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Figure3Postoperativephotographsofapatientingroup2 (topical steroid and bevacizumab) A: Theappearanceat postoperative1dshowingsubconjunctivalhemorrhageandslight graftedema;B:Thesubconjunctivalhemorrhageisreducedandthe graftishealthyat7d;C:Thereisnorecurrenceatpostoperative6 th month.
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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,...
Citations
... Even more surprisingly, patients from the recurrent pterygium cohort in the TETRA group manifested only one case of recurrence after 1 year (4.16%), which is considerably lower compared to the usual rate in untreated patients and patients treated with other topical methods [60]. By contrast, a rate of recurrence similar to the one in our study was reported in patients receiving topical therapy with a combination of corticosteroids, antibiotic therapy, and topical bevacizumab (2.4%) [61]. Nevertheless, the low compliance related to a chronic treatment with three different eyedrops along with the local side effects of both bevacizumab and corticosteroid therapy should be taken into account. ...
Purpose: Low doses of systemic doxycycline (LD-SD) inhibit angiogenesis and the expression of matrix metalloproteases, which are determinants of pterygium progression. This study aimed to compare the recurrence rate and visual outcome of pterygium excision in patients undergoing chronic treatment with LD-SD for chronic refractory blepharitis and LD-SD-naive patients. Methods: A retrospective analysis of patients that underwent surgical excision and conjunctival graft apposition was conducted. Patients were divided in a TETRA group (under LD-SD treatment at the moment of surgery) and a control group. The main outcome was the rate of recurrence at 1 year postoperatively. Secondary outcomes were the comparisons of surface regularity, visual quality, and dry-eye symptoms at 6-week, 6-month, and 1-year follow-up in the two groups. Results: The TETRA group showed a significantly lower rate of 1-year recurrence both in primary (p = 0.034) and recurrent (p < 0.001) pterygia. The best corrected visual acuity (BCVA), astigmatic error, corneal total root mean square (RMS), and ocular surface disease index (OSDI) significantly reduced during the follow-up in both groups. The surface asymmetry index and high-order aberrations (HOAs) significantly reduced only in the TETRA group. The final BCVA was significantly higher, while the OSDI score and total RMS and HOAs were significantly lower in the TETRA group compared to the control. Conclusions: Patients under treatment with LD-SD showed a lower rate of recurrence at 1-year follow-up compared to controls. These patients also experienced higher BCVA and surface regularity and less dry-eye symptoms.
... 28 Ülkemizde yapılan bir çalışma topikal bevacizumab postoperatif olarak kullanımının 2 yıl sonunda nüks oranını azaltmada bir etkisi olmadığını göstermiştir. 93 Subkonjonktival bevacizumab ve ranibizumab uygulamasıyla alakalı yapılan çalışmaların sonucunda da pterjiyum nüksünde bir azalma gösterilememiştir. 94,95 G. PTERJİUM CERRAHİSİ KOMPLİKASYONLARI ...
A. TANIM En sık görülen göz rahatsızlıklarından biri olan pterjiyum bulbar konjonktivadan başlayıp kornea üzerine doğru büyüyen bir fibrovasküler dokudur. Yunancada kanat anlamına gelen "pterygion" söz-cüğünden alınmıştır. Kozmetik üzerindeki olum-suz etkilerinin yanı sıra korneal astigmatizmayı tetiklemesi, oküler yüzeyde bozulmaya ve görme keskinliğinde azalmaya yol açması yarattığı diğer önemli bir problemdir. 1,2 Pterjiyum genellikle nazalde görülür ve horizontal büyüme eğilimindedir ancak temporal ola-rak veya her iki yönde de büyüyebilir. Genellikle tek taraflı olarak görülse de nadir olarak bilateral büyüme de söz konusu olabilir. Ülkemizde Gümüş ve ark. 3 tarafından yapılan çalışmada pterjiyum ol-gularının %34,6' sı bilateral olarak tespit edilmiştir. Gerçek pterjiyum, konjonktivanın korneayı aktif olarak invaze ettiği dejeneratif ve hiperplastik bir dokudur. Psödo-pterjiyum ise inflame konjonkti-vanın kornea kenarındaki ülsere uzanıp yapıştığı bir doku olarak tanımlanmıştır. Gerçek pterjiyum limbus ve korneaya tamamen yapışıkken, psö-do-pterjiyumda doku limbusu atlar ve sadece kor-neaya tutunur. 4 B. EPİDEMİYOLOJİ 2017 yılında 68 çalışmanın dahil edildiği bir meta analizde pterjiyum prevalansı %12 olarak bu-lunmuştur. Yapılan klinik çalışmalarda en düşük prevalans %0,07 ile Suudi Arabistan' da, en yük-sek prevalans ise %53 ile Çin' de tespit edilmiştir. 5,6 Türkiye' de geniş kapsamlı bir prevalans çalışması PTERJİYUM CERRAHİSİ olmasa da yapılan çalışmalarda %7,8 ile %12,13 olarak bulan çalışmalar mevcuttur. 3,7 İleri yaş, er-kek cinsiyet, açık havada çalışma ve kırsalda yaşa-ma, pterjiyum gelişimi için önde gelen demografik risk faktörleridir. 8 C. ETİYOPATOGENEZ
... Karlezli et al. (276) used topical bevacizumab after pterygium excision with conjunctival autografting for 1 month after surgery and compared to them to a control group who were only given steroids and antibiotics and reported no significant difference in the recurrence rate between the two groups after a follow-up of at least 2 years. Kasetuwan et al. (277) (278) . ...
... All these techniques have their own merits and demerits. Different adjuvant therapies ranging from b-radiation [17] to mitomycin (MMC) [18] and more recently, anti-VEGF agents [19] have been used to minimize recurrence. These were not devoid of complications or offered no added advantage hence lost their popularity. ...
... 1,4 Other therapies used for treatment of pterygium include irradiation therapy, use of anti mitotic agents and anti angiogenic growth factors like bevacizumab. 4,18 However , these techniques are associated with complications. 4 So, these techniques have lost their popularity. 4 Conjunctival autograft technique was first introduced by Kenyon in 1985. ...
Objective: To determine the recurrence rate of pterygium in cases treated with limbal stem stem cell graft versus connjuctival autograft. Materials and Methods: It was a randomized clinical trial conducted in Opthalmology department of Hayatabad Medical Complex Peshawar from January 2018 to February 2019 i.e one year study duration . A total of 60 diagnosed cases of pterygium of both sexes and all ages were included in the study . The cases were randomized into two groups i.e 30 cases were treated with stem cell graft while the other 30 cases were treated with conjunctival autograft .The recurrence rate of pterygium was determined in both the groups by following them for 6 months i.e at 1st , 3rd and 6th month of excision. Recurrence rate was calculated for both the procedures. Mean and standard deviations were used for quantitative variables while frequency and percentages were used for qualitative data. Results: A total of 60 diagnosed cases of pterygium were included in the study. Age of the study sample ranged from 22-55 years, with mean of 37±9.3 SD. About 36 (60%) cases were males and ,14 (40%) cases were females. Recurrence rate of pterygium was 3.3% in cases treated with limbal stem cell graft technique as compared to recurrence rate of 10% which was seen in cases treated with conjunctival autograft technique. Conclusion: Recurrence rate of pterygium was more in cases treated with conjunctival autograft as compared to those treated with limbal stem cell graft. So, limbal stem cell graft is more effective as compared to conjunctival autograft in treating pterygium and should be preferred treatment option for pterygium in order to decrease the recurrence rate and hence morbidity of the patient.
... 1,9 In addition, various adjuvant medications (antimetabolites and anti-VEGF antibodies) have been applied to reduce the recurrent rate after pterygium excision. 1,2,10,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Although mitomycin C and 5-Fluorouracil could reduce the recurrence rate to a large extent, the severe complications, such as scleral melting and necrosis and corneal perforation, have limited their clinical usage. [22][23][24][25][26][27][28] It has been established that IFN is characterized by its antiviral, anti-inflammatory, and immunomodulatory effects. ...
Purpose:
To investigate the efficacy and safety of interferon (IFN) alpha-2b eye drops in preventing pterygium recurrence after the bare sclera technique.
Methods:
Sixty eyes in 53 patients who underwent treatment for primary pterygium (the length of corneal invasion ranged from 2 to 4 mm) were enrolled in this prospective study. All patients were divided in chronological sequence into 2 groups. The control group included the first 30 eyes, whereas the treatment group included the next 30 eyes. After treatment with the bare sclera technique, levofloxacin and 0.1% fluorometholone eye drops were used 4 times a day for 3 months after surgical excision in both groups. In addition, IFN alpha-2b eye drops were applied in the treatment group 4 times a day for 3 months. Throughout an 18-month follow-up period, all patients in both groups were examined 1 day, 10 days, 1 month, 3 months, 6 months, 12 months, and 18 months after surgery. The main outcome measures were pterygium recurrence, conjunctival redness and thickness, and neovascularization and complications (ie, delayed conjunctival healing, persistent corneal epithelial defection, conjunctival granuloma, and scleral melting and necrosis).
Results:
The recurrence rates in the control group and the treatment group at the end of the sixth month were 29.2% and 3.7%, respectively, and the rates were significantly different between the 2 groups (P = 0.019). Up to 12 months after surgeries, the recurrence rate was 33.3% in the control group and 7.4% in the treatment group, and the difference between the 2 groups was statistically significant (P = 0.048). The rates at the end of 18 months were the same. During the follow-up period, no complications were observed except for 1 conjunctival granuloma (in the treatment group) and 2 corneal epithelial defects (one in the control group and the other in the treatment group).
Conclusions:
Administration of IFN alpha-2b eye drops after the bare sclera technique appear safe and effective in reducing the recurrence of pterygium.
... Recurrence of pterygium is a frequent source of dissatisfaction for the operating surgeon as well as for the patient. 1 Preoperative risk factors for recurrence of primary pterygium include younger age of less than 50 years, 2 higher grade of corneal involvement, 3 pterygium morphology, 4 operating surgeon's skill and experience. 5 Amidst these factors, the morphology of the pterygium has been associated with higher recurrence rate, with fleshy pterygia producing higher recurrence rate than atrophic ones. 3 Previous studies have correlated the morphology of the pterygium with recurrence by employing various techniques in dealing with the bare sclera after surgical excision. ...
Objective:
To investigate the effect of pterygium morphology on recurrence with preoperative subconjunctival injection of mitomycin-C in primary pterygium surgery.
Study design:
Quasi-experimental study.
Place and duration of study:
Eye Department, Combined Military Hospital, Malir Cantt, Karachi, from February 2017 to February 2018.
Methodology:
On the basis of pterygium morphology, 165 eyes of 165 patients were equally divided into three equal groups of atrophic, intermediate and fleshy pterygia. In each morphology group, length was graded into three groups using limbus, pupil margin and midiris as landmarks. All pterygia received 0.1 ml of mitomycin-C injection in a concentration of 0.15 mg/ml at 24 hours prior to undergoing a bare sclera surgical excision technique in all cases. All patients were followed up for 12 months. The recurrence rate was recorded in each morphology group. Pearson Chi-Square test was used to compare recurrence rate and morphology group. Fisher's exact test was applied to compare recurrence rate with length and age in each type of morphology.
Results:
Among the three morphology groups, the recurrence rate was statistically significant between fleshy and atrophic pterygia (p=0.01) and no significant association was found among other morphology comparisons. Age less than 40 years had a significant effect on recurrence in all morphology groups. Length did not affect the recurrence rate in any of morphology types.
Conclusion:
Recurrence of primary pterygium is related to fleshiness of the pterygium and is a significant risk factor for recurrence after preoperative subconjunctival injection of mitomycin-C given at 24 hours before sclera excision.
... Bevacizumab is a recombinant human monoclonal antibody against VEGF, which is approved by FDA treating neoplasms. Many randomized controlled trials (RCTs) were performed to assess the safety and efficacy of bevacizumab in management of pterygium, showing conflicting conclusions [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. A meta-analysis of 9 RCTs was conducted in 2014 [35], and the result showed that topical or subconjunctival bevacizumab had no statistically significant effect on preventing pterygium recurrence. ...
... A meta-analysis of 9 RCTs was conducted in 2014 [35], and the result showed that topical or subconjunctival bevacizumab had no statistically significant effect on preventing pterygium recurrence. However, the result was not been consistently supported by another 9 new RCTs published after 2014 [26][27][28][29][30][31][32][33][34]. e conclusion might be altered by the addition of 9 new studies. ...
... Characteristics of included studies are summarized in Table 1. In total, 18 RCTs were included in this review [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. 17 studies were published in English and 1 in Chinese. ...
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.
... After evaluating the data, Banifatemi's report (2011) was included as it contained more detailed results. Finally, 18 eligible articles with results [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] remained for the meta-analysis. ...
... In the 18 included studies, several anti-VEGF agents [7][8][9][10][11][12][14][15][16][17][18][19][20][21][22][23][24][25] such as bevacizumab (Avastin), pazopanib, and ranibizumab (Lucentis) were used. The method, timing, indication, and dosage of the anti-VEGF treatment are listed (see table, Supplemental Digital Content 2, http://links.lww.com/MD/C411, which summarizes the numbers of human studies) and detailed information is provided in Table 1. ...
... No any ocular adverse event was reported in either the intervention group or in the control arm in 4 RCTs. [10,14,17,20] Each adverse event served as 1 unit of analysis. Since repeat adverse events can occur in the same participant, overall adverse events were divided into 4 groups based on the grades assigned by the reviewers: ocular intolerance; conjunctival adverse events; corneal adverse events; or filtering bleb adverse events. ...
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.
... Subconjunctival bevacizumab injection without surgery for primary pterygium was shown to be effective for reducing the pterygium size and improving visual function [20,21]. However, the efficacy of the administration of bevacizumab combined with surgical excision is more controversial [22][23][24][25][26][27]. Castañeda et al. believed that subconjunctival bevacizumab injection could prevent pterygium recurrences in conjunction with surgery [23]. ...
... Ozgurhan et al. found that topical bevacizumab therapy was effective to prevent neovascularization and had lower recurrence rate [27]. However, other studies disagreed with it [24][25][26]. Treatment efficacy of such antifibrotic or anti-VEGF medications is not currently clear because direct comparisons are rare. ...
... The diagram for the network of interventional treatments included in the present meta-analysis is shown in Fig. 2. There were 10 trials that compared bevacizumab to placebo [23][24][25][26][27][31][32][33][34][35], 14 trials that compared MMC to placebo [16,[36][37][38][39][40][41][42][43][44][45][46][47][48], 2 that compared 5-FU to placebo [49,50], 2 that compared β-RT to placebo [51,52], 2 that compared MMC to 5-FU [53,54], 1 that compared MMC to β-RT [11], 1 that compared bevacizumab to MMC [55], and 1 that compared bevacizumab with 5-FU [56]. One study compared either bevacizumab or MMC to placebo [57] ( Table 1). ...
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.
