Halting Pterygium Recurrence by Postoperative 5-Fluorouracil

Pikkel, Joseph; Porges, Yair; Ophir, Avinoam

doi:10.1097/00003226-200103000-00011

Cited by 40 publications

(34 citation statements)

References 18 publications

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“…24 Although intra-and post-operative use of 5FU has been discussed previously in isolated reports, few studies have attempted to show the beneficial use of intralesional 5FU injections for early recurrences. 10,11,25 As demonstrated in this study, avoidance of repeat surgery by means of 5FU injection confers the advantages of less scarring, reduced risk of intraoperative and post-operative complications, and all difficulties associated with harvesting more tissue from limited donor sites. Furthermore, the risk of recurrence increases with increasing number of operations.…”

Section: Discussionmentioning

confidence: 72%

“…19 The effective role of 5FU in halting pterygium recurrence has been discussed by others as well. 10,11 We have now adopted intra-lesional 5FU injection as a routine in the management of recurrent pterygium and report our results herein.…”

Section: Introductionmentioning

confidence: 99%

“…2 Several adjunctive treatments have been employed to reduce recurrences. These include steroids to reduce inflammation and scarring, 8 peri-operative application of antimetabolites such as mitomycin C (MMC) 9 or 5 fluorouracil (5FU), 10,11 and, more recently, the use of anti-VEGF antibodies administered topically or subconjunctivally. 12,13 Other previously adopted techniques such as beta radiation have been abandoned because of the high risk for scleral melt.…”

Section: Introductionmentioning

confidence: 99%

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Intra-lesional 5 fluorouracil for the management of recurrent pterygium

Said

Faraj

El‐Alfy

et al. 2013

Eye

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Aim Recurrence is the most common complication arising from pterygium surgery. The aim of this study was to investigate the effectiveness of 5 fluorouracil (5FU) in halting the recurrence of pterygium after surgical excision. Methods A retrospective review of patients treated for pterygium recurrence was carried out. Patients with recurrent (secondary) pterygium were treated with multiple weekly intra-lesional injections of 0.1-0.2 ml (2.5-5 mg) 5FU post-operatively depending on the size of the recurrence. The treatment was started within 1 month from the date of recurrence. The time from surgery to start of recurrence, previous treatment modalities, and number of recurrences were documented. The number of injections required to induce arrest of progression and/ or regression of vascularity and fleshiness of the pterygium and any complications related to 5FU treatment were examined. Results Fifteen eyes from 14 patients with recurrent pterygium treated with intralesional 5FU injections were analysed. Three of the 15 eyes had undergone a secondary excision and 12 had undergone a primary excision. In all, 93.3% of patients showed regression of the fibrovascular tissue (thickness and vascularity) and arrest of progression following a dose of 0.1-0.2 ml (2.5-5 mg) 5FU. Twelve eyes required three injections or fewer, whereas one patient required eight injections. This beneficial effect was maintained over an average follow-up period of 17 months. No complications from 5FU were observed. Conclusion The use of weekly intra-lesional 5FU injections for the treatment of recurrent pterygium is safe and effective in limiting the progression and inducing the regression of recurrent pterygium. The number of injections can be tailored according to clinical need.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intra-lesional 5 fluorouracil for the management of recurrent pterygium

Said

Faraj

El‐Alfy

et al. 2013

Eye

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“…However, due to high recurrence rate with simple excision which could be as high as 40% in some cases, 3 the use of adjunct therapy such as beta radiation, antimetabolites such as mitomycin-C and 5-fluorouracil (5-FU), and conjunctiva autograft have been advocated. 4,5 Both mitomycin-C and 5-FU have been shown to cause a reduction in recurrence rate of pterygium but they are both potentially toxic to ocular tissues and have been associated with some complications. 6 Conjunctiva autograft on the other hand has been said to be free of complications and although takes longer to perform is said to be associated with little or no recurrence.…”

Section: Introductionmentioning

confidence: 99%

Pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft

Bekibele

Baiyeroju

Olusanya

et al. 2006

Eye

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Background The use of conjunctiva autograft, adjunct antimetabolite therapy has been shown to be effective in preventing pterygium recurrence. Objective To compare 5 fluorouracil (5-FU) to conjunctival autograft in the treatment of large, fleshy pterygium. Methods A randomised controlled prospective study of outcome of pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft. Thirty-five eyes with large pterygium treated with bare sclera conjunctival excision plus 5-FU were compared with 33 eyes treated with excision and conjunctival autograft alone. Results Post-operative pterygium recurrence was observed in four (11.4%) eyes treated with 5-FU and 4 (12.1%) eyes treated with conjunctiva autograft (P40.05). The post-operative complications included, granuloma formation 11.4% for 5-FU and 3.0% for autograft and conjunctival discharge 5.7% for 5-FU group only. Conclusion 5-FU is marginally superior to conjunctival autograft in the prevention of pterygium recurrence but neither gives a more desirable single digit recurrence rate. Randomised studies combining both conjunctival autograft and 5-FU in pterygium treatment is advocated to further explore their effect.

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“…Recentemente foi sugerido o uso da Mitomicina C em infiltração intra-lesional, na cabeça do pterígio, 30 dias antes da cirurgia (14) . Entretanto, o 5FU foi usado de modo injetável apenas no período pós-operatório, utilizado em 4 infiltrações subconjuntivais (15) . Não existe, até o momento, relato de infiltração do 5FU no pré-operatório, como tratamento coadjuvante do pterígio.…”

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Infiltração de 5-fluorouracil no pré-operatório do pterígio

Shiratori¹,

Hoyama²,

Schellini³

et al. 2003

Arq. Bras. Oftalmol.

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Objetivo: Avaliar o efeito do 5-fluorouracil (5FU) injetado intralesionalmente na cabeça do pterígio no período pré-operatório. Métodos: Foram estudados 53 olhos (52 pacientes), sendo 28 pterígios primários e 25 recidivados, divididos em dois grupos: grupo 1 (G1), composto por indiví-duos que receberam a injeção de 5-fluorouracil 30 dias antes do procedimento cirúrgico e grupo 2 (G2), no qual o 5-fluorouracil foi injetado 10 dias antes da cirurgia. Todas as cirurgias foram realizadas seguindo-se a mesma técnica cirúrgica, pelo mesmo cirurgião. Os pacientes foram reavaliados 7, 30 e 60 dias após a cirurgia. Os resultados observados foram submetidos à análise estatística. Resultados: A amostra estudada foi constituída por 52,8% de pterígios primários e 47,2% de recidivados, sendo composta igualmente por indivíduos de ambos os sexos. Não ocorreram complicações decorrentes da infiltração da droga. A recidiva foi mais freqüente nos pterígios recidivados e no G1. Conclusão: O uso intralesional de 5-fluorouracil no pré-operatório do pterígio não provocou efeitos deletérios aos olhos estudados. Houve menor recorrência quando usado o 5-fluorouracil 10 dias antes da exérese cirúrgica, em relação à aplicação 30 dias antes do procedimento. Pterígio é uma doença ocular benigna, caracterizada por proliferação conjuntival que se estende sobre a córnea. A sua patogênese ainda não completamente esclarecida, associada a uma variável taxa de recidiva, constitui um desafio para o médico oftalmologista no que se refere à escolha da melhor opção terapêutica.Uma das modalidades de tratamento coadjuvante é o uso de drogas antimitóticas, empregadas desde a década de 60, como o Thio-tepa e a Mitomicina C.O uso do Thio-tepa provocava alterações transitórias nos tecidos oculares (como diminuição da sensibilidade corneana, alteração do volume e estabilidade do filme lacrimal e da vitalidade dos epitélios corneano e conjuntival)(1) e até déficit visual permanente (2) , o que abriu espaço para a Mitomicina C, que, na década de 80, surgiu como uma droga promissora para o tratamento coadjuvante do pterígio, sendo amplamente estudada e usada com bons resultados quanto à diminuição dos índices de recidiva de pterígios primários e recidivados (3)(4)(5) . Contudo, há também inúmeros relatos de complicações freqüentes e importantes associadas ao uso da Mitomicina C, como: glaucoma secundário, edema e perfuração corneana,

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Halting Pterygium Recurrence by Postoperative 5-Fluorouracil

Cited by 40 publications

References 18 publications

Intra-lesional 5 fluorouracil for the management of recurrent pterygium

Intra-lesional 5 fluorouracil for the management of recurrent pterygium

Pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft

Infiltração de 5-fluorouracil no pré-operatório do pterígio

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