Intra-lesional 5 fluorouracil for the management of recurrent pterygium

Abstract

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.

A novel graft option after pterygium excision: platelet-rich fibrin for conjunctivoplasty

“…4,5,8,9 However, the most common challenging problem is recurrence rate after pterygium surgery. 16 The risk factors of pterygium recurrence are as follows: pterygium type and size, age of patient, environmental conditions, recurrent pterygium, and surgical technique. 17 Furthermore, surgical trauma, postoperative inflammation, fibroblast proliferation, and deposition of extracellular matrix protein have been related with the mechanism of pterygium recurrence.…”

“…20,22,[24][25][26][27][28] Another important finding is that the PRF grafting resulted in milder postoperative inflammation, tissue reaction, and granuloma formation. 16,19 PRF also contains a large quantity of platelet and small amount of leukocyte cytokines, which can play a significant role in the selfregulation of inflammatory and infectious phenomena. 29,30 For this reason, PRF usage might yield a less pronounced postoperative inflammation.…”

Molecular Basis of Pterygium Development

“…182 5-Fu has proven to be safe and effective in reducing pterygium recurrence rate. 183 However, the recurrent cases can develop an unacceptable cosmetic appearance with excessive neovascularization. 184 Ethanol is known to cause denaturation of peptides and proteins in tissues, and it splits the basement membrane and destroys hemidesmosome junctions between corneal epithelial cells.…”

Healing of autologous conjunctival grafts in pterygium surgery

“…The changes described in the conjunctival autograft are not be confused with conjunctival recurrence of pterygium (Said et al 2013). In the majority, the donor site conjunctiva settled satisfactorily indicating that covering the donor site with conjunctiva and use of fibrin glue, restores conjunctival integrity.…”

“…Exposed tenons can cause pyogenic granuloma formation and adequate cover should be ensured to avoid this complication. The changes described in the conjunctival autograft are not be confused with conjunctival recurrence of pterygium (Said et al 2013). Most recurrence occurs in the first 6 months, which is the maximum time taken for all changes in conjunctival autograft to completely resolve.…”