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.

A comparative study on the inhibitory effects of commonly used clinical drugs on in vitro fibroblasts from recurrent pterygium / 中华实验眼科杂志

Background Pterygium is one of the common ocular surface disorders,and the main drugs for pterygium include dexamethasone (DXM),interferon α-2b (IFN-α2b),mitomycin C (MMC),5-fluorouracil (5-FU),cyclosporin A (CsA) and tacrolimus (FKS06).However,the efficacy of these drugs on the fibroblasts from recurrence pterygium is unelucidated.Objective This study was to compare the efficacy of DXM,IFN-o2b,MMC,5-FU,CsA and FK506 on proliferation and apoptosis of recurrent pterygium-derived fibroblasts in vitro.Methods The specimens of recurrence pterygium were collected during surgery in Tianjin Medical University Ophthalmological Hospital from May 2015 to July 2016 under the written informed consent.Fibroblasts were isolated and cultured by explant culture method and identified by immunochemistry.DXM,IFN-α2b,MMC,5-FU,CsA and FK506 were added into the medium for 48 hours,respectively,and the cells cultured without drug were used as the control group.The inhibitory efficiency of different concentrations of DXM,IFN-α2b,MMC,5-FU,CsA and FK506 on the cell proliferation was assayed by cell counting kit-8 (CCK-8),and 50％ inhibiting concentration (IC50) of the drugs was calculated.The cells were treated by the IC50 dose of drugs for 48 hours,and cell apoptotic proportion and cell cycle were assessed by flow cytometry analysis.The expression of proliferating cell nuclear antigen (PCNA) in the cells after treated by drugs was detected by immunochemistry.Results Cultured cells grew well with the fusiform shape and radial arrangement.Vimentine showed the positive expression and keratin was absently expressed in the cells.The IC50 to the cells was (3.5×103±2.83×10-2)mg/L,(6.1×102±3.6×10-3)mg/L,(3.2×10-1±1×10-4)mg/L,(2.2× 101 ± 1.2× 10-3) mg/L,(6.3 × 101 ±2.5 × 10-3) mg/L and (6.0× 101 ± 0.0× 100) mg/L in the DXM,IFN-α2b,MMC,5-FU,CsA and FK506,respectively.In the 48 hours after treated by the IC50 drugs,the apoptotic ratio was (35.00± 3.21)％,(30.37±1.67)％,(26.11±0.75)％,(22.01±0.07)％,(20.95±1.68)％ and (19.85±0.52)％ in the IFN-α2b group,CsA group,MMC group,FK506 group,DXM group and 5-FU group,which was significantly higher than (11.38±2.18) ％ in the control group (all at P＜0.05).The cell proportion of G0/G1 phase,S phase and G2/M phase was (85.64±2.62)％,(5.29±1.56)％ and (2.73-±2.66)％ in the control group,and the cell proportion of G0/G1 phase was reduced,while that of S phase or G2/M phase was considerably increased in various drug groups (all at P＜0.05),with the blocking efficiency of cell cycle was in turn MMC,CsA,5-FU,DXM,IFN-α2b and FK506.The expressional rate of PCNA in the cells was (95.00 ± 2.00) ％,(82.67 ± 5.04) ％,(80.00 ± 2.78) ％,(64.00± 6.55)％,(38.00±3.00)％,(32.00±4.36)％ and (29.67±3.02)％ in the control group,FK506 group,DXM group,5-FU group,IFN-α2b group,CsA group and MMC group,showing a significant difference among the groups (F=25.995,P＜0.01),and the expressional rate of PCNA was significant lower in various drug groups than that in the control group (all at P＜0.05).Conclusions DXM,IFN-α2b,MMC,5-FU,CsA and FK506 are all able to inhibit the proliferation and promote the apoptosis of recurrent pterygium-derived fibroblasts in vitro,and MMC and CsA appear to have a stronger effect.