for autograft and conjunctival discharge 5.7% for 5-FU group only.
5-FU is marginally superior to conjunctival autograft in the prevention of pterygium recurrence but neither gives a more desirable single digit recurrence rate. Randomised studies combining both conjunctival autograft and 5-FU in pterygium treatment is advocated to further explore their effect.

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    • "Post-operative recurrence is not uncommon.1-3 Various adjunctive measures, including medications (mitomycin C, 5-fluorouracil, corticosteroids and daunorubicin) and beta irradiation have been used to prevent the recurrence of pterygia.4-6 However, these methods are associated with side effects, such as punctate epitheliopathy, bacterial superinfection, delayed-onset scleral melting, and elevation of intraocular pressure (IOP). "
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    ABSTRACT: Purpose To evaluate the local safety of bevacizumab and its effect on recurrence of primary pterygium excision. Methods This randomized, placebo-controlled clinical trial was conducted on 44 eyes of 44 patients randomized to Group 1 (bevacizumab) and Group 2 (balanced salt solution). Group 1 underwent pterygium excision with a rotational conjunctival flap and received a total of 7.5 mg subconjunctival bevacizumab (5 mg/0.2 mL on the day of surgery and 2.5 mg/0.1 mL on the fourth day after surgery). Group 2 received balanced salt solution in the same manner. Recurrence, defined as any fibrovascular tissue crossing the limbus, and the number of patients with >1.5 mm fibrovascular overgrowth on the cornea were compared between the study groups. Results There was no statistically significant difference between the study groups in terms of demographics, pterygium size, daily sun exposure, preoperative visual acuity, keratomeric readings, corneal astigmatism, or IOP (P>0.05). Three and four patients in each group at the three- and six-month visits, respectively, had more than 1.5 mm fibrovascular tissue overgrowth on the cornea (P=1 and 0.62, respectively). At the three-month visit, 3 patients in Group 1 versus 7 patients in Group 2 (P=0.13), and at the six-month visit 4 patients in Group 1 versus 8 patients in Group 2 (P=0.17) had fibrovascular tissue crossing the limbus. Patients in Group 1 experienced a statistically significant rise in IOP at the one-week visit (P=0.007). Conclusion Bevacizumab had no significant effect on the recurrence rate of pterygium. Although the frequency of fibrovascular tissue crossing the limbus in the bevacizumab group was half that of the BSS group, the difference failed to reach a statistically significant level.
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    ABSTRACT: Pterygium is a common ocular disorder in many parts of the world. At present, there is a wide variety of surgical methods but very few clinical guidelines on the optimal treatment of primary or recurrent pterygium. The purpose of this review is to summarize the more recent and relevant studies on pterygium treatment. The primary aim is to excise the pterygium and prevent its recurrence. As bare sclera excision is associated with a high recurrence rate, pterygium excision is often combined with conjunctival autograft, mitomycin C, beta-irradiation or other adjunctive therapies to reduce recurrence rates. There is currently, however, no consensus regarding the ideal treatment for the disease. Comparability between studies is also hampered by the various definitions of pterygium recurrence. This article reviews the current concepts and techniques used for the treatment of pterygium. Conjunctival autografting and mitomycin C application are the most commonly used methods for preventing recurrences. The use of mitomycin C and beta-irradiation should be used judiciously because of the potential long-term risk of sight-threatening complications. Additional clinical trials should be performed to evaluate the relative efficacies and long-term safety of the various treatment modalities.
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    ABSTRACT: To determine the clinical significance of postoperative conjunctival inflammation noted at the third or fourth week after intraoperative application of mitomycin C and amniotic membrane transplantation for pterygium. This retrospective study included 27 eyes of 23 patients with primary (n = 12) or recurrent (n = 15) pterygia. All cases were operated by extensive removal of subconjunctival fibrovascular tissue and intraoperative application of 0.04% mitomycin C in the fornix, followed by amniotic membrane transplantation by using either fibrin glue (14 eyes) or sutures (13 eyes). Main outcome measures included development of conjunctival inflammation, pyogenic granuloma, and pterygium recurrence after surgery. For a follow-up of 29.6 +/- 17.2 months (range, 6-56 months), 16 (59.3%) eyes without postoperative conjunctival inflammation resulted in favorable outcomes. Conjunctival inflammation around the surgical site was noted in the remaining 11 (40.7%) eyes and was significantly more common in eyes with sutures than those with fibrin glue (61.5% vs. 21.4%, respectively; P = 0.05). Among those with this inflammation, 7 eyes receiving subconjunctival injection of triamcinolone resulted in complete resolution and a good aesthetic outcome. Four eyes without this injection gradually developed conjunctival (n = 1) or corneal (n = 1) recurrence and/or pyogenic granuloma (n = 3). Host conjunctival inflammation is still common after intraoperative application of mitomycin C and amniotic membrane transplantation, especially when sutures are used in pterygium surgery. If left untreated, persistent inflammation may lead to a poor surgical outcome.
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