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

Tirado, A. García; Boto-de-los-Bueis, Ana; Jara, Luis Rivas

doi:10.1177/1120672118757428

Cited by 7 publications

(7 citation statements)

References 30 publications

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“… 19 Another study assessed the changes in pathological parameters of the ocular surface before and after 10 intralesional injections of 5-FU in recurrent pterygium cases. 49 They reported an increase in the number of epithelial cells and density of goblet cells, reduction in the squamous metaplasia, and changing in abnormal cytology to normal in these injected eyes. Patients also reported lower conjunctival redness and less eye dryness after 5-FU injection.…”

Section: R Esultsmentioning

confidence: 89%

“…The recovery of the conjunctival goblet cell population after CAU surgery in the pterygium may require more than 1 year. 49 Short durations of follow-up in most studies published before 2009 was a major limitation for the contribution of results in routine clinical practice. 7 15 17 44 50 Furthermore, since the loss to follow-up is common in the postoperative period, the validity of the reported recurrence rates is under debate.…”

Section: R Esultsmentioning

confidence: 99%

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Recurrent pterygium: A review

et al. 2021

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Purpose: To summarize the recent evidence regarding different aspects of pterygium recurrence. Methods: Human-based studies from PubMed, Scopus, and Google Scholar were identified using the following keywords: conjunctival disease, pterygium, recurrent pterygium, pterygium recurrence, pterygium management/surgery, conjunctival autograft (CAU), amniotic membrane graft/transplant, and adjuvant therapy (January 2009 to February 2021). We reviewed risk factors associated with the recurrence of pterygium, timing of recurrence, medical treatments to prevent from recurrence, and nonsurgical and surgical alternatives for management of recurrence. Results: Dry eye disease, black race, and young age are considered definite risk factors for recurrence. However, fleshy appearance of the pterygium and preoperative size remain controversial. Surgical techniques such as excessive suturing, insufficient conjunctival graft size, thick conjunctival graft with remained Tenon tissue, and postoperative graft retraction are considered possible risk factors for recurrence. Using fibrin glue instead of sutures can further reduce recurrence rates. Although recurrence could occur even after many years, most recurrences happen in the first 3–6 months after surgery. Multiple kinds of adjuvant medications are used before, during, or after the operation including mitomycin C (MMC), 5-ﬂuorouracil (5-FU), corticosteroids, and anti-vascular endothelial growth factors (anti-VEGFs). Multiple weekly subconjunctival 5-FU injections are shown to be safe and effective in halting the progression of recurrent pterygium. Although topical bevacizumab is found to inhibit the growth of impending recurrent pterygium, the effect is mostly temporary. CAU is superior to amniotic membrane transplantation in the treatment for recurrent pterygia. Conclusions: There is yet to be a panacea in treating recurrent pterygium. Currently, there is not a globally accepted recommendation for treating recurrent pterygium with anti-VEGFs or 5-FU as a nonsurgical treatment. We strongly recommend using MMC as an adjunct to surgery in recurrent cases, with consideration of its specific complications. CAU is the most effective surgical treatment for recurrent pterygium, and other new surgical therapies need further investigation.

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Section: R Esultsmentioning

confidence: 89%

Section: R Esultsmentioning

confidence: 99%

Recurrent pterygium: A review

et al. 2021

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“…The presence of squamous metaplasia is, however, a problematic area, as the classical pathological knowledge conflicts with the current pterygium state-of-the-art. Multiple reports uniformly describe squamous metaplasia in pterygium [ 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ]. Squamous metaplasia is known as the process by which a mature, non-squamous epithelium is replaced by a stratified, squamous epithelium ( Figure 3 D) [ 111 ].…”

Section: Uv-induced Cellular Reactionsmentioning

confidence: 99%

“…Grading systems for impression cytology—Four different systems have been published to evaluate the severity of metaplasia in impression cytology samples of pterygium: Murube and Rivas’s grading system [ 103 , 104 ], Nelson’s classification [ 106 ], Tseng’s grading system [ 110 ] and Wittpen’s grading system [ 109 ]. The criteria used for assessment are related to the nuclear/cellular morphology, epithelial cell size, nucleus-to-cytoplasmic ratio, cytoplasmic staining characteristics, goblet cell density, cellular organization and keratinization.…”

Section: Uv-induced Cellular Reactionsmentioning

confidence: 99%

Pterygium—The Good, the Bad, and the Ugly

Acker

Bogerd

Haagdorens

et al. 2021

Cells

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Pterygium is a multifaceted pathology that displays apparent conflicting characteristics: benign (e.g., self-limiting and superficial), bad (e.g., proliferative and potentially recurrent) and ugly (e.g., signs of preneoplastic transformation). The natural successive question is: why are we lacking reports showing that pterygium lesions become life-threatening through metastasis, especially since pterygium has considerable similarities with UV-related malignancies on the molecular level? In this review, we consider how our pathophysiological understanding of the benign pterygium pathology overlaps with ocular surface squamous neoplasia and skin cancer. The three UV-related disorders share the same initial insult (i.e., UV radiation) and responsive repair mechanisms to the ensuing (in)direct DNA damage. Their downstream apoptotic regulators and other cellular adaptations are remarkably alike. However, a complicating factor in understanding the fine line between the self-limiting nature of pterygium and the malignant transformation in other UV-related diseases is the prominent ambiguity in the pathological evaluation of pterygium biopsies. Features of preneoplastic transformation (i.e., dysplasia) are used to define normal cellular reactions (i.e., atypia and metaplasia) and vice versa. A uniform grading system could help in unraveling the true nature of this ancient disease and potentially help in identifying the earliest intervention point possible regarding the cellular switch that drives a cell’s fate towards cancer.

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“…found that eyes with pterygium showed markedly higher tear osmolarity levels, corneal staining, and conjunctiva redness scores, as well as lower tear break‐up time and tear volumes than the healthy fellow eyes (Ozsutcu et al., ). Two more recent studies also demonstrated the high prevalence of dry eye in patients with pterygium, and pterygium recurrence was found to be associated with a greater severity of dry eye, probably through perpetuating ocular surface inflammation in the postoperative period (Garcia Tirado, Boto de Los Bueis, & Rivas Jara, ; Tan, Vollmer‐Conna, Tat, & Coroneo, ). All of these studies implicated the potentially close relationship between pterygium and abnormal ocular surface function.…”

Section: Introductionmentioning

confidence: 94%

Shared gene signature between pterygium and meibomian gland dysfunction uncovered through gene‐expression meta‐analysis

Zhang

Xiang

et al. 2019

Annals of Human Genetics

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Background Pterygium and meibomian gland dysfunction (MGD) are two clinically correlated ocular diseases. We propose to investigate the shared gene signature between pterygium and MGD. Methods Microarray datasets were retrieved from the Gene Expression Omnibus (GEO) database. Initial processing of the data was performed using the R programming package. Gene‐expression values were log2 transformed and normalized by quantile normalization. The differentially expressed genes (DEGs) in each individual dataset were analyzed by the limma package. The integration of different pterygium datasets and gene‐expression meta‐analysis was conducted by the NetworkAnalyst package. A Venn diagram was created to find the overlapped DEGs between MGD and pterygium datasets. Gene ontology enrichment and pathway analysis were performed using the ToppGene Suite. Results We found 193 DEGs significantly up‐regulated in pterygium, with the combined effect sizes ranging from 1.53 to 3.78. A gene signature consisting of 11 DEGs were found to be shared by pterygium and MGD (SPRR3, SERPINB13, NMU, KRT10, IL37, KRT6B, PI3, S100A2, MAL, AURKA, and RGCC), and bioinformatics analyses showed that these overlapped DEGs were significantly enriched in pathways related to keratinization, cell‐cycle regulation, and formation of the cornified envelope. Conclusion We identified a shared gene signature between pterygium and MGD through gene‐expression meta‐analysis. The analysis of this signature underlined that keratinization‐related pathways may play important roles in the development of these two clinically correlated pathologies.

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

Abstract: 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.

Cited by 7 publications

References 30 publications

Recurrent pterygium: A review

Recurrent pterygium: A review

Pterygium—The Good, the Bad, and the Ugly

Shared gene signature between pterygium and meibomian gland dysfunction uncovered through gene‐expression meta‐analysis

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