Subtenon Injections of Ranibizumab Arrest Growth in Early Recurrent Pterygium

Rose, L. R. F.; Byrd, Julia M.; Qaseem, Yousuf

doi:10.1097/icl.0000000000000292

Cited by 5 publications

(6 citation statements)

References 21 publications

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“… 84 89 Therefore, in recent years, anti-VEGF agents such as bevacizumab and ranibizumab have been studied widely in primary and recurrent pterygium treatment as adjunctive therapy to surgical excision or as a nonsurgical treatment alone. 58 85 86 87 88 89 90 91 92 93 Different routes and doses of administration have been evaluated in multiple studies. Subconjunctival and topical application are the most popular administration techniques.…”

Section: R Esultsmentioning

confidence: 99%

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: 99%

Recurrent pterygium: A review

et al. 2021

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“… 3 , 4 More aggressive pterygia are sometimes targeted with 5-FU and subconjunctival anti-VEGF, though these treatments are less proven. 5 , 6 , 7 , 8 …”

Section: Discussionmentioning

confidence: 99%

“…5 , 6 More recent studies, however, have concluded that anti-VEGF injections, particularly subtenon ranibizumab, may have therapeutic utility in pterygium treatment, effectively preventing regression in up to 50% of cases. 7 …”

Section: Discussionmentioning

confidence: 99%

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Simple limbal epithelial transplantation for recurrent pterygium: A case series

Mednick

Boutin

Einan‐Lifshitz

et al. 2018

American Journal of Ophthalmology Case Reports

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PurposePterygium recurrence is a common complication of pterygium removal. Multiple surgical and medical approaches have been utilized to reduce recurrence rates. The present case series proposes a novel way to treat recurrent pterygia, by using the simple limbal epithelial transplantation (SLET) technique.ObservationsThe cases of four patients who presented with recurrent pterygium were reviewed. In all four of the cases reported, the SLET procedure went without complication. There were no significant recurrences at each of the patient's most recent follow-up visits.Conclusions and importanceThis is the first report of SLET being used as a treatment modality for recurrent pterygium. Further studies are required to more reliably demonstrate the utility of the procedure in this clinical circumstance, but our results are encouraging that in select patients, this may be a viable option in treating aggressive recurrent pterygia.

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“…The recurrence rate is with varying rates from 25% to 90% in just excision without covering the conjunctival defect. Therefore, using augmented drugs [e.g., Mitomycin-C, 5-fluorouracil, bevacizumab [5] , ranibizumab [6] , aflibercept [7] , cyclosporine A [8] and interferon α2b [9] ] or other techniques with the covering of the bare area is mandatory [10] .…”

Section: Introductionmentioning

confidence: 99%

Comparison Study between Intralesional Injection of MMC with Bare Sclera Excision of Pterygium and Conjunctiva Auto Grafting Technique

El-Sayed

2021

International Journal of Medical Arts

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Background: Pterygium is a fibrovascular tissue that abnormally invades the cornea from the conjunctiva. Aim of the work:Comparison Bare sclera technique of pterygium excision immediately after injecting it with MMC and conjunctival autografting without using MMC regarding recurrence rate and other complications. Methods: This prospective interventional study included 40 cases of pterygia from September 2017 to March 2019. cases were divided into two groups: Group 1 included 20 eyes received 0.1 ml [0.01%] of intrapterygial mitomycin-C [MMC] injection, then excision with bare scleral Group 2 included 20 eyes with simple excision then covering the bare sclera with a conjunctival autograft from superior bulbar conjunctiva. Results: The mean age was 45.175 and 45.4 years in Group 1 and 2, respectively, [P = .527]. There were 7 [35%] males and 13 [65%] females in Group 1 and 8 [40%] males and 12 [60%] females in Group 2 [P = .744]. The regression rate was 5% in each Groups [P = 1]. Postoperatively, scleral hypo vascularity occurred in 5 eyes [25%] in Group 1 while never in Group 2 [P = .009]. Graft necrosis noticed in 2 cases [10%] in group 2. Conclusion: Both techniques resulted in a negligible [5%] recurrence rate. Although conjunctival graft with a significant reduction of complications as scleral hypo vascularity but with more surgical time.

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Subtenon Injections of Ranibizumab Arrest Growth in Early Recurrent Pterygium

Abstract: In half of the subjects, subtenon ranibizumab appeared to arrest growth. Although the response is variable, this may warrant the drug's use when attempting to control growth of recurrent pterygia, and may prevent consecutive surgery for some patients.

Cited by 5 publications

References 21 publications

Recurrent pterygium: A review

Recurrent pterygium: A review

Simple limbal epithelial transplantation for recurrent pterygium: A case series

Comparison Study between Intralesional Injection of MMC with Bare Sclera Excision of Pterygium and Conjunctiva Auto Grafting Technique

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