[Drug therapy for corneo-conjunctival neoplasm]. / Tratamiento farmacológico de la neoplasia corneal y conjuntival.

BACKGROUND: The goal of therapy for corneo-conjunctival neoplasm is lesion removal, with the most widespread procedure being complete tumor resection with or without associated chemotherapy lines. As this sort of procedure entails a high relapse rate (9-52%) the use of adjuvant therapies to reduce the occurence of relapse becomes a need. The administration of a number of topically administered drugs has been used for adjuvant therapy, including mitomycin C, 5-fluorouracil and interferon a 2b. OBJECTIVE: To determine the clinical experience published regarding the effectiveness of the various drug therapies for cor-neo-conjunctival neoplasm. SEARCH STRATEGY: Information reported on this topic in the Medline database (1966-2004) was searched using corneo-conjunctival neoplasm, 5-fluorouracil, mitomycin C, and interferon ca2b as key words. SELECTION CRITERIA: All papers quoting dosage for drugs used,treatment length, adverse effect development, and clinical response obtained were included. PRIMARY RESULTS: Papers reporting the use of 5-fluorouracil re few when compared to those quoting other drugs, with a response rate of 88% and a relapse rate of 20%. The use of mitomycin C is widely described in the medical literature with a response rate of 90% and a relapse rate of 13%, but in association with the development of adverse effects in a high percentage of patients. Interferon ca 2b is the last drug to be incorporated in the treatment of these ocular lesions, with a response rate of 100% and a low incidence of adverse effects, with a relapse rate of 4%. CONCLUSIONS: Mitomycin C is an effective drug, but its use is associated with a high number of adverse events, some of which may lead to therapy discontinuation. Interferon ct 2b has efficacy outcomes comparable to mitomycin C and a lower incidence of adverse effects, which are mostly mild in nature. The use of 5-fluorouracil is relegated to a second-tier status.

Tratamiento farmacológico de la neoplasia corneal conjuntival / Drug therapy for corneo-conjunctival neoplasm

Antecedentes: El objetivo del tratamiento de la neoplasia córneo- conjuntival es la eliminación de la lesión, siendo el más extendido la resección quirúrgica completa del tumor asociado o no a varias hileras de crioterapia. Debido a la elevada tasa de recidivas de este tipo de intervención (9-52%), se hace necesaria la utilización de tratamientos adyuvantes que la reduzcan. Para el tratamiento adyuvante se ha empleado la administración de varios fármacos por vía tópica tales como: la mitomicina-C, el 5-fluorouracilo y el interferón alfa 2b. Objetivo: Conocer la experiencia clínica publicada sobre la efectividad de los diferentes tratamientos farmacológicos de la neoplasia córneo-conjuntival. Estrategia de la búsqueda: Se revisó la información publicada sobre este tema en la base de datos Medline (1966-2004), utilizando como palabras clave neoplasia córneo conjuntival, 5- fluorouracilo, mitomicina C e interferón alfa 2b. Criterios de selección: Se incluyeron todos los trabajos en los que se expresaba la dosis de fármaco utilizado, la duración del tratamiento, la aparición de efectos adversos y la respuesta clínica obtenida. Resultados principales: Los artículos publicados en los que se ha utilizado el 5-fluorouracilo son escasos en comparación con los publicados con los otros dos fármacos, presentando una tasa de respuesta del 88% y una tasa de recidivas del 20%. La utilización de mitomicina-C está ampliamente descrita en la literatura médica con una tasa de respuesta del 90% y tasa de recidivas del 13%, pero está asociada a la aparición de efectos adversos en un porcentaje elevado de pacientes. El interferón alfa 2b, ha sido el último fármaco incorporado para el tratamiento de estas lesiones oculares obteniendo unos resultados en cuanto a respuesta del 100% y un bajo número de efectos adversos, con un tasa de recidivas del 4%. Conclusiones: La mitomicina C es un fármaco eficaz, pero que se asocia a la aparición de un gran número de efectos adversos, que en algunos casos obligan a suspender el tratamiento. El interferón alfa 2b presenta unos resultados de eficacia comparables a la mitomicina-C y con un menor número de reacciones adversas, siendo en su mayoría de carácter leve. Queda en un segundo plano la utilización del 5-fluorouracilo

Background: The goal of therapy for corneo-conjunctival neoplasm is lesion removal, with the most widespread procedure being complete tumor resection with or without associated chemotherapy lines. As this sort of procedure entails a high relapse rate (9-52%) the use of adjuvant therapies to reduce the occurence of relapse becomes a need. The administration of a number of topically administered drugs has been used for adjuvant therapy, including mitomycin C, 5-fluorouracil and interferon alpha 2b. Objective: To determine the clinical experience published regarding the effectiveness of the various drug therapies for corneo- conjunctival neoplasm. Search strategy: Information reported on this topic in the Medline database (1966-2004) was searched using corneo-conjunctival neoplasm, 5-fluorouracil, mitomycin C, and interferon alpha 2b as key words. Selection criteria: All papers quoting dosage for drugs used, treatment length, adverse effect development, and clinical response obtained were included. Primary results: Papers reporting the use of 5-fluorouracil are few when compared to those quoting other drugs, with a response rate of 88% and a relapse rate of 20%. The use of mitomycin C is widely described in the medical literature with a response rate of 90% and a relapse rate of 13%, but in association with the development of adverse effects in a high percentage of patients. Interferon alpha 2b is the last drug to be incorporated in the treatment of these ocular lesions, with a response rate of 100% and a low incidence of adverse effects, with a relapse rate of 4%. Conclusions: Mitomycin C is an effective drug, but its use is associated with a high number of adverse events, some of which may lead to therapy discontinuation. Interferon alpha 2b has efficacy outcomes comparable to mitomycin C and a lower incidence of adverse effects, which are mostly mild in nature. The use of 5-fluorouracil is relegated to a second-tier status

[Treatment of persistent epithelial defects using autologous serum application]. / Tratamiento de defectos epiteliales persistentes mediante suero autólogo.

PURPOSE: To study the impact of topical treatment with autologous serum on the clinical evolution of persistent corneal epithelial defects (PED) and to observe its effect on squamous metaplasia in 7 cases of dry eye. PATIENTS AND METHODS: In this prospective, clinical, non-comparative case series study we evaluated a total of 17 eyes (14 patients). We analized the clinical evolution (fluorescein staining, Schirmer's I and II tests and photographic control) of PED in these patients, to whom 20% autologous serum eyedrops were applied for 28 days. Using impression cytology technique (Tseng's method) we evaluated the involution of squamous metaplasia in 7 eyes of 4 patients with ocular cicatricial pemphigoid and dry eye who were treated with autologous serum. The Wilconxon test was used for the statistical treatment of the data. RESULTS: The epithelial defect healed within 2 weeks in 6 eyes (35.2%). Eight eyes (47%) healed within 2-4 weeks and 3 eyes (17.6%) did not heal after week 4. The duration of PED, before serum therapy was 36 days. Six of seven eyes treated with autologous serum presented an involution of squamous metaplasia 28 days after initiation of the serum drops. CONCLUSIONS: Autologous serum treatment accelerates PED healing. Autologous serum application causes an involution of squamous metaplasia.

[Bioadhesives in ocular surgery]. / Bioadhesivos en cirugía ocular.

PURPOSE: To evaluate the histological inflammatory activity that bioadhesives such as fibrin, cyanoacrylate, unsutured valved closure and suturing, generate when applied on scleral tissue. METHODS: We used a total of 80 eyes of 80 white rabbits which we divided into 8 groups of ten eyes each and distributed according to the two periods of time (1 week and 30 days) and four technique used for closure: 10/0 nylon suture, sutureless self-sealing, cyanoacrylate glue (Histoacryl), and fibrin glue (Tissucol). ANOVA was used for the statistical study of histological inflammation. Descriptive statistical analysis was used for the study of the degree of healing. RESULTS: After 7 days, the fibrin bioadhesive led to greater inflammatory response than did the other techniques (p<0.001). The cyanoacrylate adhesive caused less inflammatory activity than did suturing material (p<0.005). On day 30, the inflammatory reaction generated by the fibrin and cyanoacrylate adhesives was greater than of the suturing and self valved closure technique (p<0.005). After 7 days, the degree of healing with the suture, sutureless technique and cyanoacrylate adhesive was incomplete, while healing was moderate with the fibrin glue. After 30 days the degree of healing with cyanoacrylate glue was incomplete. At this time the degree of healing, with the suture, sutureless technique and fibrin adhesive was complete. CONCLUSIONS: Fibrin causes greater inflammatory reaction than do the other techniques. The cyanoacrylate adhesive shows a biological tolerance identical to the suture technique. This shows that cyanoacrylate bioadhesives are a viable alternative to suturing in scleral surgery.

Bioadhesivos en cirugía ocular / Bioadhesives in ocular surgery

Objetivo: Evaluar la actividad inflamatoria histológica que los bioadhesivos de fibrina, cianoacrilato, cierre valvulado sin sutura y material de sutura generan al ser aplicados en el tejido escleral. Métodos: Utilizamos un total de 80 ojos de 80 conejos albinos, que clasificamos en 8 grupos de 10 ojos cada uno, distribuidos según los dos tiempos (1semana y 30 días) y las cuatro técnicas utilizadas: sutura de nylon 10/0, cierre autovalvulado sin sutura, adhesivo de cianoacrilato (Histoacryl®) y de f¦brina (Tissucol®). El análisis estadístico del grado de inflamación histológica fue realizado con el test del análisis factorial de la Varianza (ANOVA). El estudio sobre el grado de cicatrización se realizó mediante análisis estadístico descriptivo. Resultados: A los 7 días, el bioadhesivo de fibrina indujo una respuesta inflamatoria superior al resto de técnicas (p<0,001). El adhesivo de cianoacrilato demostró una actividad inflamatoria inferior a la sutura (p<0,005). A los 30 días la reacción inflamatoria generada por los adhesivos de fibrina y cianoacrilato superó a la presentada por las técnicas con sutura y cierre autovalvulado (p<0,005). A los 7 días, se observa una respuesta cicatricial incompleta con las técnicas con sutura, sin sutura y con cianoacrilato, y moderada con la técnica de fibrina. El grado de cicatrización observado con la técnica con cianoacrilato es incompleto al cabo de los 30 días. En este tiempo, el grado de cicatrización con las técnicas sin sutura, con sutura y con fibrina es completo. Conclusiones: El bioadhesivo de fibrina demuestra ser una sustancia más inflamatoria que el resto de técnicas. El adhesivo de cianoacrilato presenta una tolerancia biológica semejante a la sutura. Según esto, los bioadhesivos de cianoacrilato pueden constituir una alternativa al material de sutura en cirugía escleral (AU)

No disponible