Inyecciones Intralesionales de 5-Fluorouracilo: tratamiento innovador y efectivo de Pterigión Primario / Intralesional Injections of 5-Fluorouracil: innovative and effective treatment of Primary Pterygium

OBJETIVO: Determinar la efectividad de 5-Fluorouracilo intralesional en el alivio sintomático, astigmatismo y deseo de cirugía en pacientes con pterigión primario. Métodos: Estudio experimental realizado entre enero y marzo de 2020 en la Unidad de Oftalmología del Hospital del Salvador, Chile. Se seleccionaron 14 ojos (14 pacientes) en lista de espera quirúrgica, expuestos a inyecciones intralesionales quincenales de 10 mg de 5-FU. Se realizó una evaluación clínica inicial con OSDI para medición sintomática, cámara fotográfica y lámpara de hendidura para apariencia clínica, y autorrefractómetro para astigmatismo, siendo reevaluados 60 días después, añadiéndose la pregunta de si mantenían el deseo de operarse. Se dividió la muestra en grupo A y B según recibieron dos o una dosis de 5-FU, respectivamente. RESULTADOS: La edad promedio de los participantes fue 56,8 ± 11,1 años. El grupo A presentó un OSDI inicial de 50 ± 23,8 que, posterior a la intervención, se redujo a 21 ± 13,5 (p < 0,001). El grupo B tuvo un OSDI inicial de 47 ± 17,3, disminuyendo a 22 ± 16,2 (p < 0,005). Ambos cambios estadísticamente significativos. En cuanto al aspecto físico, hubo reducción del tamaño lesional en 2 de los 14 pacientes, ambos del grupo A. No hubo cambios respecto al grado de astigmatismo. Hubo 2 pacientes que decidieron no realizarse la cirugía posterior a la intervención. Conclusión: La inyección intralesional de 5-FU demostró mejoría significativa en el alivio sintomático, sin complicaciones asociadas, generando un tratamiento alternativo al quirúrgico en pacientes con pterigión primario, pudiendo posponer la cirugía.

OBJETIVES: To determine the effectiveness of intralesional 5-Fluorouracil (5-FU) in symptomatic relief, astigmatism, and desire for surgery in patients with primary pterygium. Methods: The experimental study was carried out between January and March 2020 in the Ophthalmology Unit of the Hospital del Salvador, Chile. Fourteen eyes (14 patients) were selected on the surgical waiting list and exposed to fortnightly intralesional injections of 10 mg of 5-FU. An initial evaluation was performed with OSDI for symptomatic measurement, a photographic camera and slit lamp for clinical appearance, and an auto-refractometer for astigmatism, being re-evaluated 60 days later, adding the question of whether they maintained the desire to undergo surgery. The sample was divided into groups A and B depending on whether they received two or one dose of 5-FU, respectively. RESULTS: The average age of the participants was 56.8 ± 11.1 years. Group A presented an initial OSDI of 50 ± 23.8, which, after the intervention, decreased to 21 ± 13.5 (p < 0.001). Group B had an initial OSDI of 47 ± 17.3, decreasing to 22 ± 16.2 (p < 0.005)-statistically significant changes. The degree of astigmatism had no changes. Regarding the physical aspect, there was a reduction in the size of the lesion in 2 of the 14 patients, both in group A. Two patients decided not to undergo surgery after the intervention. Conclusions: The intralesional injection of 5-FU showed a significant improvement in symptomatic relief without associated complications, generating a therapeutic alternative in patients with primary pterygium without surgical indication.

Topical cyclosporine A 0. 05% before and after surgery to prevent pterygium recurrence / Ciclosporina A 0, 05% antes e após a cirurgia do pterígio para a prevenção da recorrência

ABSTRACT Purpose: We evaluated the role of the conjunctival flap rotation technique using 5-fluorouracil and adjuvant therapy with topical cyclosporine A at 0.05% during short pre- and postoperative periods for the prevention of primary pterygium recurrence. Methods: In this prospective study, 76 patients with primary pterygium (76 eyes) were categorized into two groups: the control group with 31 patients who did not receive cyclosporine treatment, and the cyclosporine group with 45 patients who received topical cyclosporine A (0.05%) twice a day, for 10 days before and 10 days after the pterygium excision operations. Patients were examined for disease recurrence, side effects, and complications at 10 and 21 days, and at 2 and 6 months after the operation. Data on demography, systemic diseases, and ophthalmologic histories were obtained from all patients, and these data were analyzed using descriptive statistics involving the absolute and relative percentages of frequency distribution. Goodman test was used for contrasts among multinomial populations to study the association between cyclosporine A and recurrence. Results: Most patients were between 30 and 60 years of age, and 67.1% were women. We confirmed a higher recurrence in patients with occupational sunlight exposure. The cyclosporine A used topically 10 days before and 10 days after the pterygium removal did not significantly reduce the recurrence of the pterygium. Conclusion: Topical 0.05% cyclosporine A when used for 10 days before and 10 days after the pterygium removal does not prevent or reduce the recurrence of primary pterygium.

RESUMO Objetivo: Avaliamos os resultados da técnica de rotação de retalho conjuntival com uso de 5-fluorouracil e terapia adjuvante com ciclosporina A tópica a 0,05%, usada no pré e pós-operatório por curto período, quanto à prevenção da recidiva do pterígio primário Métodos: Estudo prospectivo, com 76 pacientes portadores de pterígio primário (76 olhos), divididos em dois grupos: controle com 31 pacientes que não receberam tratamento com ciclosporina e grupo ciclosporina com 45 pacientes que receberam ciclosporina tópica A (0,05%) duas vezes ao dia, por 10 dias antes e 10 dias após a cirurgia de excisão do pterígio. Os pacientes foram avaliados quanto à recorrência, efeitos colaterais e complicações com 10, 21 dias, 2 e 6 meses de pós-operatório. Dados demográficos, doenças sistêmicas e histórico oftalmológico foram coletados de todos os pacientes e esses dados foram analisados por meio de estatística descritiva envolvendo o percentual absoluto e relativo de distribuição de frequência. O teste de Goodman para contrastes entre populações multinomiais foi utilizado para o estudo da associação entre a ciclosporina A e a recorrência Resultados: A maioria dos pacientes tinha entre 30 e 60 anos e 67,1% eram mulheres. Confirmamos uma maior recorrência em pacientes com exposição ocupacional ao sol. A ciclosporina A tópica utilizada 10 dias antes e 10 dias após a remoção do pterígio não reduziu significativamente a sua recorrência Conclusão: A ciclosporina A tópica a 0,05% quando utilizada por 10 dias no pré e 10 dias no pós-operatório, não previne ou reduz a recidiva do pterígio primário significativamente.

Therapeutical evaluation of bevacizumab application in relapsed pterygium / Avaliação terapêutica da aplicação de bevacizumabe em pterígio recidivado

Abstract Objective: Therapeutic evaluation of Bevacizumab application in relapsed pterygium concerning visual acuity, keratometry, refraction, symptomatology. Methods: Group 1 (4 patients) received 0.1 ml of Bevacizumab (avastin), being evaluated posteriorly on the tenth and thirtieth days after the application, seeking to compare with the exam previously made, being it realized with the other two groups, in which Group 2 (4 patients) received 0.2 ml of Bevacizumab and the Group 3 (3 patients) received 1 ml of the placebo injection. Results: In this study, eleven eyes of eleven patients were evaluated. Among these patients, 7 were women (63.6%) and 4 men (36.4%). There was a variation in the cylindrical diopter after the treatment with a dose of 0.1 ml of bevaciumab during the evaluation on the thirtieth day. Whereas the cylindrical shaft had a significantly larger modification after the application of 0.2 ml. Regarding the spherical diopter variation, there were modifications in the 3 groups. The keratometry varied in the 3 groups, mostly after the thirtieth day of evaluation. In relation to symptomatology, it was observed a reduction in the subjective evaluation of the eye burning sensation, the prurience mentioned by the patient and a reduction of the hyperemia biomicroscopy evaluation. Conclusion: In bevacizumab application in the recurrent pterygium treatment, there is modification of the spherical and cylindrical parameters of refraction, besides the changes in keratometry and the reduction of the symptomatology.

Resumo Objetivo: Avaliação terapêutica da aplicação de bevacizumabe em pterígio recidivado com relação a acuidade visual, ceratometria, refração, sintomatologia. Métodos: O Grupo 1 (4 pacientes) recebeu 0,1ml de bevacizumabe (avastin) sendo avaliado posteriormente, nos dias 10 e 30 após a aplicação, buscando-se comparar com o exame previamente realizado, sendo o mesmo realizado com os outros dois grupos, em que o Grupo 2 (04 pacientes) recebeu 0,2ml de bevacizumabe e o grupo 3 (3 pacientes) recebeu 0,1 de injeção placebo. Resultados: Neste estudo foram avaliados 11 olhos de 11 pacientes. Dentre esses pacientes, 7 (63,6%) eram mulheres e 4 (36,4%) homens. Houve a variação na dioptria cilíndrica após o tratamento com dose de 0,1ml de bevacizumabe, durante a avaliação no trigésimo dia. Já o eixo cilíndrico teve uma modificação significativamente maior após a aplicação de 0,2ml. Em relação a variação dióptrica esférica, houve modificações nos três grupos. A ceratometria variou nos três grupos, principalmente no trigésimo dia de avaliação. Em relação a sintomatologia, observou-se uma redução na avaliação subjetiva da ardência, do prurido referida pelo paciente, e uma redução na avaliação biomicroscópica da hiperemia. Conclusão: Na aplicação do bevacizumabe no tratamento de pterígio recorrente, há modificação dos parâmetros esféricos e cilíndricos da refração, além da mudança ceratométrica e redução da sintomatologia.

Avaliação de aplicação única subconjuntival pré-operatória de mitomicina C em pterígio primário / Evaluation of preoperative subconjunctival single application of mitomycin C in primary pterygium

Resumo Pterígios são lesões geralmente benignas que na maioria dos casos não requer tratamento específico. É um crescimento fibrovascular sobre a córnea, geralmente a partir do lado nasal. Sua causa ainda não foi elucidada, mas parece estar relacionada à exposição aos raios ultravioleta. Quando os sintomas não são controlados com tratamento conservador, a cirurgia é indicada, porém o índice de recidiva ainda é alto, e os esforços têm sido no sentido de reduzir esse índice. A mitomicina C (MMC) é uma opção de adjuvante à cirurgia por ser um inibidor da proliferação de fibroblastos, diminuindo o risco de recorrência do pterígio. Relatamos aqui um caso que descreve cirurgia de pterígio realizada em ambos os olhos de uma mesma paciente, sendo um com MMC e outro sem ela. Os resultados e o índice de proliferação celular dos dois olhos foram comparados entre si.

Abstract Pterygia are usually benign lesions that do not require specific treatment. It is a fibrovascular growth onto the nasal side of the cornea. It`s cause has not been fully elucidated yet, but seems to be related to long -term ultraviolet ray exposure. When symptoms are not controlled with conservative treatment surgery is considered, but the recurrence rate is still high, and efforts have been made to avoid it. Mitomycin C (MMC) is a fibroblast proliferation inhibitor that can be used as adjuvant to surgery to reduce recurrence. We report here a case that describes pterygium surgery performed in both eyes of the same patient, being one with MMC and the other eye without it. Both pterygium were sent to laboratory analysis. The results and proliferation index were compared between the eyes.

Preoperative tranilast as adjunctive therapy to primary pterygium surgery with a 1-year follow-up / Terapia auxiliar com o tranilast pré-operatório na cirurgia do pterígio primário com um ano de seguimento

Purpose: To determine the efficacy of tranilast as an adjunctive therapy in conjunctival autograft. Methods: Twenty-nine patients were randomly allocated to the Tranilast Group (n=15) or the Control Group (n=14). The Tranilast Group received a subconjunctival injection of 0.5% tranilast 30 days prior to surgery. Conjunctival autograft was performed in both groups using fibrin sealant and 0.02% subconjunctival mitomycin C at the end of the surgery. After the resection of the pterygium, immunohistochemistry was performed with 100 cells to identify epithelial cells positive for transforming growth factor-β (TGF-β). Subjective symptoms were evaluated using a 5-point scale, and the recurrence rate was assessed. Results: Both groups showed improvements in their symptoms and similar clinical results. Compared with the Control Group, the Tranilast Group failed to show a decreased recurrence rate (p=0.59). However, the number of epithelial cells expressing TGF-β was lower in the Tranilast Group (5 cells; 95% CI: 2.56-13.15; Control Group, 16 cells, 95% CI: 11.53-24.76; p=0.01). Minimal but reversible complications, including glaucoma secondary to corticosteroids and granuloma, occurred during the study. Conclusion: Tranilast was effective in decreasing the number of pterygium epithelial cells expressing TGF-β. .

Objetivo: Determinar a eficácia do tranilast, como terapia auxiliar no transplante autólogo de conjuntiva. Métodos: Vinte e nove pacientes foram randomizados em dois grupos: Grupo Tratado (15) e Grupo Controle (14). Trinta dias antes da cirurgia, o Grupo Tratado recebeu uma injeção subconjuntival de tranilast a 0,5%. O transplante autólogo de conjuntiva foi realizado em ambos os grupos, usando-se a cola de fibrina e a mitomicina 0,02% subconjuntival, ao final da cirurgia. Cada paciente foi examinado por 12 meses de acompanhamento. A imuno-histoquímica foi realizada, mediante um total de 100 células, a fim de que se contassem as células epiteliais positivas, para o fator de crescimento transformador beta (TGF-β), após a cirurgia do pterígio. Os sintomas subjetivos foram avaliados usando-se uma escala de cinco pontos, e a taxa de recorrência foi avaliada. Resultados: Os 2 grupos apresentaram melhora dos sintomas e com resultados clínicos similares. Quando comparado com o Grupo Controle, o Grupo Tratado falhou em mostrar uma diminuição da taxa de recorrência (p=0,59). Entretanto o número de células epiteliais expressando o TGF-β foi menor no Grupo Tratado (5 células; 95% CI=2,56-13,15; Grupo Controle, 16 células; 95% CI: 11,53-24,76, p=0,01). Complicações mínimas, mas reversíveis, ocorreram durante o estudo, incluindo glaucoma secundário ao uso de corticoide e granuloma. Conclusão: O tranilast foi efetivo em diminuir o número células epiteliais do pterígio expressando o TGF-β. .

Efficacy and safety of subconjunctival bevacizumab for recurrent pterygium / Eficácia e segurança da aplicação subconjuntival de bevacizumabe em pterígio recidivado

Purpose: To evaluate the clinical outcome(s) and complication(s) of subconjunctival bevacizumab treatment in patients with recurrent pterygium. Methods: This prospective case series included patients who had undergone pterygium surgery and were diagnosed with recurrent pterygium. All patients received one subconjunctival injection of 0.5 mL of bevacizumab (2.5 mg/0.1 mL). The main outcome was the change in size and clinical appearance. The clinical appearance of the pterygium was graded according to Tan and colleagues. The horizontal size of the pterygium (from limbus to apex) was recorded from baseline to 2 months after injection. Treatment-related complications and adverse events were reported. Results: We included 36 eyes of 36 patients (18 males) with a mean age of 58.75 ± 10.98 years. Totally, 30.6% patients developed recurrent pterygium in both eyes (only the worst eye was treated), with 47.2% developing it in the left eye and 22.2% in the right eye. More than half the patients (58.3%) had a family history of pterygium. There was a significant difference in the size of pterygium at different intervals (P<0.05). Approximately two-thirds (66.7%) of patients presented with hyposphagma on the 2nd day after subconjunctival application; this value decreased to 30.6% by day 7 and to 0% at 1 month. Most patients (69.4%) exhibited amelioration of irritative symptoms within 2 days, 88.9% after 7 days, and 97.2% after 1 month. Conclusions: Subconjunctival bevacizumab injection is useful for the management of patients with recurrent pterygium, with no significant local or systemic adverse effects. .

Objetivo: Avaliar os resultados e complicações da injeção subconjuntival de bevacizumabe em pacientes com pterígio recidivado. Métodos: Série de casos prospectiva envolvendo pacientes submetidos à exérese de pterígio que foram diagnosticados com pterígio recidivado. Todos pacientes receberam uma aplicação subconjuntival 0,5 ml de bevacizumabe (2,5 mg/0,1 ml). O principal resultado foi a mudança no tamanho dos pterígios. A aparência clínica do pterígio foi graduada de acordo com os critérios de Tan et al. O tamanho horizontal do pterígio (do limbo ao ápice) foi observado até 60 dias semanas após a injeção. Os efeitos adversos e as complicações do tratamento foram descritos. Resultados: Foram incluídos 36 olhos de 36 pacientes (18 masculinos) com média de idade de 58,75 ± 10,98 anos. 30,6% dos pacientes tinham pterígio recidivado em ambos os olhos (apenas o pior olho foi tratado), 47,2% no olho esquerdo e 22,2% no olho direito. Mais da metade dos pacientes (58,3%) possuíam história familiar de pterígio. Houve uma diferença estatisticamente significante no tamanho do pterígio em diferentes intervalos (P<0,05). 66,7% dos pacientes apresentaram hemorragia subconjuntival no segundo dia após a aplicação, diminuindo para 30,6% no sétimo dia e nenhum paciente após um mês. A maioria dos pacientes (69,4%) teve melhora dos sintomas irritativos após dois dias, 88,9% após 7 dias e 97,2% após um mês. Conclusão: A injeção subconjuntival de bevacizumabe é uma alternativa válida na condução de pacientes com pterígio recidivado, não apresentando efeitos locais e sistêmicos significantes. .

Efeitos de algumas drogas sobre a proliferação de fibroblastos de pterígio primário in vitro / Effects of some drugs in the fibroblastic proliferation in primary pterygium in vitro

OBJETIVO: Este estudo tem por objetivo observar a inibição da proliferação celular in vitro em pterígios primários utilizando mitomicina C, ciclofosfamida e metotrexato. MÉTODOS: Os pterígios foram retirados de 7 pacientes com idade entre 30 e 60 anos e foram submetidos à cultura de suas células epiteliais. Foi então verificado o efeito de drogas sobre as células: ciclofosfamida, metotrexato e mitomicina. As células foram observadas por 5 dias ao microscópio para avaliar a proliferação celular e os experimentos foram repetidos 5 vezes. RESULTADOS: Quando a mitomicina foi utilizada observou-se importante inibição da proliferação celular. Quando a ciclofosfamida foi utilizada houve também inibição do crescimento, 50% após 24 horas de cultura após a exposição da droga aumentando nos dias subsequentes. Nenhum efeito foi observado quando o metotrexato foi utilizado. CONCLUSÃO: Os efeitos de inibição da proliferação celular pela mitomicina C já eram esperados, porém a ciclofosfamida também apresentou-se bastante eficaz. A ação inibitória da ciclofosfamida sobre a proliferação fibroblástica in vitro nos leva a acreditar que ela possa ser usada para prevenir a recorrência do pterígio depois da excisão. Entretanto, testes em animais e posteriormente em humanos se fazem necessários para se chegar a essa conclusão.

OBJECTIVE: This study aims at observing the inhibition of cell proliferation in primary pterygium by the use in vitro of mitomicyn C, cyclophosphamide, methotrexate. METHODS: Pterigyum was removed from seven pacients between 30 and 60 years and were submitted to culture of epithelial cells. Later the effect of drugs was tested on the cells: cyclophsphamide, methotrexate, mitomicyn. The cells were observed for five days under the microscope to assess cellular proliferation, and the experiments were repeated five times RESULTS: When mitomicyn was used, a marked inhibition of cellular proliferation was observed. When cyclophosphamide was used there also was inhibition of cellular proliferation, 50% within 24 hs of the culture exposition to the drug increasing in the following days CONCLUSION: The inhibition effects in the cellular proliferation by the use of mitomicyn C was already expected, but the use of cyclophosphamide was also very effective. The cyclophsphamide inhibitory action on fibroblastic proliferation in vitro lead us to believe that it may be used to prevent pterygium recurrence after incision. However, tests in animals and later in humans are necessary.

Eficácia do uso intraoperatório de mitomicina C na cirurgia do pterígio: análise de 102 casos / Eficacy of intraoperative use of mitomycin C pterygium surgery: analysis of 102 cases

OBJETIVO: Avaliar a eficácia e a segurança do uso intraoperatório da mitomicina C (MMC) no tratamento cirúrgico do pterígio. MÉTODOS: Estudo de 102 pacientes (204 olhos) divididos em dois grupos, e submetidos a exérese do pterígio com rotação de retalho conjuntival e aplicação intra-operatória de MMC 0,02% por 2 minutos e a mesma técnica utilizando solução salina a 0,9% (grupo controle). Os pacientes foram avaliados no 1º, 7 º, 21º, 30º, 60º e 90º dia de pós-operatório (PO). RESULTADOS: Houve um maior acometimento do pterígio no sexo feminino (59,9%). A idade variou entre 33 a 69 anos. As recidivas (9) no no grupo MMC foram identificadas no 90º PO. No grupo controle foi identificado 18 recidivas em 60 dias de pós-operatório. As complicações identificadas no grupo da MMC foram: ceratite, edema de pálpebra, deiscência de sutura, isquemia, granuloma, corneal dellen e simbléfaro. CONCLUSÃO: O uso da MMC foi útil na redução da taxa de recidiva do pterígio, comparada ao uso de solução salina, porém seus efeitos deletérios devem sempre ser avaliados.

PURPOSE: Measure of efficacy and the security of intraoperative of mitomycin C (MMC) in the pterygium surgery. METHODS: Realized prospective analysis of 102 patients (204 eyes) divided in two groups submitted intraoperative MMC 0.02 % for 2 minutes or saline solution 0.9%. The patients were available in 1º, 7 º, 21º, 30º, 60º and 90º days of postoperative. RESULTS: The pterygium was more prevalence in females (58,33%). The age various 33 to 69 years. The recidive (9) was in the 90º PO in the group of MMC. In the control group was identificated two recidives in 60 days. The complications found in MMC group were: ceratitis, lips edema, dehiscence of suture, ischemia, granuloma, corneal dellen and simblefaro. CONCLUSION: The use of MMC was useful in reducing the rate of recurrence in pterygium compared to the use of saline solution, but its harmful effects must always be evaluated.

Segurança e efetividade no tratamento do pterígio usando infiltração de 5-fluoruracila no intraoperatório / Safety and efficacy of intraoperative 5-fluorouracil infiltration in pterygium treatment

Objetivo: Avaliar a segurança e a efetividade do uso do 5-fluoruracila(5-FU) como tratamento adjuvante do pterígio, aplicado sob a forma de infiltração subconjuntival, no período intraoperatório. Métodos: Foram avaliados prospectivamente 125 indivíduos (125 olhos) portadores depterígio. Os indivíduos foram operados segundo a técnica de retalho de deslizamento e receberam, ao final do procedimento, injeção subconjuntivalde 0,2 mL de 5-FU (25 mg/mL). Foram anotados os dados do paciente como idade, sexo, profissão, características da lesão (primário ou recidivado, tamanho, carnoso ou involutivo) e feito seguimento pósoperatório, aos 7, 21, 60 e 180 dias. Os dados foram submetidos àavaliação estatística. Resultados: Não foram observados casos de complicaçãodecorrente do uso do 5-FU em injeção no intraoperatório do pterígio. A taxa de recidiva geral observada aos 180 dias de pós-operatório foi de 35,8%, sendo de 35,7% para os pterígios primários e de 36,4% para os recidivados. Conclusão: A aplicação do 5-FU no período intraoperatório sob a forma de infiltração subconjuntival é segura. Entretanto, ainda resulta em altas taxas de recidiva e novos estudos devem serrealizados a fim de conhecer a concentração/dose ideal que permitirámenores chances de recidiva da lesão.

Purpose: To investigate the safety and efficacy of intraoperative infiltration of 5-fluorouracil (5-FU) as an adjuvant drug in pterygium treatment. Methods: Of 125 consecutive patients, 125 eyes with primary and recurrent pterygium underwent pterygium excision with intraoperative 5-FU (25 mg/mL) infiltration. The superior and inferior conjunctiva was approximated to cover the scleral bed and 0.2 mL 5-FU wasinjected at the end of the surgical procedure. The gender, occupation, pterygium characteristics and the follow-up at 7, 21, 60 e 180 days after surgery were evaluated and the data were statistically analyzed. Results: With follow-up of 180 days the patients had no serious complications observed duringor after surgery. The relapse rate was 35.8% and occurred in primary (35.7%) and recurrent (36.4%) lesions with no statistical difference. Conclusions: This study suggests that intraoperative infiltration of 5-FU is safe. However the high recurrence rate indicated that other studies would be necessary to show the concentration/dose to better prevent it.

Local injection of bevacizumab as an alternative method for management of recurrent pterygium

Surgery has so far been used for primary treatment of pterygium; however, one of the major limitations is its high recurrence rate. This study was performed to determine the effect of bevacizumab in recurrent pterygium. Patients with recurrent pterygium were divided into two groups, receiving bevacizumab [Group 1] or normal saline [Group 2]. They were evaluated for photophobia and any conjunctival congestion and were scored from 0 to 4 prior to any injection. The size of pterygium was assessed in relation to extension of pterygium on the cornea over the limbus. All patients were followed in regular 48 hour intervals weekly up to one month and then monthly up to 6 months after the injection. There were 50 patients in group 1 and 48 in group 2 and the mean age of the patients was 40.94 +/- 13.82 and 47.10 +/- 5.9 years, respectively with a male to female ratio of 1 2. The mean size of ptrygium was 52.84 in group 1 and 46.02 in group 2. In group 1, photophobia and conjunctival congestion were 59.53 and 61.27, respectively while in group 2, they were 39.16, and 37.24, respectively. In the first 48 hours, conjunctival congestion and photophobia were higher in group 1 but there was no significant difference regarding the size of pterygium. After one week, the scores were significantly lower in group 1 while the mean rank for the size of pterygium was 52.84 in group 1, and 46.02 in group 2. After 1 and 6 months, the scores were lower in group 1. Subconjunctival injection of bevacizumab can be considered as an effective temporary treatment in the management of recurrent pterygium in those who are not a candidate for secondary operation. It can decrease conjunctival congestion and photophobia and prevent further progression even in the long term

Evaluation of epithelial cell proliferating activity and fibroblast nuclear kariometry in recurrent pterygium treated with mitomycin C / Avaliação da atividade proliferativa das células epiteliais e da cariometria do núcleo dos fibroblastos em pterígios recidivados previamente tratados com a mitomicina C

PURPOSE: To evaluate the effectiveness of mitomycin C (MMC) in preventing recurrence of pterygium following conjunctival autograft transplantation (CAT). Ki-67 antigen to evaluate epithelial cell proliferation and fibroblast nuclear kariometry were used to assist treatment evaluation. METHODS: Twenty-nine patients with recurrent pterygium were divided into three groups: Group (G) 1 - CAT and placebo eyedrops (PED); G2 - CAT, 0.015 percent MMC subconjunctivally, and PED; G3 - CAT and 0.02 percent MMC eyedrops. Immunohistochemistry for the Ki-67 antigen and fibroblast nuclei kariometry were performed on the excised tissue, divided into nasal and temporal sides. Kariometry was evaluated in terms of volume (Vl) and area (Ar) using at least 50 cells/patient. RESULTS: The percentage of positive epithelial cells for the Ki-67 antigen on the nasal and temporal side after treatment of the three groups were: nasal (5.39 percent G1, 4.49 percent G2, and 3.88 percent G3); temporal (3.30 percent G1, 4.46 percent G2, 4.14 percent G3), did not show significant differences. Fibroblast nucleus kariometry was: nasal Vl (792.1 µ3 G1, 605.1 µ3 G2, and 549.9 µ3 G3) and Ar (100.58 µ2 G1, 83.13 µ2 G2, and 78.41 µ2 G3). The three groups showed significant differences: p=0.039 and p=0.035, for respectively Vl and Ar, on the nasal side. After a six month of treatment, the three groups presented the following recurrence rates: G1, 22.22 percent, G2, 18.18 percent and G3, 33.33 percent, respectively. CONCLUSION: MMC did not reduce the number of positive epithelial cells for the Ki-67 antigen in recurrent pterygium, but decreased fibroblast nucleus volume and area on the nasal side of the pterygia. The number of positive epithelial cells for the Ki-67 antigen seemed not to be related to pterygium recurrence observed over a six-month post-surgery period. The role of epithelial cell proliferation in pterygium recurrence should be evaluated by further studies.

OBJETIVO: Avaliar a eficácia da mitomicina C (MMC) na prevenção da recorrência quando previamente utilizada no transplante autólogo de conjuntiva (TAC). A avaliação da proliferação celular epitelial pelo antígeno Ki-67 e a cariometria do núcleo dos fibroblastos foram usados como auxiliares na avaliação do tratamento. MÉTODOS: Vinte e nove pacientes com pterígio recidivado foram divididos em três grupos: Grupo (G) 1-TAC e colírio placebo (PLA); G2-TAC, MMC 0,015 por cento subconjuntival e PLA; G3-TAC e colírio de MMC 0,02 por cento. A imuno-histoquímica foi realizada no tecido excisado para o antígeno Ki-67, como a cariometria dos núcleos dos fibroblastos (divididos em lado nasal e temporal). A cariometria dos núcleos dos fibroblastos foi avaliada de acordo com os seguintes parâmetros: volume (Vl) e área (Ar) em pelos menos 50 células por paciente. RESULTADOS: A porcentagem das células epiteliais positivas para o antígeno Ki-67 no lado nasal e temporal após o tratamento dos três grupos estudados foi: nasal (3,30 por cento G1, 4,49 por cento G2 e 3,38 por cento G3) e temporal (3,30 por cento G1, 4,46 por cento G2 e 4,14 por cento G3) não mostrando diferença significativa. A cariometria do núcleo dos fibroblastos foi: Vl nasal (792,1 µ3 G1, 605,1 µ3 G2, e 549,9 µ3 G3) e a Ar (100,58 µ2 G1, 83,13 µ2 G2, e 78,41 µ2 G3). Os três grupos mostraram uma diferença significativa p=0,039 e p=0,035, respectivamente do Vl e da Ar no lado nasal. Após seis meses de tratamento, os três grupos apresentaram a seguinte taxa de recidiva: 22,22 por cento G1, 18,18 por cento, G2 e 33,33 por cento G3 respectivamente. CONCLUSÃO: O uso da MMC não interferiu nas células epiteliais positivas para o antígeno Ki-67 no pterígio recidivado, mas acarretou diminuição do volume e área dos núcleos dos fibroblastos no lado nasal do pterígio. As células epiteliais positivas para o antígeno Ki-67 parecem não ter relação com a recidiva do pterígio após seis meses...

Autoinjerto conjuntival de células límbicas para el tratamiento del pterigion, una alternativa para disminuir la recurrencia / Conjuctival autograft of limbic cells in treatment of pterygium, an option to decrease recurrence

Se estudió el uso del autoinjerto conjuntival de células límbicas para el tratamiento quirúrgico del pterigion simple, así como las complicaciones derivadas sobre el uso de esta técnica con el objetivo de mejorar la recurrencia del pterigion. Se realizó la técnica de autoinjerto conjuntival de células límbicas en 144 pacientes que presentaban pterigion simple con una invasión grado III y 10,1 por ciento grado IV. El 68 por ciento se presentó en el ojo derecho y el 32 por ciento en el ojo izquierdo. Se obtuvo un éxito de la operación en el 97,3 por ciento y solo el 2,7 por ciento presentó recurrencia. La complicación más frecuente fue un granuloma que continuó con el tratamiento de esteroide durante 3 meses y se resolvió de forma espontánea.

Use of conjunctival autograft of limbic cells was studied for surgical treatment of simple pterygium, as well as derived complications on use of this technique to improve pterygium recurrence. Technique of conjunctival autograft of limbic cells was applied in 144 patients presenting with simple pterygium with grade III and 10.1 invasion. Sixty eight percentage (68 percent) was present in right eye, and 32 percent in left eye. We had a successful surgery in 97.3 percent, and only 2.7 percent presenting with recurrence. More frequent complication was a granuloma treated with steroids for 3 months, and resolving in a spontaneous way.

Treatment of pterygium with conjunctival limbal autograft and mitomycin C--a comparative study.

A total of 60 eyes with primary progressive pterygium were selected. They were randomly divided into two groups ie, group A and group B each consisting of 30 eyes. Group A patients were treated with pteryglum excision with ipsilateral conjunctival-limbal autografting. Group B patients were treated with pterygium excision followed by mitomycin C 0.02% for two minutes. Both groups were followed up for one year postoperatively to document recurrence rates and postoperative complications. In group A recurrence rate was 3.0% with minimal ocular complication after one year follow-up. But in group B recurrence rate was high as 10.0% and ocular complications were significant after the same period of postoperative follow-up. Both conjunctival-limbal autograft and intra-operative mitomycin use are effective method of surgical treatment of pterygium but considering the rate of recurrence and other postoperative ocular morbidity conjunctival-limbal autografting seems to be the best method of pterygium treatment.

Simple excision alone versus simple excision plus mitomycin C in the treatment of pterygium

Pterygium is a common ocular disorder throughout the world. The purpose of this study was to evaluate the efficacy of simple excision alone with or without topical mitomycin in the treatment of pterygium. This study was performed in two stages. In the first stage, from 1991 to 1994, 100 patients [group 1] were operated on with simple excision and in the second stage, from 1995 to 1999, 300 patients [group 2] were treated with the same procedure plus topical mitomycin [0.02% eye drops four times a day for 4 days after operation]. All cases were followed for 5 years. The recurrence rate of pterygium in these two treated groups were compared. The mean age of the subjects was 49 +/- 13 years in group 1 and 47 +/- 17 years in group 2. The clinical manifestations in these two groups were two groups were similar [P>0.05]. After one year, relapse was seen in 21 cases [21%] in group 1 and in 3 cases [1%] in group 2. After five years, 31 cases [31%] in group 1 and 3 cases [1%] in group 2 had relapse [P=0.0001]. The mean time to recurrence at five years for the simple excision group was 3.83 years [95% CI: 3.48 to 4.17 years] and for simple excision plus mitomycin C was 4.96 years [95% CI: 4.91 to 5.0 years] [P<0.0001]. Instillation of mitomycin C eye drops appears to be safe in the treatment of pterygium

Conjunctival grafting and cytotoxic drugs for advanced and recurrent pterygia

Although there are many surgical methods for treating pterygium, there are also several complications, the most important of which is recurrence, which usually associated with increased conjunctival inflammation, induced astigmatism and aggravated preoperative symptoms. Repeated surgery often worsens the situation, as loss of conjunctival tissue and scarring can result in obliteration of the fornices and mechanical restriction of ocular movement. In this retrospective study, forty two cases were operated for advanced primary and recurrent pterygium. In twenty six cases excision and free conjunctival auto graft taken from superio-temporal bulbar conjunctiva were done, in sixteen cases excision, application of mitomycin c and sliding flap graft were done. In one case [3.8%] there was graft failure, that occurred in the first post operative week, in three cases out of the grafted group [8.7%] recurrence of the Pterygia was reported within three months postoperative, recurrence occurred in one case [6.3%] in the sliding flap group

Intraoperative application of topical mitomycin C 0.05 for pterygium surgery

BACKGROUND: Pterygium recurrence is a common problem encountered by ophthalmic surgeons. Several methods have been suggested to avoid these recurrences. We studied the recurrence rate of pterygium after administration of a single intraoperative dosage of topical mitomycin C 0.05. METHODS: A retrospective analysis of fifty eyes in forty-nine patients who underwent pterygium excision by the same surgeon using intraoperative topical mitomycin C during the years 2002--2003. Mitomycin concentration was 0.05 applied to pterygium and adjacent areas after undermining and separation from sclera but prior to excision for three minutes. Postoperative follow up time was 12 months. RESULTS: The pterygium recurred in 4 (8) eyes. Another four eyes (8) had a cosmetically acceptable recurrence of < 2.0 mm. The only complication was a corneal dellen in one eye. CONCLUSION: Intraoperative administration of mitomycin C at 0.05 is safe and effective in preventing pterygium recurrences

Manejo quirúrgico del pterigium / Surgical management of pterygium

Objetivo: Se presenta la técnica quirúrgica y resultados de una serie prospectiva de pacientes portadores de pterigion. Métodos: Estudios prospectivos realizado en el Hospital Base de Osorno y Clínica Alemana de Osorno, entre marzo del 2000 y abril del 2003. Se revisan 8 casos, siendo 9 de ellos recurrentes y 59 primarios, en ojos no operados previamente. Se presenta la técnica quirúrgica en detalle, la que incluyó autoinjerto de conjuntiva y el uso de mitomicina C. Se muestran los resultados a largo plazo (1 año). Resultados: No hubo ninguna recurrencia en esta serie, luego de un seguimiento de un año. Las complicaciones incluyeron dehiscencia de sutura (1 caso), granulomas (3 casos), retardo de la epitelización (3 casos), hipertensión ocular (5 casos). Conclusiones: La técnica se demuestra efectiva y segura en el tratamiento quirúrgico del pterigion, por lo que nos permitimos sugerir su indicación sin importar si el caso es primario o recurrente.

Infiltração de 5-fluorouracil no pré-operatório do pterígio / Preoperative 5-fluorouracil infiltration in pterygium surgery

OBJETIVO: Avaliar o efeito do 5-fluorouracil (5FU) injetado intralesionalmente na cabeça do pterígio no período pré-operatório. MÉTODOS: Foram estudados 53 olhos (52 pacientes), sendo 28 pterígios primários e 25 recidivados, divididos em dois grupos: grupo 1 (G1), composto por indivíduos que receberam a injeçäo de 5-fluorouracil 30 dias antes do procedimento cirúrgico e grupo 2 (G2), no qual o 5-fluorouracil foi injetado 10 dias antes da cirurgia. Todas as cirurgias foram realizadas seguindo-se a mesma técnica cirúrgica, pelo mesmo cirurgiäo. Os pacientes foram reavaliados 7, 30 e 60 dias após a cirurgia. Os resultados observados foram submetidos à análise estatística. RESULTADOS: A amostra estudada foi constituída por 52,8 por cento de pterígios primários e 47,2 por cento de recidivados, sendo composta igualmente por indivíduos de ambos os sexos. Näo ocorreram complicaçöes decorrentes da infiltraçäo da droga. A recidiva foi mais freqüente nos pterígios recidivados e no G1. CONCLUSÄO: O uso intralesional de 5-fluorouracil no pré-operatório do pterígio näo provocou efeitos deletérios aos olhos estudados. Houve menor recorrência quando usado o 5-fluorouracil 10 dias antes da exérese cirúrgica, em relaçäo à aplicaçäo 30 dias antes do procedimento

Role of post-operative topical corticosteroids in recurrence rate after pterygium excision with conjunctival autograft.

BACKGROUND: Recurrence of pterygium is the most common failure of the pterygium operation. The use of conjunctival autograft after pterygium excision has shown a low recurrence rate. However, it has a board range of variations regarding the recurrence rates, which may be influenced by many factors. From the authors' clinical observation, it was found that the recurrence rate was higher in patients who received inadequate post-operative topical corticosteroid treatment. OBJECTIVE: To study the association between adequacy of post-operative topical corticosteroids and recurrence rate in patients with primary pterygium who underwent excision with conjunctival autograft. DESIGN: Retrospective, case-control study. SUBJECTS AND METHOD: A total of 142 eyes of 137 patients with primary pterygium who underwent excision with conjunctival autograft between January 1996 and June 2002 were enrolled in this study. These patients were evaluated for recurrence of their pterygia and adequacy of post-operative topical corticosteroids by chart review, re-examination, self-reported questionnaire, and interview. Cases were patients with recurrent pterygium. Controls were from patients without recurrence. RESULTS: There were 21 recurrences (14.8%) of a total of 142 eyes treated. Five of the 21 recurrences occurred in good compliant patients with adequate post-operative topical corticosteroid therapy. Sixteen recurrences occurred in patients with inadequate post-operative topical corticosteroids. In this group, 6 cases missed their follow-up schedules, 3 cases were lost to follow-up after 1.5-2 months, 1 case had poor compliance with treatment, and 6 cases were steroid responders then the treatment was discontinued or changed to a weaker preparation. The study demonstrates significant association between the adequacy of post-operative topical corticosteroid and pterygium recurrence rate. The odds ratio was 190.4 (95% CI, 36.61-951.84). CONCLUSIONS: A high recurrence rate was found in patients who received inadequate post-operative topical corticosteroid. However, the recurrence rate was much lower from 14.8 per cent to 4 per cent when the patients with inadequate corticosteroid therapy were excluded. The study provides evidence that post-operative topical corticosteroids appear to play a role in reducing the pterygium recurrence rate.