Evaluation of antimitotic and antiangiogenic effect of preoperative subconjunctival application of mitomycin C in primary pterygium: a randomized trial

Martins, Thiago Gonçalves dos Santos; Costa, Ana Luiza Fontes de Azevedo; Furuzawa, Karina Mie; Chammas, Roger; Alves, Mílton Ruiz

doi:10.1007/s10792-019-01081-0

Cited by 10 publications

(9 citation statements)

References 18 publications

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“…TWIST1 has shown a dramatic role in the formation of CAFs (K.‐W. Lee, Yeo, Sung, & Kim, ), and interestingly the formation of fibroblasts in the pterygium is possible because of its high recurrence rate, dropping the relapse rate in exposing of mitomycin (dos Santos Martins et al, ; Jaworski et al, ) and the overexpression of α‐SMA (Kato et al, ).…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…TWIST1 has shown a dramatic role in the formation of CAFs (K.-W Lee, Yeo, Sung, & Kim, 2014),. and interestingly the formation of fibroblasts in the pterygium is possible because of its high recurrence rate, dropping the relapse rate in exposing of mitomycin(dos Santos Martins et al, 2016;Jaworski et al, 2009) and the overexpression of α-SMA(Kato et al, 2007).Since cancer and pterygium shared EMT, we investigated the expression of TWIST1 in case of pterygium. Our data presents overexpression of TWIST1 in pterygium samples who had recurrence and growth activity.…”

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confidence: 98%

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Signaling roadmap to epithelial–mesenchymal transition in pterygium, TWIST1 centralized

Meshkani

Kooshan

Moghadam

et al. 2019

Journal Cellular Physiology

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Pterygium as a complex disease shares common features with other malignant cells in its onset recurrence and especially epithelial–mesenchymal transition (EMT) transition. Although using different approaches including conjunctival autografts, amniotic membrane, radiotherapy, mitomycin C (MMC) has shown promising insights in the inhibition of pterygium recurrence, it needs to be investigated in more details in molecular pathways to present adjuvant target therapy. In this study, we aimed to evaluate the expression of and then illustrate the role of signaling pathways on EMT in pterygium. Using real‐time polymerase chain reaction, the twist‐related protein 1 (TWIST1) expression was compared in primary pterygium and normal conjunctiva. This study assessed the mRNA expression, as well as the association between the clinicopathological indices and the gene expression level. The expression level of TWIST1 was overexpressed in 36% of our cohort ( n = 76). There was a significant positive correlation between recurrence with grade T, grade V and a significant negative correlation with growth activity. Our vast literature review on different signaling pathways in pterygium showed that EMT has centralization role in recurrence of this disease. Our data confirmed that EMT is important in the recurrence of pterygium samples and different signaling pathways end up activating the EMT markers. It is suggested to evaluate the environmental factors and their correlation with molecular markers to select favorable treatment for this kind of diseases.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

mentioning

confidence: 98%

Signaling roadmap to epithelial–mesenchymal transition in pterygium, TWIST1 centralized

Meshkani

Kooshan

Moghadam

et al. 2019

Journal Cellular Physiology

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“…Preoperative and intraoperative MMC injection have been shown to decrease the rate of pterygium recurrence, but dosage, timing, and safety profile are debated. Dos Santos Martins et al 39 concluded that preoperative subconjunctival MMC injection for pterygium surgery with conjunctival autograft reduces pterygium recurrence. Mandour et aland Zaky and Khalifa showed similar efficacy of preoperative injection of MMC compared with intraoperative application of MMC for bare sclera technique; Lotfy et al showed similar results comparing preoperative and intraoperative MMC for pterygium excision with conjunctival autograft.…”

Section: Mitomycin Cmentioning

confidence: 99%

Surgical Techniques and Adjuvants for the Management of Pterygium

Patel

Rhee

2021

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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To provide an updated review of surgical techniques and adjuvants for the management of pterygium. Methods: A literature search was conducted in PubMed for studies published since January 2011. "Pterygium surgery" and the MeSH term "Pterygium/surgery" was used. The results were filtered for randomized controlled trials in English, yielding 60 citations. Results: One study compared topical anesthetic agents. One study compared methods of corneal polishing of the corneoscleral bed after pterygium excision. Numerous studies evaluated the use of conjunctival autograft versus amniotic membrane, superior versus inferior conjunctival autograft, and conjunctival versus limbal-conjunctival autograft. Many studies evaluated graft fixation methods. Several studies evaluated the adjuvant use of mitomycin C, 5-fluorouracil, and bevacizumab. A few studies evaluated the adjuvant use of steroids. Eleven studies evaluated various methods of postoperative management. Conclusions: Current evidence supports pterygium excision with conjunctival autograft fixation using fibrin glue, followed by patching until the first postoperative visit. Surgical adjuvants and postoperative use of artificial tears and topical cyclosporine 0.05% may further reduce recurrence. Postoperative use of topical steroids is highly variable because there is no consensus regarding the optimal dose, frequency, and duration of treatment.

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“…Similarly, in the trial by Agahan et al, steroid-induced elevation of intraocular pressure and formation of Tenon’s cyst were reported; however, they were not considered related to the use of MMC ( 20 ). Martins et al also reported no MMC-related side effects during the follow-up period in their study ( 21 ). Most of the adverse events reported in the RCTs analyzed in the present study were present in the other subgroups (i.e., the CAG and AMT subgroups).…”

Section: Discussionmentioning

confidence: 66%

“…Adverse events were reported in nine RCTs ( n = 890) ( 19 – 21 , 24 – 28 , 30 ). Patients treated using CAG + MMC and CAG alone showed similar rates of adverse events (RR = 1.81; 95% CI, 0.40–8.31; P = 0.44; I 2 = 28%); however, the range of the CI was wide.…”

Section: Resultsmentioning

confidence: 99%

Amniotic membrane transplantation and conjunctival autograft combined with mitomycin C for the management of primary pterygium: A systematic review and meta-analysis

et al. 2022

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BackgroundPterygium is a common ocular surface disease. Recurrence is the greatest concern in the treatment of pterygium. Thus, a standardized and effective treatment modality with minimal risk for complications is needed for the management of pterygium. The aim of this systematic review and meta-analysis was to evaluate different tissue grafting options, including conjunctival autograft (CAG) with mitomycin C (MMC), CAG alone, and amniotic membrane transplantation (AMT), for the management of primary pterygium.MethodsWe searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases for relevant studies. We included randomized controlled trials (RCTs) in which CAG + MMC and AMT were compared with surgical excision with CAG alone for the treatment of primary pterygium. The rates of recurrence and adverse events reported in the studies were also evaluated. Risk ratio (RR) was used to represent dichotomous outcomes. The data were pooled using the inverse variance weighting method. The quality of the evidence derived from the analysis was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials.ResultsTwelve RCTs (n = 1144) were deemed eligible and included for analysis. Five RCTs had a low risk of bias, five had some concerns, and two had a high risk of bias. Subgroup analysis showed a statistically significant reduction in the rate of pterygium recurrence after CAG + MMC (RR = 0.12; 95% confidence interval [CI], 0.02–0.63). This outcome was rated as high-quality evidence according to the GRADE criteria. There were insignificant differences between the rates of recurrence after AMT and CAG (RR = 1.51; 95% CI, 0.63–3.65). However, this result was rated as low-quality evidence. Regarding adverse events, patients treated using AMT showed significantly lower rates of adverse events than those treated using CAG (RR = 0.46; 95% CI, 0.22–0.95). However, this finding was rated as low-quality evidence as well. CAG + MMC showed a safety profile comparable to that of surgical excision with CAG alone (RR = 1.81; 95% CI, 0.40–8.31). This result was also rated as low-quality evidence.ConclusionA single intraoperative topical application of 0.02% MMC during excision of pterygium followed by CAG has significantly shown to decrease the rate of pterygium recurrence to 1.4% with no severe complications.

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Evaluation of antimitotic and antiangiogenic effect of preoperative subconjunctival application of mitomycin C in primary pterygium: a randomized trial

Cited by 10 publications

References 18 publications

Signaling roadmap to epithelial–mesenchymal transition in pterygium, TWIST1 centralized

Signaling roadmap to epithelial–mesenchymal transition in pterygium, TWIST1 centralized

Surgical Techniques and Adjuvants for the Management of Pterygium

Amniotic membrane transplantation and conjunctival autograft combined with mitomycin C for the management of primary pterygium: A systematic review and meta-analysis

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