Preventing Pterygium Recurrence Research Articles

Comparison of postoperative topical interferon-α2b versus intraoperative mitomycin C for pterygium recurrence prevention: a randomized clinical trial.

To evaluate the effect of postoperative interferon-alpha 2b (IFN-α2b) ophthalmic drops versus intraoperative mitomycin-c (MMC) on preventing pterygium recurrence. This prospective randomized clinical trial was conducted on patients who were candidates for pterygium surgery. A total of 75 patients were included in the study from December 2021 to December 2022, of which 64 patients (one eye each) were examined and analyzed based on the inclusion criteria. Then the patients were randomly assigned to control groups, intra-operative MMC (32 patients) and the intervention group, IFN-α2b drops after the operation (32 patients). All patients underwent pterygium surgery using the rotational conjunctival flap method. In terms of pterygium grading, 8 (12.5%), 25 (39.06%), and 31 (48.44%) eyes were in grades 1, 2, and 3, respectively. The average size of the pterygium was 3.6 ± 0.7mm. The grade and size of pterygium had the same distribution in the two groups. There was no statistically significant difference between the two groups in the level of post-operative clinical inflammation. The present study showed no significant difference in complications between the two groups (p = 0.999). The recurrence rate in the control group was 9.4% (3 eyes), and 0% (no recurrence) in the intervention group (p = 0.119). interferon-alpha 2b group did not show a statistically significant difference in preventing pterygium recurrence compared to the mitomycin C group. The post-surgery administration of IFN-α 2b drops can effectively prevent pterygium recurrence with a comparable and even more compelling effect than MMC during surgery.

ZD6474 Attenuates Fibrosis and Inhibits Neovascularization in Human Pterygium by Suppressing AKT-mTOR Signaling Pathway.

Purpose: To investigate the antifibrotic effect of ZD6474 in human pterygium fibroblasts (HPFs) and angiogenesis in human umbilical vein endothelial cells (HUVECs) compared with mitomycin C (MMC). Methods: Pterygium and tenon fibroblasts were isolated from patients undergoing surgery to culture HPFs and human tenon fibroblasts (HTFs). The effects of ZD6474 on HPF, HTF, and HUVEC proliferation and migration were detected using CCK8 and wound-healing assays, respectively. Fibrosis and epithelial-mesenchymal transformation (EMT) were evaluated by western blotting [transforming growth factor beta (TGF-β)1/2 and snail] and immunofluorescence (vimentin and α-smooth muscle actin). The antiangiogenic effect of ZD6474 on HUVECs was assessed using a tube formation assay. To determine the potential mechanism, the expression of phosphorylated AKT (p-AKT) and phosphorylated mTOR (p-mTOR) was evaluated by treatment with ZD6474 via western blotting. Results: ZD6474 robustly inhibited the proliferation and migration of HPFs rather than HTFs compared with those in the MMC group (**P < 0.01). In HPFs, fibrosis and EMT (vimentin, TGF-β1/2, and snail) were significantly reversed by ZD6474. MMC (>50 μg/mL) significantly reduced HTF viability, whereas ZD6474 (<5 μM/mL) did not decrease HTF viability. HUVEC proliferation and migration were clearly decreased, and tube formation was notably interrupted by ZD6474. Activation of p-AKT and p-mTOR was inhibited by ZD6474 treatment of HPFs and HUVECs. Conclusion: ZD6474 is more effective than MMC in reducing fibrosis and EMT in HPFs. In addition, ZD6474 was less toxic to HTFs. ZD6474 also exhibited antiangiogenic effects in HUVECs. This study may aid in the development of novel agents to prevent pterygium recurrence after pterygium excision.

Ciclosporin use for prevention of pterygium recurrence

BACKGROUND: Despite the development of new methods for treatment of pterygium, the frequency of its recurrence ranges from 5 to 89%.&#x0D; AIM: Was to evaluate the effectiveness of ciclosporin for prevention of pterygium recurrence.&#x0D; MATERIALS AND METHODS: Under follow-up, there were 104 patients operated for pterygium, of which 26 had a high risk of recurrence, they were divided into 2 groups: the 1st group 13 patients received 0.05% ciclosporin in addition to basic therapy; the 2nd group 13 patients receiving only basic therapy. Patients of studied groups were under dynamic observation for 1 year.&#x0D; RESULTS: After 3 months, all patients of the 1st group showed normalization of the osmolarity of the lacrimal fluid (OLF) and the ocular surface disease index (OSDI). In patients of the 2nd group, elevated values of OLF and OSDI remained characterizing the persistence of an inflammatory reaction signs and a high risk of the disease recurrence, as well as the formation of a hypertrophic scar in 38.5% of cases. In one year after surgery, 3 patients of group 2 had a recurrent pterygium, which required surgical retreatment.&#x0D; CONCLUSIONS: We obtained results showing a positive effect of ciclosporin use on dynamics of inflammatory reactions of the ocular surface in postoperative period, which made it possible to prevent pterygium recurrence after its surgical treatment in patients with high risk of recurrence.

Pilot study of a glue-less, suture-less amniotic membranefor pterygium excision.

Pterygium is a non-cancerous, fibrovascular growth of the bulbar conjunctiva that can cause visual disturbance, ocular pain, and cosmetic concerns. Surgical management is required in certain cases, which consists of excising the pterygium and associated Tenon's, then overlaying the bare sclera with an autograft or amniotic membrane using glue or sutures. The purpose of this study is to assess outcomes of pterygium repair using a newly developed self-adhesive amniotic membrane that does not require glue or sutures for fixation. Chart review of pterygium excision using a new self-adhesive amniotic membrane from a single surgical practice from 2012-2018. Descriptive statistics from 51 primary cases of pterygium excision were included. Pterygium recurrence occurred in 3 of the 51 self-adhesive amniotic membrane cases studied, resulting in a recurrence rate of 5.9%. Pterygium excision with the self-adhesive amniotic membrane had high rate of pyogenic granuloma formation of 27%. Self-adhesive amniotic membranes were found to perform comparably to more widely used techniques for pterygium excision, namely amniotic membranes and conjunctival autographs with glue or sutures. However, the self-adhesive grafts are associated with substantially more pyogenic granuloma formation. Self-adhesive amniotic membranes offer comparable efficacy for preventing pterygium recurrence in comparison to other amniotic membranes and the conjunctival autograft. The incidence of pyogenic granuloma formation is higher in self-adhesive grafts compared to other widely used options.

Curcumin as Potential Adjuvant Therapy to Prevent Recurrence in Pterygium Excision.

Pterygium is a wing-shaped growth from the conjunctiva and fibrovascular tissue onto the surface of the cornea. It has a high postoperative recurrence rate (which can be as high as 89% and its severity may vary according to the approach adopted and the preoperative conditions). To reduce the postoperative recurrence rate, several surgical techniques have been developed. The pathophysiology of pterygium development is diverse, one of the main factors is the proliferative process initiated by the TGF-? mediator. One of the therapies developed to prevent pterygium recurrence is by targeting therapy on the proliferative pathway by adding pterygium surgery with adjuvant MMC therapy. MMC plays a role in inhibiting DNA synthesis, thereby reducing TGF-? expression and ultimately inhibiting cell proliferation. Although it can reduce the recurrence rate quite well, MMC has numbers of complications. Therefore, an agent is needed to suppress pterygium proliferation which is relatively safer. Curcumin is a compound derived from the tuber of Curcuma longa L. which includes polyphenols. Curcumin modulates proliferation by stimulating the formation of TGIF which is a negative regulator of TGF-? so that it can modulate proliferation.

Minimally Invasive Primary Excision and Primary Closure versus Primary Closure Using Mitomycin C to prevent Pterygium Recurrence

Objective: This study aimed to present a surgical technique in which we performed minimal excision and primary closure, which may reduce the recurrence rate, especially without using time-consuming graft procedures. Materials and Methods: Data from primary pterygium excision performed from 2013 to 2019, were retrospectively analyzed from the patient's electronic database. Patients who underwent only primary closure constituted Group 1, patients who underwent primary closure using mitomycin C as adjuvant therapy constituted Group 2. After the pterygium detached from the cornea with the help of blunt dissection, only the cap of the pterygium was resected with a Westcott scissor by vertical incision on the vascular and avascular region border. The primary closure involved a complete closure of the defect in the limbal surface by suturing the pterygium's head. Results: The study comprised a total of 31 patients, including 12 participants in Group 2 and 19 in Group 1. The average age of all subjects was 58.7 ± 9.4 years. The average postoperative follow-up time of groups was 29.2 ± 20.1 months and 30.0 ± 21.9 months, respectively(p = 0.88). Recurrence was observed in 4 (12.9%) of all patients during follow-up. While recurrence occurred in 10.5% of patients in group 1, recurrence was observed in 16.7% of patients in group 2. When the groups were compared in terms of recurrence, no statistically significant difference was observed (p=0.62). Conclusions: This minimal excisional and maximum physiological pterygium surgery is simple, fast, and safe in primary pterygium. It also has a relatively acceptable recurrence rate.

Role of topical cyclosporine in prevention of pterygium recurrence, after primary excision.

Role of topical cyclosporine in prevention of pterygium recurrence, after primary excision.&#x0D; Purpose: To evaluate the effect of cyclosporine on pterygium recurrence after primary excision&#x0D; Study Design: Non randomized prospective comparative study.&#x0D; Place and Duration of Study: The study was conducted in the department of Ophthalmology Liaquat University of Medical and Health Sciences Jamshoro from 2015 to 2017&#x0D; Material and Methods: One hundred and thirty eyes of 65 patients having bilateral pterygium, at least 2mm encroaching on the cornea, were randomly selected for study. After informed consent patient was seen on slit lamp, the dimensions of pterygium was measured. The eye with more pterygium was selected for post-operative cyclosporine and was named as cyclo- eye and fellow eye was selected for simple excision and was named as non-cyclo eye. Immediate post-operative treatment was tobramycin dexamethasone eye ointment twice and moxifloxacine eye drops three times daily until corneal epithelium was restored, followed by moxifloxacine and Cyclosporine eye drops twice daily until complete healing of ocular surface occurred and then cyclosporine 0.05% alone once daily in the evening up to three months. In the fellow eye tobramycin dexamethasone eye ointment and moxifloxacine eye drops were used for complete healing time followed by tears alone three times for three months. Recurrence was defined as 1mm encroachment of pterygium on the cornea. Follow up was done for six months.&#x0D; Results: Fifty-three patients who completed 6 months follow were only included in the results. In cyclo-eyes recurrent pterygium was observed only in 04(07.55%) and in non-cyclo eyes recurrence was observed in 23(43.40%). Therefore, cyclosporine was able to reduce pterygium recurrence further in 19(35.85%) eyes, but healing time increased. Mean healing time in cyclo-eyes 21.1354 days and in non-cyclo-eyes 15.0213 days. Standard deviation in cyclo-eyes 1.3412 and in non-cyclo-eyes 1.0413. P-value was 0.002 and 0.004 respectively.&#x0D; Conclusion: Cyclosporine is effective in reducing the recurrence rate of pterygium.&#x0D; Key words: Pterygium, cyclosporine, recurrence&#x0D;

Platelet-Rich Fibrin Membrane for Pterygium Surgery: Literature Review and Feasibility Assessment.

Pterygium is a common ocular disease caused by abnormal cellular proliferation leading to abnormal fibrovascular growth of the conjunctiva. The main treatment is surgical removal; however, despite the improvement of surgical techniques and development of adjuvant therapies, postoperative recurrence, which can be as high as 89%, remains a challenge. Currently, pterygium excision with conjunctival autograft remains the preferred surgical technique, although there is no gold standard technique to prevent pterygium recurrence. We have conducted a thorough and comprehensive review of the scientific literature regarding the use of PRF membranes in pterygium surgery. We aim to assess the safety, effectiveness, and applicability of platelet-rich fibrin membrane for primary pterygium surgery and assess its possible benefits in resource-limited settings.

Evaluation of the Use of Intraoperative Subconjunctival Injection of Triamcinolone Acetonide and Limited Peritomy during Bare Scleral Pterygium Excision

Aims: To evaluate the efficacy and safety of subconjunctival injection of triamcinolone acetonide (TA) and limited peritomy during bare scleral pterygium excision in preventing pterygium recurrence.&#x0D; Study Design: A prospective non-randomized interventional case series.&#x0D; Place and Duration of Study: All surgeries were done at the department of ophthalmology of Assiut university hospital (27 eyes) and Alforsan eye center in Assiut (3 eyes), Egypt, between November 2017 to December 2019.&#x0D; Methodology: Thirty eyes of 26 patients who underwent pterygium excision with bare sclera combined with intraoperative subconjunctival TA injection and limited peritomy primary pterygium grade 2 (T2, 3 eyes) and grade 3 (T3, 30 eyes). All patients were followed up for 12 months after surgery. Pterygium recurrence and complications were the key outcome steps.&#x0D; Results: Pterygium recurrence was seen in 3 eyes (10.0%) as following: grade 2 in one eye (3.3%) and grade 3 in two eyes (6.7%). Intraocular pressure elevation was observed in 9 eyes (30%). The IOP rise ranged from (22.4 to 37 mmHg). All eyes were successfully treated medically and reached normal values by the end of postoperative sixth month.&#x0D; Conclusion: This procedure appears to be reasonably safe and successful in reducing pterygium recurrence.

Role of oxidative stress and vascular endothelial growth factor expression in pterygium pathogenesis and prevention of pterygium recurrence after surgical excision.

To assess the roles of oxidative stress and vascular endothelial growth factor (VEGF) in pterygium pathogenesis and prevention of pterygium recurrence after surgical excision. Surgically removed pterygium tissue from 35 pterygium patients and normal conjunctival samples from 15 patients matched for age and sex (used as controls) constituted the study samples. The conjunctival samples were preserved at - 80 °C until analysis. Catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH) and total antioxidant (TAO) enzymatic activity and the levels of nitric oxide (NO), malondialdehyde (MDA) and VEGF were studied in both groups. To evaluate the recurrence rate after surgical excision, the pterygium patients were further subdivided into three groups according to the adjuvant therapy used to prevent recurrence. Group 1 consisted of 10 patients who were treated with 0.2 mg mitomycin-c (MMC) for 2 min. Group 2 consisted of 12 patients treated with subconjunctival bevacizumab injection after surgical removal of the pterygium. Group 3 consisted of 13 patients who underwent combined treatment with 0.2 mg of MMC for 2 min and subconjunctival bevacizumab injection. The follow-up of patients in the three groups ranged from 7 to 15 months. The activities of CAT, SOD, GSH and TAO were significantly lower in pterygium samples than in normal conjunctival samples (p < 0.0001 each). The levels of MDA (p = 0.046), NO (p < 0.0001) and VEGF (p < 0.0001) were significantly higher in pterygium patients than in controls. The lowest recurrence rate after surgical excision was that of the third group. Oxidative stress and VEGF could play a role in the pathogenesis of pterygium as indicated by decreased antioxidant enzymatic activity and increased levels of VEGF in the pterygium tissue and the role of MMC and anti-VEGF therapy in decreasing the recurrence rate after surgical excision.

Pterjium nüksünde mast hücresinin rolü

Purpose: To investigate the role in pterygium recurrence of mast cell, which is known to play a role in inflammatory and immunological events, we aimed to determine the mast cell number in primary and recurrent pterygium tissue samples and to determine its relationship with angiogenesis.Materials and Methods: The study included 61 patients with pterygium who underwent primary pterygium excision with a bare sclera technique, but recurrent after a while. Primary and recurrent pterygium tissue samples of the same patient were examined histopathologically. The mean mast cell count was calculated by counting from 3 different areas under light microscope at 400 x magnification. In addition, the number of vessels was scored at 200x magnification.Results: 34 of the patients were male and 27 were female. The mean age was 57.02 ± 7.96. The mean mast cell count was 8.46±2.52 in the primary pterygium tissue and 14.07±3.05 in the recurrent pterygium tissue. The mean vascular count was 12.90 ± 3.17 in primary pterygium tissue and 16.21 ± 2.24 in recurrent pterygium. Statistical analysis revealed a significant increase in the number of mast cells and vascular number in the recurrent pterygium. Mast cell number and vascularity were correlated in primary pterygium and recurrent pterygium tissue samples.Conclusion: Increased mast cell in pterygium tissue may play an important role in the recurrence of pterygium. Determining mast cell count in preventing pterygium recurrence may be important.

Role of Topical Cyclosporine in Prevention of Pterygium Recurrence, after Primary Excision

Purpose: To study the effect of cyclosporine on pterygium recurrence after primary excision Study Design: Non randomized controlled trial. Place and Duration of Study: The study was conducted in the department of Ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro from 2015 to 2017. Material and Methods: One hundred and thirty eyes of 65 patients having bilateral pterygium, at least 2 mm encroaching on the cornea, were selected for study. Dimensions of pterygium were measured on slit lamp. Half of the eyes were selected for post-operative cyclosporine and was named as cyclo- eye and fellow other eye was named as non-cyclo eye. Immediate post-operative treatment was tobramycin dexamethasone eye ointment twice and moxifloxacin eye drops three times daily until corneal epithelium was restored, followed by moxifloxacin and Cyclosporine eye drops twice daily until complete healing of ocular surface occurred and then cyclosporine 0.05% alone once daily in the evening up to three months. In the fellow eye tobramycin dexamethasone eye ointment and moxifloxacin eye drops were used for complete healing time followed by tears alone three times for three months. Follow up was done for six months. Results: Only Fifty-three patients who completed 6 months of follow-up were included in the results. In cyclo-eyes recurrent pterygium was observed only in 4 (07.55%) and in non-cyclo eyes recurrence was observed in 23 (43.40%) eyes. Mean healing time in cyclo-eyes was 21.1354 days and in non-cyclo-eyes, 15.0213 days. Conclusion: Cyclosporine is effective in reducing the recurrence rate of pterygium. Key Words: Pterygium, Cyclosporine, Cornea.

Comparison of hyperdry amniotic membrane transplantation and conjunctival autografting for primary pterygium

BackgroundThe purpose of this study was to evaluate the safety and effectiveness of the hyperdry amniotic membrane transplantation compared with conjunctival autografting for the treatment of primary pterygium.MethodsOne hundred and forty-one eyes from 130 patients with primary pterygium were treated with excision followed by hyperdry amniotic membrane or conjunctival autografting after random selection. Seventy-nine eyes from 71 patients received hyperdry amniotic membrane transplantation (HD-AM group), and 62 eyes from 59 patients received conjunctival autografting (CG group). Patients were followed up at one week and one, three, six, and 12 months post-surgery. Recurrence rate, postoperative complications, and final follow-up patient visits were prospectively evaluated.ResultsThe mean follow-up duration was 12.56 ± 4.35 months in the HD-AM group and 12.85 ± 3.90 months in the CG group. Recurrences were detected in four eyes (5.06%) in the HD-AM group and 13 eyes (20.97%) in the CG group. A statistically significant difference in frequency of recurrence between the two groups (P = 0.003) was observed. The cumulative non-recurrence rates at six and 12 months in all patients stratified by age and sex were not significantly different (P = 0.642 and P = 0.451, respectively, by log-rank test). Graft retraction and necrosis were not detected in the two groups during the follow-up period.ConclusionHyperdry amniotic membrane transplantation was effective in preventing pterygium recurrence when compared with conjunctival autografting and can be considered a preferable and safe grafting procedure for primary pterygium.Trial registrationCurrent Controlled Trials ISRCTN16900270, Retrospectively registered (Date of registration: 3 May 2018).

Ocular surface changes in recurrent pterygium cases post-operatively treated with 5-fluorouracil subconjunctival injections.

To investigate the ocular surface changes occurring in eyes with recurrent pterygium post-operatively treated with 5-fluorouracil intralesional injections. Retrospective observational study of recurrent pterygium cases treated with weekly intralesional injections of 0.1 mL (5 mg) of 5-fluorouracil (10 injections). Impression cytology samples taken from the lesion, the healthy conjunctivae (inferior, superior, and contralateral to injury), and the cornea before and after treatment were analyzed. Clinical ocular characteristics (including Schirmer's test and break-up time) were evaluated during treatment. A total of 15 eyes were treated, with the mean follow-up of 27 ± 8.7 months (mean ± standard deviation). Prior to treatment initiation, the ocular surface citology over the pterygium was found to be abnormal. No epithelial cells (27%) and a lower goblet cell density (73%) compared to the healthy conjunctivae (p < 0.01) were found. Squamous metaplasia was observed to some degree in the cornea (100%), pterygium (81%) and healthy conjunctivae (73%). Following treatment, pterygium composition had changed: epithelial cell number (100%) and goblet cell density (47%) had increased (p < 0.05). Goblet cell density was also increased in healthy conjunctivae (67%; p < 0.05). The degree of squamous metaplasia decreased in the cornea (67%), pterygium (45%), and healthy conjunctivae (60%; p < 0.05). No adverse effects were reported, recurrence progression was arrested, and conjunctival redness and dry-eye severity level were decreased in all cases (p < 0.01). The cytology of ocular surface in recurrent pterygium is abnormal. After weekly intralesional 5-fluorouracil injections, it tends to normalize. The 5-fluorouracil compound is a safe and effective treatment to prevent pterygium recurrence.

Conjunctival Autograft Versus Amniotic Membrane Transplantation for Treatment of Pterygium: Findings From a Cochrane Systematic Review

To summarize key findings from a systematic review of the effectiveness and risks of conjunctival autograft (CAG) compared with amniotic membrane transplant (AMT) for pterygium. Cochrane systematic review. We included only randomized controlled trials (RCTs) in which CAG and AMT had been compared for primary or recurrent pterygia. The primary outcome was recurrence of pterygium ≥1mm onto the cornea by 3 and 6months post surgery. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis. Twenty RCTs with 1866 participants (1947 eyes) were included. Pterygium recurrence 6months after surgery ranged from 3.3% to 16.7% in the CAG group and 6.4% to 42.3% in the AMT group based on data from 1021 eyes in 10 RCTs. Estimated risk ratios from meta-analysis indicated that CAG-treated eyes had a 47% lower risk of recurrence 6months after surgery compared with the AMT group (RR, 0.53, 95% confidence interval [CI], 0.33-0.85). For 96 eyes with recurrent pterygium, the risk of recurrence 6months after CAG was reduced by 55% compared with AMT (risk ratio [RR], 0.45, 95% CI, 0.21-0.99). Three-month recurrence rates were similar for CAG and AMT based on data from 538 eyes (6 RCTs). CAG was more effective than AMT to prevent pterygium recurrence by 6months post surgery, especially in recurrent pterygia. CAG-treated eyes had half the recurrence rates of AMT-treated eyes. Future RCTs should assess changes in patient-reported outcomes (symptoms, cosmesis) and visual acuity, and evaluate effects of surgical variations.

Efficacy of Subconjunctival Bevacizumab Injections before and after Surgical Excision in Preventing Pterygium Recurrence.

Purpose To evaluate the efficacy of subconjunctival bevacizumab injections, before and after surgical excision with bare sclera technique, in preventing postoperative pterygium recurrence. Material and Methods 83 eyes of 83 patients affected with primary pterygia underwent surgical excision. 42 eyes received two subconjunctival bevacizumab injections, at the dosage of 2.5 mg/0.1 ml, one week prior surgery and one week after intervention. Recurrence rate was evaluated among the two groups. Moreover, modifications of pterygium size and grade one week after the first injection were evaluated. Results At 6 months after surgery, the recurrence rate was 7.14% in the bevacizumab group and 24.39% in the control group. Significant changes of pterygium size and grade were reported after the first injection. No important complications related to bevacizumab subconjunctival injections were registered. Conclusions The application of subconjunctival bevacizumab injections, at the dosage of 2.5 mg/0.1 ml, before and after surgical pterygium excision, may be useful in preventing lesion recurrence after bare scleral procedures. Furthermore, bevacizumab subconjunctival administration is well tolerated and may represent a safer alternative if compared with other surgical techniques and adjunctive drugs. This trial is retrospectively registered with ISRCTN Registry on 18 April 2017, TRN: ISRCTN11424742.

Pterygium surgery using the principle of contact inhibition: results of 13 years\u2019 experience

PurposeTo report a technique to prevent pterygium recurrence using the principle of contact inhibition.MethodsTwo hundred and fifteen patients (232 eyes; average age, 64.1 years) with primary pterygia who underwent pterygium surgery at the Hara Eye Hospital between 1999 and 2012. We retrospectively evaluated the patients who underwent the following procedure to prevent pterygium recurrence. The surface conjunctiva on the pterygium body was not removed. After removing the pterygium body, by placing a narrow pedicle autoconjunctival flap along the corneal limbus and tying it tightly to the front area of the residual conjunctiva, there is no room for the active residual tissue to proliferate, thus preventing a recurrence by contact inhibition. The key factor is conjunctival suturing, which establishes face-to-face contact of both areas of cut conjunctival tissue. Mitomycin C is applied locally for 3 min intraoperatively and 5 days postoperatively. The main outcome measure was the prevention of pterygium recurrence using this technique.ResultsBy the end of the average follow-up of 5 years 4 months, three eyes (1.3%) had a recurrence. Among the 232 eyes, 23 eyes had large pterygia extending to the pupillary area. Using the surgical technique, there were no recurrences. No specific characteristic of the recurrence was found in association with the eye, sex, and preoperative grade.ConclusionsThis surgery has three relevant features: (1) reconfirmation of the effect of contact inhibition, (2) the anatomic structure of the conjunctival sac scarcely changes postoperatively, because the surface conjunctiva of the pterygium body is not removed, and (3) a low recurrence rate.

Interleukin-17 and its correlation with vascular endothelial growth factor expression in ocular surface pathologies: a histologic study.

Interleukin-17 (IL-17), a cytokine that was recently associated with various inflammatory processes, was evaluated in ocular surface inflammatory pathologies, namely pterygium and inflamed juvenile conjunctival nevus (IJCN). Its expression was examined in correlation with vascular endothelial growth factor (VEGF) expression. Expression of IL-17 and VEGF was immunohistochemically evaluated in 50 pterygia and 9 IJCN specimens. The pattern of IL-17 and VEGF expression was studied as well as the correlation between the 2 cytokines. Interleukin-17 was expressed in all IJCN samples and in 84% of pterygia (Fisher exact test, p&lt;0.002). In pterygium, it was expressed mainly in the basal layer of the epithelial cells, in the perivascular tissues, and in the vascular endothelial cells. In IJCN, it was mainly expressed in the inflammatory infiltrate. In normal conjunctival epithelium, it was barely detected and was positive in only 11%. Vascular endothelial growth factor was expressed in all IJCN samples and in 92% of pterygia (Fisher exact test, p&lt;0.002). It was expressed in the surface epithelial layers of the pterygium and in the vascular endothelium. In IJCN, it was again seen in the vascular endothelial cells and in the inflammatory infiltrate. Vascular endothelial growth factor expression was noted in 67% of normal conjunctival sections. The present study describes the expression of IL-17 in pterygium and in IJCN. These findings provide new insights into pterygium and IJCN pathogenesis. Interleukin-17 blockade may have a potential role in management of pterygium and IJCN or preventing pterygium recurrence.

Dexamethasone modifies mitomycin C-triggered interleukin-8 secretion in isolated human Tenon's capsule fibroblasts

Intraoperative mitomycin C (MMC) is widely used to prevent pterygium recurrence and glaucoma filtering bleb failure, but it has been shown to induce corneal inflammation and cell death. Postoperative dexamethasone (DEX) is advocated to reduce MMC-related inflammation and cell death in corneal fibroblasts. Nevertheless, its long-term regulation mechanism in Tenon's capsule remains to be explored. The purpose of this study was to investigate how DEX modifies MMC's effects in human Tenon's capsule fibroblasts (HTFs). HTFs isolated from the pterygium surgical patients (n = 6) were treated with MMC at 0, 0.1, 0.2, and 0.4 mg/ml for 5 min and incubated in DEX at 10 μM for 0, 1, 2, and 3 days. Recombinant interleukin-8 (IL-8) was used to verify the effect of MMC-related IL-8 secretion. Cell proliferation of all the treated cells was analyzed by WST-1 assay. The amount of IL-8 secretion in HTFs was determined by enzyme-linked immunosorbent assay. Immunoblotting assay was used to analyze the expression of peroxisome-proliferator-activated receptor gamma (PPARγ) and B-cell lymphoma-extra large (Bcl-xL). Our results revealed that MMC significantly reduced the HTF cell proliferation rate. Additionally, MMC significantly upregulated IL-8 secretion in HTFs concentration-dependently. At 3 days post treatment (dpt), 5-min exposures to 0.1, 0.2, and 0.4 mg/ml MMC resulted in 1.4-fold (p = 0.012), 1.6-fold (p = 0.012), and 2.5-fold (p = 0.001) increases of IL-8 secretion. In contrast, DEX reversed the MMC-retarded cell proliferation rate (p = 0.036) and repressed MMC-related IL-8 secretion by 33.5% at 3 dpt (p = 0.003). Addition of recombinant IL-8 noticeably suppressed HTF cell proliferation in a concentration-dependent manner. DEX stimulated upregulation of both PPARγ and Bcl-xL at 1 dpt in normal HTFs and at 2 dpt in MMC-treated HTFs. PPARγ silencing reduced expression of PPARγ and Bcl-xL, but enhanced IL-8 secretion (p < 0.001). On the other hand, Bcl-xL silencing enhanced IL-8 secretion (p < 0.001), but did not affect PPARγ expression. These revealed that IL-8 secretion in HTFs is modulated by PPARγ-dependent Bcl-xL signaling. We conclude that DEX reversed the MMC-inhibited HTF cell proliferation via diminishing the MMC-induced IL-8 secretion, which resulted from a late-phase upregulation of the PPARγ and Bcl-xL. These long-term effects suggest a beneficial postoperative DEX treatment following intraoperative MMC application.

Bevacizumab in the Treatment of Pterygium

The aim of this study was to assess the efficacy and safety of bevacizumab in the treatment of pterygium and to mainly explore its effects on recurrence rate and complications. We searched MEDLINE, EMBASE, Web of Science, and Cochrane Central Register from the inception to July 2013 for relevant randomized controlled trials that examined bevacizumab therapy for pterygium. Data concerning study design, patient characteristics, treatment, and outcomes were extracted. The methodological quality of the studies included was assessed using the Jadad score. Relative risk (RR) was calculated for recurrence rate and complications. A total of 474 patients with 482 eyes in 9 randomized controlled trials were analyzed. The pooled estimate showed that bevacizumab had no statistically significant effect on preventing pterygium recurrence [RR 0.90, 95% confidence interval (CI) 0.77-1.07, P = 0.23]. None of the subgroup analyses yielded significant results in favor of bevacizumab (surgery group: RR 0.77, 95% CI 0.50-1.18, P = 0.23; nonsurgery group: RR 0.98, 95% CI 0.86-1.11, P = 0.76; primary pterygium group: RR 0.82, 95% CI 0.53-1.26, P = 0.36; recurrent pterygium group: RR 0.95, 95% CI 0.82-1.09, P = 0.44). There were no statistically significant differences in the complications between the 2 groups (RR 1.00, 95% CI 0.73-1.37, P = 1.00). However, the bevacizumab group was associated with a higher risk of developing subconjunctival hemorrhage (RR 3.34, 95% CI 1.07-10.43, P = 0.04). Topical or subconjunctival bevacizumab was relatively safe and well tolerated, but it had no statistically significant effect on preventing pterygium recurrence. A large-scale trial with a suitable dosage and a longer follow-up would be required to rule out the possibility of any treatment benefit.