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Tawfik HA, Ali MJ. A Major Review on Punctal Stenosis: Part II: Updated Therapeutic interventions, complications, and Outcomes. Surv Ophthalmol 2024:S0039-6257(24)00056-0. [PMID: 38796110 DOI: 10.1016/j.survophthal.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
We continue our review of on punctal stenosis by providing a detailed discussion of management modalities, their complications, and outcomes. There is a significant change in the understanding of punctal and peripunctal anatomy, puncto-canalicular junction, and the lacrimal pump mechanisms. While the snip punctoplasty procedures are still practiced, there is an increasing trend toward nonincisional procedures. The nonincisional procedures in select cases appear to be equally effective as the incisional ones. Although simple to use, punctal plugs never became the mainstay of treatment because of design issues and the inability to address the coexisting canalicular stenosis. Placing stents only in the lower punctum in cases of upper and lower punctal stenosis should be discouraged, and management needs to address punctal stenosis and not which punctum is involved. Several types of stents are used in the management of punctal stenosis, mostly based on surgeon's preference. The benefits of adjuvant mitomycin C are uncertain. In view of literature on how stent biofilms can themselves cause chronic inflammation, placing them for prolonged periods should be reviewed and debated. Enhanced understanding of the molecular pathogenesis of punctal stenosis and addressing the current controversies in management would help standardize the therapeutic interventions available in the lacrimal armamentarium.
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Affiliation(s)
- Hatem A Tawfik
- Department of Ophthalmology, Ain Shams University, Cairo, Egypt
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India.
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Han R, Zhong H, Zhang Y, Yu H, Zhang Y, Huang S, Yang Z, Zhong Y. MiR-146a reduces fibrosis after glaucoma filtration surgery in rats. J Transl Med 2024; 22:440. [PMID: 38720358 PMCID: PMC11080255 DOI: 10.1186/s12967-024-05170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE To explore the impact of microRNA 146a (miR-146a) and the underlying mechanisms in profibrotic changes following glaucoma filtering surgery (GFS) in rats and stimulation by transforming growth factor (TGF)-β1 in rat Tenon's capsule fibroblasts. METHODS Cultured rat Tenon's capsule fibroblasts were treated with TGF-β1 and analyzed with microarrays for mRNA profiling to validate miR-146a as the target. The Tenon's capsule fibroblasts were then respectively treated with lentivirus-mediated transfection of miR-146a mimic or inhibitor following TGF-β1 stimulation in vitro, while GFS was performed in rat eyes with respective intraoperative administration of miR-146a, mitomycin C (MMC), or 5-fluorouracil (5-FU) in vivo. Profibrotic genes expression levels (fibronectin, collagen Iα, NF-KB, IL-1β, TNF-α, SMAD4, and α-smooth muscle actin) were determined through qPCR, Western blotting, immunofluorescence staining and/or histochemical analysis in vitro and in vivo. SMAD4 targeting siRNA was further used to treat the fibroblasts in combination with miR-146a intervention to confirm its role in underlying mechanisms. RESULTS Upregulation of miR-146a reduced the proliferation rate and profibrotic changes of rat Tenon's capsule fibroblasts induced by TGF-β1 in vitro, and mitigated subconjunctival fibrosis to extend filtering blebs survival after GFS in vivo, where miR-146a decreased expression levels of NF-KB-SMAD4-related genes, such as fibronectin, collagen Iα, NF-KB, IL-1β, TNF-α, SMAD4, and α-smooth muscle actin(α-SMA). Additionally, SMAD4 is a key target gene in the process of miR-146a inhibiting fibrosis. CONCLUSIONS MiR-146a effectively reduced TGF-β1-induced fibrosis in rat Tenon's capsule fibroblasts in vitro and in vivo, potentially through the NF-KB-SMAD4 signaling pathway. MiR-146a shows promise as a novel therapeutic target for preventing fibrosis and improving the success rate of GFS.
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Affiliation(s)
- Ruiqi Han
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Huimin Zhong
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yang Zhang
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Huan Yu
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Yumeng Zhang
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Shouyue Huang
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Zijian Yang
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Yisheng Zhong
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
- Department of Ophthalmology, Wuxi Branch of Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Zhixian Road, Wuxi, China.
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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4
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Di Felice C, Machuzak MS, Shepherd RW. Use of Mitomycin-C in Laryngotracheal Stenosis: A Focused Clinical Review. J Bronchology Interv Pulmonol 2023; 30:223-231. [PMID: 37271867 DOI: 10.1097/lbr.0000000000000933] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Therapeutic options for managing laryngotracheal stenosis (LTS) are limited. Endoscopy is a minimally invasive approach to treating LTS, but carries a high risk of stenosis recurrence. Mitomycin C (MMC) is often used as an adjunct therapy to delay the time to symptomatic recurrence of LTS. This review synthesizes the current literature on the topic of MMC as an adjunct treatment strategy for LTS. METHODS A focused literature search was carried out from PubMed on June 12, 2022 using the terms "mitomycin c AND stenosis" in all fields with no date limitations. Evidence-based recommendations relevant to the clinical application of MMC as an adjunct therapy for LTS were formulated. Three questions were addressed: 1) efficacy of MMC, 2) single versus multiple application(s) of MMC, and 3) safety of MMC. The evidence rating and recommendation strength were guided by the GRADE system. RESULTS Twenty-nine studies were reviewed. The efficacy of MMC as an adjunct therapy for LTS varied across studies. Randomized controlled trials have not shown an outcome difference with MMC use, although methodologic flaws including underpowering were noted. A meta-analysis of observational studies with a comparator arm found the unadjusted probability of remaining symptom-free for > 1 year is greater with versus without MMC application (73% vs. 35%). Single versus multiple application(s) of MMC resulted in similar restenosis rates at long-term follow-up. Complications related to MMC use are rarely reported using conventional doses (0.4 mg/mL). Overall, the quality of evidence was low and the recommendation for intervention was weak. CONCLUSION The role for MMC as an adjunct therapy in LTS is uncertain. While safe in its application, the efficacy of MMC in reducing stenosis recurrence remains a matter of debate. Large, prospective studies are needed to inform future recommendations.
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Affiliation(s)
- Christopher Di Felice
- Department of Pulmonary and Critical Care Medicine, Louis Stokes Cleveland VA Medical Center
| | - Michael S Machuzak
- Department of Pulmonary, Allergy and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Ray W Shepherd
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
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5
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Bulloch G, Seth I, Sukumar S, Chen Y, Zhu Z. Scleral thinning causes, diagnosis, and management: A narrative review. Cont Lens Anterior Eye 2023; 46:101825. [PMID: 36894372 DOI: 10.1016/j.clae.2023.101825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Sclera forms the outer fibrous coat of the eye and provides structural integrity for the housing of intraocular contents. Scleral thinning is a serious progressive condition which can lead to perforation and worsening visual functioning. This review aims to summarize the anatomical consideration and causes of scleral thinning, diagnosis, and the various surgical approaches available to treat scleral thinning. MATERIALS AND METHODS The narrative literature review was conducted by senior Ophthalmologists and researchers. PubMed, EMBASE, Web of Science, Scopus, and Google Scholar databases were searched for relevant literature from infinity till March 2022. Terms of the search referred to 'sclera' or 'scleral thinning' or 'scleral melting', and were combined with 'treatment', or 'management' or 'causes'. Publications were included in this manuscript if they offered information about the nature of these topics. Reference lists of relevant literature was searched. There were no limits on type of article to be included for this review. RESULTS Scleral thinning arises from diverse congenital, degenerative, immunological, infectious, post-surgical, and traumatic etiologies. It is diagnosed upon slit-lamp examination, indirect ophthalmoscopy, and optical coherence tomography. Conservative pharmacological treatment of scleral thinning may include anti-inflammatory drugs, steroid drops, immunosuppressors, monoclonal antibodies, and surgical treatments including tarsorrhaphy, scleral transplantation, amniotic membrane transplantation, donor corneal graft, conjunctival flaps, tenon's membrane flap, pericardial graft, dermis graft, cadaveric dura mater graft, and other autologous and biological grafts. CONCLUSION Scleral thinning treatments have developed dramatically in recent decades and the rise of alternative grafts for scleral transplantation procedures or use of conjunctival flaps have taken center stage in surgical management. This review adds a comprehensive summary of the scleral thinning with attention to the positive and negative features of new treatments alongside previous mainstay management strategies.
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Affiliation(s)
- Gabriella Bulloch
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Australia; Faculty of Science, Medicine, and Health, The University of Melbourne, Australia
| | - Ishith Seth
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Australia; Faculty of Science, Medicine, and Health, The University of Melbourne, Australia; Faculty of Medicine, Central Clinical School, Monash University, Australia.
| | - Sharanya Sukumar
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Australia
| | - Yanping Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Province Key Laboratory of Ophthalmology and Vision Science, Guangzhou, China
| | - Zhuoting Zhu
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Australia; Faculty of Science, Medicine, and Health, The University of Melbourne, Australia
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Baheran SS, Alany RG, Schwikkard S, Muen W, Salman LN, Freestone N, Al-Kinani AA. Pharmacological treatment strategies of pterygium: Drugs, biologics, and novel natural products. Drug Discov Today 2023; 28:103416. [PMID: 36280041 DOI: 10.1016/j.drudis.2022.103416] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/02/2022] [Accepted: 10/18/2022] [Indexed: 02/02/2023]
Abstract
Pterygium is a fibrovascular tissue growth invading the cornea. Adjunctive treatment post-surgery includes conventional immunosuppressants as well as antiviral drugs. The use of large- and small-molecule antivascular endothelial growth factor (VEGF) agents remains an integral part of pterygium treatment as well as other neovascular conditions of the eye. Naturally occurring polyphenolic compounds have favorable characteristics for treating neovascular and inflammatory eye conditions, including good efficacy, stability, cost-effectiveness, and the versatility of their chemical synthesis. In this review, we discuss pharmacological treatments of pterygium. Natural products, such curcumin, ellagic acid, and chalcones, are reviewed, with emphasis on their potential as future pterygium treatments.
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Affiliation(s)
- Sanaz Sadig Baheran
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK
| | - Raid G Alany
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK; School of Pharmacy, The University of Auckland, Auckland 1023, New Zealand
| | - Sianne Schwikkard
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK
| | - Wisam Muen
- Royal Eye Unit, Kingston NHS Foundation Trust, Kingston upon Thames KT2 7BE, UK
| | - Lena Namaan Salman
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK
| | - Nicholas Freestone
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK
| | - Ali A Al-Kinani
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK.
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7
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Yeoh CHY, Lee JJR, Lim BXH, Sundar G, Mehta JS, Chan ASY, Lim DKA, Watson SL, Honavar SG, Manotosh R, Lim CHL. The Management of Ocular Surface Squamous Neoplasia (OSSN). Int J Mol Sci 2022; 24:ijms24010713. [PMID: 36614155 PMCID: PMC9821412 DOI: 10.3390/ijms24010713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
The rise of primary topical monotherapy with chemotherapeutic drugs and immunomodulatory agents represents an increasing recognition of the medical management of ocular surface squamous neoplasia (OSSN), which may replace surgery as the standard of care in the future. Currently, there is no consensus regarding the best way to manage OSSN with no existing guidelines to date. This paper seeks to evaluate evidence surrounding available treatment modalities and proposes an approach to management. The approach will guide ophthalmologists in selecting the most appropriate treatment regime based on patient and disease factors to minimize treatment related morbidity and improve OSSN control. Further work can be done to validate this algorithm and to develop formal guidelines to direct the management of OSSN.
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Affiliation(s)
- Clarice H. Y. Yeoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jerome J. R. Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
| | - Blanche X. H. Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Gangadhara Sundar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Jodhbir S. Mehta
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore
- Singapore Eye Research Institute, Singapore 169856, Singapore
- Singapore National Eye Centre, Singapore 168751, Singapore
| | - Anita S. Y. Chan
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore
- Singapore Eye Research Institute, Singapore 169856, Singapore
- Singapore National Eye Centre, Singapore 168751, Singapore
- Histopathology, Pathology Department, Singapore General Hospital, Singapore 169608, Singapore
| | - Dawn K. A. Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Stephanie L. Watson
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW 2000, Australia
| | | | - Ray Manotosh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Chris H. L. Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
- Singapore Eye Research Institute, Singapore 169856, Singapore
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence:
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Jomar DE, AlHilali S, AlMutlak M. Scleral melt and uveal prolapse following 23-gauge pars plana vitrectomy. Am J Ophthalmol Case Rep 2022; 29:101769. [PMID: 36544747 PMCID: PMC9762149 DOI: 10.1016/j.ajoc.2022.101769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To report a case of uncontrolled juvenile open angle glaucoma (JOAG), with secondary high axial myopia who presented with scleral melting and uveal prolapse post pars plana-vitrectomy. Observations A 17-year-old male juvenile glaucoma patient, not known to have any systemic disease underwent a right eye 23-gauge-pars plana vitrectomy for retinal detachment repair. Three weeks following his surgery he presented complaining of tearing and photophobia in the operated eye in the absence of any ocular pain. Clinical exam revealed enlarged sclerotomy sites with localized conjunctival and episcleral injection, scleral thinning and uveal prolapse. Infectious and serologic work up were obtained to rule out an infectious etiology or underlying autoimmune disease. Patient was successfully managed with topical steroids and a donor scleral patch graft. Conclusion and importance This report addresses multiple risk factors for a devastating complication that may occur in predisposed patients, with primary or secondary axial myopia and a compromised sclera. This group of patients can be at risk of post-operative scleral melting and thinning and should be identified pre-operatively and monitored closely during their post-operative course.
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Affiliation(s)
- Deema E. Jomar
- Corresponding author. Cornea and Anterior Segment Division, King Khaled Eye Specialist Hospital, Uruba Road, Riyadh, 11462, Saudi Arabia.
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Paczka JA, Ponce-Horta AM, Tornero-Jimenez A. Acute Attack of Glaucoma after Scleral Melting and Iris Blockage of the Surgical Ostium: A Case Report of a Complication Derived from a Mitomycin C Supplemented Trabeculectomy. J Curr Glaucoma Pract 2022; 16:199-204. [PMID: 36793259 PMCID: PMC9905880 DOI: 10.5005/jp-journals-10078-1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 06/29/2022] [Indexed: 01/25/2023] Open
Abstract
Aim To describe a case of an acute attack of glaucoma due to scleral melting in the area where a trabeculectomy was previously done. This condition resulted from the blockage of the surgical opening due to an iris prolapse in an eye that was previously supplemented with mitomycin C (MMC) during a filtering surgery and bleb needling revision. Case description A 74-year-old Mexican female with a prior glaucoma diagnosis who assisted to an appointment presenting an acute ocular hypertensive crisis after several months of adequately controlled intraocular pressure (IOP). Ocular hypertension had been regulated after undergoing a trabeculectomy and bleb needling revision; both supplemented with MMC. The severe IOP increase occurred due to uveal tissue blockage in the filtering site, related to melting of the sclera in the same area. The patient was successfully treated through the use of a scleral patch graft and the implantation of an Ahmed valve. Conclusion An acute attack of glaucoma associated with scleromalacia after trabeculectomy and needling has not been previously reported and is currently attributed to MMC supplementation. Nevertheless, the use of a scleral patch graft and further glaucoma surgery seems to be an efficient way to treat this condition. Clinical significance Even though this complication was appropriately managed with this patient, we want to prevent further cases like this through the judicious and careful use of MMC. How to cite this article Paczka JA, Ponce-Horta AM, Tornero-Jimenez A. Acute Attack of Glaucoma after Scleral Melting and Iris Blockage of the Surgical Ostium: A Case Report of a Complication derived from a Mitomycin C Supplemented Trabeculectomy. J Curr Glaucoma Pract 2022;16(3):199-204.
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Affiliation(s)
- Jose A Paczka
- Instituto de Oftalmología y Ciencias Visuales, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Ana M Ponce-Horta
- Department of Research, Global Glaucoma Institute Occidente, Guadalajara, Jalisco, Mexico
| | - Andrea Tornero-Jimenez
- Department of Research, Global Glaucoma Institute Occidente, Guadalajara, Jalisco, Mexico
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10
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Lee BWH, Sidhu AS, Francis IC, Coroneo MT. 5-Fluorouracil in primary, impending recurrent and recurrent pterygium: Systematic review of the efficacy and safety of a surgical adjuvant and intralesional antimetabolite. Ocul Surf 2022; 26:128-141. [PMID: 35961535 DOI: 10.1016/j.jtos.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
Pterygium is an ultraviolet-related disease characterized by an aberrant, wing-shaped and active wound-healing process. There is nothing quite as disheartening for the surgeon or patient as the recurrence of pterygium, and various adjuvants have been studied to ameliorate this. This systematic review provides a comprehensive summary of the efficacy and safety of 5-Fluorouracil (5-FU) as an antimetabolite agent for pterygium management. An appraisal of electronic searches of six databases identified 34 clinical studies reporting recurrence outcomes of 5-FU use in primary, impending recurrent and recurrent pterygia. In vitro and in vivo studies of 5-FU showed dose- and duration-dependent cytostatic and cytotoxic effects in human cells. 5-FU is relatively inexpensive, available, and easy to administer, making it attractive for resource-limited scenarios. However, the published evidence demonstrates a recurrence rate of 11.4-60% with the bare scleral technique, 3.5-35.8% with conjunctival rotational flaps, 3.7-9.6% with conjunctival autografts for intraoperative topical 5-FU, and 14-35.8% for preoperative and intraoperative injections. This suboptimal efficacy brings the role of 5-FU as an adjuvant for pterygium surgery into question and the authors do not recommend its use. In contrast, postoperative intralesional injections of 5-FU to arrest progression in impending recurrent pterygium and true recurrent pterygia were more promising, with success rates of 87.2-100% and 75-100%, respectively. Furthermore, 5-FU as a treatment modality, without surgery, effectively arrested progression in 81.3-96% of primary and recurrent pterygia. Other treatments such as topical and intralesional corticosteroids, cyclosporine and anti-VEGF agents are discussed. Complications of 5-FU increase with higher doses and range from transient and reversible to severe and sight-threatening. For pterygium, 5-FU has a predilection for causing scleral thinning, corneal toxicity, and graft-related complications. Additional study with extended follow-up is needed to elucidate the optimal dose, frequency, duration, and long-term safety of 5-FU injections. If 5-FU is used in the management of pterygium, it should be with caution, in selected patients and with vigilant long-term monitoring.
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Affiliation(s)
- Brendon W H Lee
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia; University of Sydney Medical School, University of Sydney, Camperdown, Australia.
| | - Amitouj S Sidhu
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Ian C Francis
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Minas T Coroneo
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia
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11
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Moshirfar M, West WB, Milner DC, McCabe SE, Ronquillo YC, Hoopes PC. Delayed Epithelial Healing with Corneal Edema and Haze After Photorefractive Keratectomy Using Intraoperative Mitomycin C. Int Med Case Rep J 2022; 14:863-870. [PMID: 34992474 PMCID: PMC8714007 DOI: 10.2147/imcrj.s342774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
We report an unusual presentation of presumed mitomycin C toxicity with possible subsequent hypersensitization to other medication toxicities. A 50-year-old female presented three months after photorefractive keratectomy with intraoperative mitomycin C for the management of persistent epithelial defects, corneal haze, and edema. She was found to have used an expansive and rapidly changing medical regimen which may have caused additional toxicity. These medications included besifloxacin, bromfenac, and ketotifen. Additives such as benzalkonium chloride and DuraSite® may have also contributed. Intraoperative mitomycin C can result in longstanding corneal haze, edema, and delayed epithelial healing in the setting of corneal refractive surgery. These may leave the cornea more susceptible to additional subsequent medication toxicities during the postoperative period. This report describes a case of mitomycin C exposure leading to a prolonged sensitivity to other medication toxicities, which has not been discussed elsewhere in the literature.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, 84020, USA.,John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA.,Utah Lions Eye Bank, Murray, UT, 84107, USA
| | - William B West
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Dallin C Milner
- University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Shannon E McCabe
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, 84020, USA
| | | | - Phillip C Hoopes
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, 84020, USA
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12
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Jha A, Simba A. Conjunctival Autograft versus Combined Amniotic Membrane and Mini-Simple Limbal Epithelial Transplant for Primary Pterygium Excision. J Ophthalmic Vis Res 2022; 17:4-11. [PMID: 35194490 PMCID: PMC8850855 DOI: 10.18502/jovr.v17i1.10164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 02/12/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose To compare outcomes of conjunctival autograft (CAG) and combined amniotic membrane with mini-simple limbal epithelial transplant (mini-SLET) after primary pterygium excision. Methods All consenting adults with primary pterygium were included in this study. After pterygium excision, patients were randomized to receive either CAG or mini-SLET and both grafts were held in place with fibrin glue. The patients were followed-up at days 1, 3, 7, 14, and 30 and subsequently at the third, sixth, and ninth months. The recurrence rate was considered as the primary outcome measure whereas the operating time, postoperative symptoms, and surgical complications were considered the secondary outcome measures. Results The study comprised of 264 eyes of 264 patients, of which 233 (88%) completed the nine months of follow-up. Of these, 118 (51%) received CAG and 115 (49%) received mini-SLET. The groups were comparable at baseline. Recurrence of pterygium was seen in two (1.6%) eyes in the CAG group and three (2.6%) eyes in the mini-SLET group (P = 0.68). Operative time for mini-SLET (20.33 ± 1.28 min) was significantly higher than that for CAG (12.01 ± 1.26 min) (P < 0.001). Graft displacement was observed in one case in group II (P = 0.999). The Lim Bon Siong (foreign body sensation, lacrimation, pain, and irritation) score in the CAG group was statistically significant for all four symptoms at days 1 and 3; however, at day 7, foreign body sensation, pain, and irritation scores were significantly higher for the CAG group. Conclusion In this study, the overall recurrence rate was very low and comparable between mini-SLET and the established technique of CAG after performing the primary pterygium excision. Despite a longer surgical time, mini-SLET appears to be a viable option for the management of primary pterygium.
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Affiliation(s)
- Ashok Jha
- Department of Ophthalmology, Military Hospital Gaya, Gaya, India
| | - Abhay Simba
- Department of Ophthalmology, Anugrah Narayan Medical College, Gaya, India
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13
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Alfarhan A, Alhamzah A, Abuabat A, Debasi T, Almudhaiyan T. Surgical Preferences in the Management of Primary Pterygium among Anterior Segment Specialists. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
The purpose of this study is to reflect anterior segment specialists’ current practice pattern regarding the management of primary pterygium.
Methods:
A 24-item survey regarding indications for surgery, different surgical techniques, use of adjuvant pharmacological therapy, type of intraoperative and postoperative pharmacological therapy, and the preferred treatment of early recurrences was sent to members of the Saudi Ophthalmological Society (SOS) and practicing cornea experts including consultants, specialists, and fellows in Saudi Arabia.
Results:
A total of 61 cornea specialists completed the questionnaire (response rate 49%). More than 95% considered the proximity of the pterygium to the visual axis an indication for excision. The most frequent technique for pterygium excision was extensive head and conjunctival resection, including the base (69%) and intermediate resection of the Tenon's capsule (53%). For conjunctival replacement, conjunctival autograft was preferred by 79%, amniotic membrane (54%), and simple conjunctival closure (46%). Interrupted vicryl sutures, fibrin glue, and combined sutures and tissue adhesive were the preferred graft fixation conveyed by 85%, 46%, and 34% of our experts, respectively. An estimated recurrence rate of 1-5% was stated by 29% of respondents and 46% reported recurrence within 6 to 12 months. Half of the respondents specified using mitomycin C intraoperatively to prevent early pterygium recurrences. When recurrence occurred, corticosteroid was the agent of choice.
Conclusion:
This study set out to reflect the practice pattern of anterior segment specialists regarding the management of primary pterygium, and it may serve as an insight for further studies to define the optimal management of pterygium.
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14
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Masoomian B, Eshraghi B, Latifi G, Esfandiari H. Efficacy of probing adjunctive with low-dose mitomycin-C irrigation for the treatment of epiphora in adults with nasolacrimal duct stenosis. Taiwan J Ophthalmol 2021; 11:287-291. [PMID: 34703745 PMCID: PMC8493988 DOI: 10.4103/tjo.tjo_25_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/06/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE: The purpose of the study was to investigate the efficacy of adjunctive low-dose mitomycin-C (MMC) during successful lacrimal duct probing in adults with nasolacrimal ducts (NLDs) stenosis. MATERIALS AND METHODS: This is a prospective case–control study on patients with NLD stenosis who were randomized into two groups. All patients underwent probing without or with an application of MMC. Former group received 0.2 mg/ml MMC irrigation for 5 min. The main outcome measures were objective evaluation of patency with irrigation, as well as patients' subjective assessment of improvement. RESULTS: There were 73 eyes in 58 consecutive patients; patient mean age ranged from 19 to 78 years (mean 44 years). Female included larger group of patients (63%) and mean duration of the symptoms was 26.1 months (range, 2–120 months). After mean follow-up of 11 months (range, 9–14 months), 23 (60%) of the 38 eyes in the MMC groups and 8 (22%) of the 35 eyes in control group had complete response and remained symptom free. This difference was statistically significant (P = 0.005). According to the patient's satisfaction, epiphora was partially improved in 6 (17%) eyes of control group and 4 (10%) eyes in MMC group. Application of MMC has a better outcome in patients with severe stenosis (P = 0.007); patients who had symptoms more than 12 months (P = 0.02) and patients with constant epiphora were compared with intermittent symptoms (P = 0.001). No complications were detected during patients follow-up. CONCLUSION: This study suggests acceptable long-term results for probing adjunctive with MMC irrigation for adults with NLD stenosis that can be recommended as a simple and effective procedure for these patients.
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Affiliation(s)
- Babak Masoomian
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Eshraghi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Golshan Latifi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Esfandiari
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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15
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Bunod R, Tahiri Joutei Hassani R, Robin M, Liang H, Rabut G, Baudouin C, Labbé A. Evaluation of pterygium severity with en face anterior segment optical coherence tomography and correlations with in vivo confocal microscopy. J Fr Ophtalmol 2021; 44:1362-1369. [PMID: 34384622 DOI: 10.1016/j.jfo.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe en face anterior segment optical coherence tomography (EF-OCT) characteristics of pterygia and their correlation with in vivo confocal microscopy (IVCM). PATIENTS AND METHODS In this observational case series, we prospectively included 21 eyes of 17 subjects with pterygium. All subjects underwent detailed ophthalmic examination, anterior segment photography, an ocular surface disease index (OSDI) questionnaire, IVCM, and EF-OCT. Eyes were divided into two groups according to pterygium severity (Modified Pterygium Classification System) and OSDI score. EF-OCT images for both groups were analyzed for surface area of Fuchs Patches (FP). The IVCM activity score was based on the number of inflammatory cells, blood vessels, activated keratocytes and the appearance of the cornea/pterygium at the head of the pterygium. The correlations between EF-OCT and IVCM images were then analyzed and compared in both groups. RESULTS EF-OCT permits clear visualization and evaluation of FPs and the border between the pterygium and the adjacent cornea. The severe pterygium group was characterized by irregular borders and larger FPs (0.13±0.06 mm2 versus 0.06±0.02 mm2 respectively) (P=0.003). The mean IVCM activity score was 2.36±0.81 in the severe pterygium group and 1.2±0.42 in the mild pterygium group (P=0.0013). There was a positive correlation between FP surface area and IVCM activity score. A larger FP surface area was associated with a higher activity score on IVCM. CONCLUSION EF-OCT allows good evaluation of pterygium extension, borders and FP surface area. EF-OCT analysis of pterygium could represent a simple, non-invasive and reproducible method to evaluate pterygium severity and activity.
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Affiliation(s)
- R Bunod
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France.
| | | | - M Robin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France
| | - H Liang
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France
| | - G Rabut
- CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France
| | - C Baudouin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, University of Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - A Labbé
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, University of Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
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16
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Maeng S, Park TY, Min JS, Jin L, Joo KI, Park WC, Cha HJ. Sutureless Transplantation of Amniotic Membrane Using a Visible Light-Curable Protein Bioadhesive for Ocular Surface Reconstruction. Adv Healthc Mater 2021; 10:e2100100. [PMID: 34050621 DOI: 10.1002/adhm.202100100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/16/2021] [Indexed: 02/06/2023]
Abstract
The conjunctiva is a thin mucous membrane of the eye. Pterygium, a commonly appearing disease on the ocular surface, requires surgery to excise the conjunctiva to prevent visual deterioration. Recently, transplantation of the amniotic membrane (AM), which is the innermost membrane of the placenta, has been highlighted as an efficient method to cure conjunctiva defects because of its advantages of no side effects compared to mitomycin C treatment and not leaving additional scars on donor site compared to conjunctival autografting. However, to minimize additional damage to the ocular surface by suturing, AM transplantation (AMT) needs to be simplified by using a less invasive, time-saving method. In this work, a visible light-curable protein bioadhesive (named FixLight) for efficient sutureless AMT is applied. FixLight, which is based on bioengineered mussel adhesive protein (MAP), is easily applied between damaged ocular surfaces and transplanted AM, and rapidly cured by harmless blue light activation. Through in vivo evaluation using a rabbit model, the authors demonstrated that FixLight enabled facile, fast, and strong attachment of AM on sclera and promoted ocular surface reconstruction with good biocompatibility. Thus, FixLight can be successfully used as a promising clinical bioadhesive in opthalmological surgeries that require sutureless and rapid operation.
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Affiliation(s)
- Seong‐Woo Maeng
- Department of Chemical Engineering Pohang University of Science and Technology Pohang 37673 Republic of Korea
| | - Tae Yoon Park
- Department of Chemical Engineering Pohang University of Science and Technology Pohang 37673 Republic of Korea
| | - Ji Sang Min
- Department of Ophthalmology Dong‐A University College of Medicine Busan 49201 Republic of Korea
- Institute of Vision Research Department of Ophthalmology Yonsei University College of Medicine Seoul 03722 Republic of Korea
| | - Longyu Jin
- Department of Ophthalmology Dong‐A University College of Medicine Busan 49201 Republic of Korea
- Department of Ophthalmology Shenzen People's Hospital Shenzen 1017 China
| | - Kye Il Joo
- Department of Chemical Engineering Pohang University of Science and Technology Pohang 37673 Republic of Korea
- Division of Chemical Engineering and Materials Science Ewha Womans University Seoul 03760 Republic of Korea
| | - Woo Chan Park
- Department of Ophthalmology Dong‐A University College of Medicine Busan 49201 Republic of Korea
| | - Hyung Joon Cha
- Department of Chemical Engineering Pohang University of Science and Technology Pohang 37673 Republic of Korea
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17
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Rokohl AC, Heindl LM, Cursiefen C. [Pterygium: pathogenesis, diagnosis and treatment]. Ophthalmologe 2021; 118:749-763. [PMID: 33782734 DOI: 10.1007/s00347-021-01366-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 12/30/2022]
Abstract
The pterygium is a frequent ultraviolet (UV) light-induced focal fibrovascular proliferation of the conjunctival tissue onto the cornea. Surgical excision should be performed in the case of reduced visual acuity, progressive astigmatism, impending invasion of the optical axis and ocular surface complaints. The main factors in preventing recurrence include optimal surgical treatment by an excision combined with a free conjunctival autograft, consistent postoperative treatment with preservative-free artificial tears and topical steroids as well as long-term UV protection.
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Affiliation(s)
- Alexander C Rokohl
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Straße 62, 50924, Köln, Deutschland.
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Straße 62, 50924, Köln, Deutschland
| | - Claus Cursiefen
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Straße 62, 50924, Köln, Deutschland.,Zentrum für Molekulare Medizin Köln (ZMMK), Universität zu Köln, Köln, Deutschland
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18
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Evaluation of Conjunctival Autografting Augmented with Mitomycin C Application versus Ologen Implantation in the Surgical Treatment of Recurrent Pterygium. J Ophthalmol 2021; 2021:8820926. [PMID: 33505715 PMCID: PMC7815381 DOI: 10.1155/2021/8820926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/08/2020] [Accepted: 01/03/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives To evaluate the safety and efficacy of augmenting conjunctival autografting with intraoperative mitomycin C (MMC) application versus Ologen implantation in the management of recurrent pterygium. Materials and Methods This prospective randomised study included 63 eyes of 63 patients, with recurrent nasal pterygium, who presented to the outpatient clinic of Menoufia University Hospital in Shebin El Kom and Manshiet Soltan from January 2016 to December 2019. Patients were randomly enrolled into two groups. Group A included 32 eyes of 32 patients who underwent conjunctival autografting augmented with the topical application of MMC (0.2 mg/mL), and group B included 31 eyes of 31 patients who underwent conjunctival autografting augmented with Ologen implantation. All the patients underwent follow-up examinations for a period of 24 months. During each visit, a complete ophthalmic examination was performed. Pterygium regrowth of 1 mm or more, over the cornea, was considered a recurrence. Results In the MMC group, no recurrence was reported during the 24-month follow-up period. In the Ologen implantation group, recurrence was reported in 2 (8%) eyes. The time interval from surgery to recurrence was 5 months in one case and 8 months in the other. No other serious postoperative complications were reported, and there was no statistically significant difference between the groups in this regard. Conclusion Ologen implantation with conjunctival autografting shows promising results in the surgical management of recurrent pterygium with mild non-vision-threatening postoperative complications comparable to that of MMC application with conjunctival autografting. Registration number: ClinicalTrials.govNCT04419038.
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19
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Ruiz-Lozano RE, Garza-Garza LA, Davila-Cavazos O, Foster CS, Rodriguez-Garcia A. The clinical and pathogenic spectrum of surgically-induced scleral necrosis: A review. Surv Ophthalmol 2021; 66:594-611. [PMID: 33422510 DOI: 10.1016/j.survophthal.2020.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/20/2022]
Abstract
The onset of scleral necrosis after ocular surgery may have catastrophic ocular and systemic consequences. The two most frequent surgeries causing surgically-induced scleral necrosis (SISN) are pterygium excision and cataract extraction. Several pathogenic mechanisms are involved in surgically induced scleral necrosis. All of them are poorly understood. Ocular trauma increasing lytic action of collagenases with subsequent collagen degradation, vascular disruption leading to local ischemia, and immune complex deposition activating the complement system represents some of the events that lead to scleral necrosis. The complex cascade of events involving different pathogenic mechanisms and the patient's abnormal immune response frequently leads to delayed wound healing that predisposes the development of scleral necrosis. The management of SISN ranges from short-term systemic anti-inflammatory drugs to aggressive immunosuppressive therapy and surgical repair. Therefore, before performing any ocular surgery involving the sclera, a thorough ophthalmic and systemic evaluation must be done to identify high-risk patients that may develop SISN.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Lucas A Garza-Garza
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Osvaldo Davila-Cavazos
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institute, Waltham, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico.
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20
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Panda BB, Sharma J. Role of Surgeon Experience in Pterygium Surgical Outcomes: A Comparative Study Between Ophthalmology Resident and Consultant. Cureus 2020; 12:e11711. [PMID: 33391944 PMCID: PMC7772103 DOI: 10.7759/cureus.11711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose Although surgical technique and patient variables are responsible for the recurrence of pterygium, the surgeon's experience has been sparsely studied. This retrospective study was designed to compare the surgical time, complications, and rates of recurrence after primary pterygium excision between consultant ophthalmologists and trainee residents. Material and methods In this retrospective study, we collected the data of 176 primary pterygium eyes, who were operated on with excision and sutureless/glueless conjunctival autograft either by the consultant (group A) or by the trainee (group B). The demographic profile, surgical time, complications, and recurrences between both groups were analyzed. Results Both the groups were comparable with regards to age, gender, religion, side of the eye, size of the pterygium, and duration of follow-up. The mean operative time was longer in group B (26.5+/-3.8 minutes) than group A (14.2+/-1.6 minutes). Though a relatively higher percentage of complications was observed in group B (12% vs. 9%), the difference was statistically not significant (Mann-Whitney U test, p-value 0.271). There was no statically significant difference in recurrence rate (6.8% vs 9.4%) between the groups. Conclusion With regards to the role of surgeon experience in primary pterygium excision using the sutureless and glueless conjunctival autografting technique, the residents did not have any statistically significant differences in their postoperative complications and recurrence rates. However, the surgical time was significantly higher in the resident group owing to the learning curve.
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21
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Aziza Y, Inatomi T, Sotozono C, Kinoshita S. Pterygium excision with modified bare sclera technique combined with mitomycin C. Jpn J Ophthalmol 2020; 65:89-96. [PMID: 33205316 DOI: 10.1007/s10384-020-00786-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Numerous surgical methods, with varying rates of recurrence, have been applied for the treatment of pterygium. Adjuvant mitomycin C (MMC) application has shown promising results in the prevention of recurrence. Here we propose and describe modified bare sclera technique combined with the intraoperative application of MMC for pterygium excision. STUDY DESIGN Retrospective study. METHODS Primary pterygium patients who underwent pterygium excision via the bare sclera combined with 0.04% MMC technique from January 2014 to December 2016 were reviewed. In all patients, the subconjunctival pterygium strand was exposed and then sufficiently excised in combination with the safe use of MMC; i.e., the prevention of MMC dilution and diffusion to surrounding tissue. Surgical complications, recurrence rates, and recurrence onset were recorded. RESULTS This study involved 32 primary pterygium eyes (grade T1 = 22 eyes; 68.7%). The mean postoperative follow-up period was 26.4 ± 14.5 months (range: 12-60 months). MMC was applied for 1-3 min. The mean complete epithelialization was 12.6 ± 7.6 days and no surgical complications were observed. In 1 patient with double-head primary pterygium, recurrence occurred at 15-months postoperative. CONCLUSIONS The modified bare sclera technique combined with MMC application was found to be safe, effective, and presents good cosmetic appearance for the treatment of primary pterygium when safety points are strictly applied.
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Affiliation(s)
- Yulia Aziza
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan.,Department of Ophthalmology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Tsutomu Inatomi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan. .,Department of Ophthalmology, National Center for Geriatrics and Gerontology, Aichi, Japan.
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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22
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Kwok SS, Wong FSY, Shih KC, Chan YK, Bu Y, Chan TCY, Ng ALK, Lo ACY, Tong L, Yam GHF, Jhanji V. Lycium barbarum Polysaccharide Suppresses Expression of Fibrotic Proteins in Primary Human Corneal Fibroblasts. J Clin Med 2020; 9:jcm9113572. [PMID: 33171906 PMCID: PMC7694544 DOI: 10.3390/jcm9113572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/24/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023] Open
Abstract
(1) Objective: To study the anti-fibrotic effects of Lycium barbarum polysaccharides (LBP) on corneal stromal fibroblasts and assess LBP’s effect on cell viability. (2) Methods: Primary human corneal keratocytes of passage 3 to 6 were used for all experiments. Cells are pretreated with LBP solution for 24 h and then transforming growth factor beta 1 (TGFβ1) for 48 h and collected for experiments. Fibrotic protein analysis was performed using immunofluorescence and Western blot. The effect of LBP on cell viability was assessed using the MTS assay. (3) Results: LBP significantly reduced the expression of fibrotic proteins, including α-SMA and extracellular matrix proteins (collagen type I and III). LBP significantly decreased the viability of myofibroblasts but not the fibroblasts. Conclusions: In this study, LBP was effective in the prevention of fibrosis gene expression. Further studies to assess the underlying mechanism and pharmacological properties will facilitate the formation of a topical LBP solution for in vivo studies.
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Affiliation(s)
- Sum Sum Kwok
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Francisca Siu-Yin Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
- Correspondence:
| | - Yau-Kei Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Yashan Bu
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Tommy Chung-Yan Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Alex Lap-Ki Ng
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Amy Cheuk-Yin Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Centre, Singapore 168751, Singapore;
- Ocular Surface Research Group, Singapore Eye Research Institute, Singapore 169856, Singapore
| | - Gary Hin-Fai Yam
- Department of Ophthalmology, University of Pittsburgh Medical Centre, Pittsburgh, PA 15213, USA; (G.H.-F.Y.); (V.J.)
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Centre, Pittsburgh, PA 15213, USA; (G.H.-F.Y.); (V.J.)
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Long-Term Results of P.E.R.F.E.C.T. for PTERYGIUM. Cornea 2020; 40:1141-1146. [PMID: 33009095 DOI: 10.1097/ico.0000000000002545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/09/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify the recurrence rate, complication rate, cosmetic results, and patient satisfaction after P.E.R.F.E.C.T. for PTERYGIUM more than 10 years after surgery. METHODS This is a prospective cohort study with 312 patients (351 surgeries). All patients underwent pterygium removal using P.E.R.F.E.C.T. for PTERYGIUM in 1 eye or both eyes by the author. The main parameters studied were recurrence rate, complication rate, esthetic outcomes, and patient satisfaction. RESULTS Two hundred twenty-nine patients (77% of surviving cohort group) were able to be followed up with 16 patients deceased. The basic biographical data of the group followed up and those lost to follow-up were not different. The follow-up period was 153 ± 20 months. Twenty-five percent of the surgeries were for recurrent pterygia. The recurrence rate was zero, and there were no serious complications. Ninety-four percent of patients were graded as having normal or excellent cosmetic appearance by the surgeon, and 95% of the patients graded the appearance of their eye as greater than 8 of 10. Ninety-four percent of the patients gave more than 8 of 10 as their satisfaction with the service and surgery. CONCLUSIONS P.E.R.F.E.C.T. for PTERYGIUM provides long-term and stable results for primary and recurrent pterygium patients with a zero recurrence rate and excellent cosmetic appearance of the eye and no serious complications. P.E.R.F.E.C.T. for PTERYGIUM should be considered as the standard by which other pterygium surgeries should be compared. Cosmetic outcomes after pterygium surgeries are now a more sensitive measure of success than recurrence rate alone.
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Boumil EF, Castro N, Phillips AT, Chatterton JE, McCauley SM, Wolfson AD, Shmushkovich T, Ridilla M, Bernstein AM. USP10 Targeted Self-Deliverable siRNA to Prevent Scarring in the Cornea. MOLECULAR THERAPY. NUCLEIC ACIDS 2020; 21:1029-1043. [PMID: 32829179 PMCID: PMC7452140 DOI: 10.1016/j.omtn.2020.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/17/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
Ocular scarring after surgery, trauma, or infection leads to vision loss. The transparent cornea is an excellent model system to test anti-scarring therapies. Cholesterol-conjugated fully modified asymmetric small interfering RNAs (siRNAs) (self-deliverable siRNAs [sdRNAs]) are a novel modality for in vivo gene knockdown, transfecting cells and tissues without any additional formulations. Myofibroblasts are a main contributor to scarring and fibrosis. αv integrins play a central role in myofibroblast pathological adhesion, overcontraction, and transforming growth factor β (TGF-β) activation. Previously, we demonstrated that αv integrins are protected from intracellular degradation after wounding by upregulation of the deubiquitinase (DUB) ubiquitin-specific protease 10 (USP10), leading to integrin cell surface accumulation. In this study, we tested whether knockdown of USP10 with a USP10-targeting sdRNA (termed US09) will reduce scarring after wounding a rabbit cornea in vivo. The wounded corneal stroma was treated once with US09 or non-targeting control (NTC) sdRNA. At 6 weeks US09 treatment resulted in faster wound closure, limited scarring, and suppression of fibrotic markers and immune response. Specifically, fibronectin-extra domain A (EDA), collagen III, and a-smooth muscle actin (p < 0.05), CD45+ cell infiltration (p < 0.01), and apoptosis at 24 (p < 0.01) and 48 h (p < 0.05) were reduced post-wounding. Corneal thickness and cell proliferation were restored to unwounded parameters. Targeting the DUB, USP10 is a novel strategy to reduce scarring. This study indicates that ubiquitin-mediated pathways should be considered in the pathogenesis of fibrotic healing.
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Affiliation(s)
- Edward F Boumil
- Department of Ophthalmology and Visual Sciences, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Nileyma Castro
- Department of Ophthalmology and Visual Sciences, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Andrew T Phillips
- Department of Ophthalmology and Visual Sciences, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | | | | | | | | | - Marc Ridilla
- Repair Biotechnologies, 841 East Fayette Street, Syracuse, NY 13210, USA
| | - Audrey M Bernstein
- Department of Ophthalmology and Visual Sciences, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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Wu M, Wang S, Wang Y, Zhang F, Shao T. Targeted delivery of mitomycin C-loaded and LDL-conjugated mesoporous silica nanoparticles for inhibiting the proliferation of pterygium subconjunctival fibroblasts. Exp Eye Res 2020; 197:108124. [PMID: 32598971 DOI: 10.1016/j.exer.2020.108124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 11/26/2022]
Abstract
Pterygium is a degenerative disease that characterized by excessive fibrovascular proliferation. To reduce the recurrence rate, surgery is the main strategy, in combination with adjacent procedures or adjunctive therapy. One of the most common adjunctive agents, mitomycin C (MMC), is known as an alkylating agent that inhibits fibroblast proliferation but is limitedly applied in pterygium due to various complications. A previous study demonstrated that activated pterygium subconjunctival fibroblasts overexpressed low-density lipoprotein (LDL) receptors. In this study, we designed and synthesized MMC-loaded mesoporous silica nanoparticles conjugated with LDL (MMC@MSNs-LDL) to deliver MMC into activated pterygium fibroblasts in a targeted manner. The MMC loading efficiency was approximately 6%. The cell viability test (CCK-8 assay) revealed no cytotoxicity for the empty carrier MSNs at a concentration of ≤1 mg/ml after administration for 48 h in subconjunctival fibroblasts. Primary pterygium and normal human subconjunctival fibroblasts with or without stimulation by vascular endothelial growth factor (VEGF) were treated as follows: 1) 10 μg/ml MMC@MSNs-LDL for 24 h (MMC concentration: 0.6 μg/ml); 2) 0.2 mg/ml MMC for 5 min then cultured for 24 h after MMC removal; and 3) normal culture without any drug treatment. At 24 h, the anti-proliferative effect of MMC@MSNs-LDL in activated pterygium fibroblasts was similar to that of MMC (cell viability: 46.2 ± 5.5% vs 40.5 ± 1.1%, respectively, P = 0.349). Furthermore, the cytotoxicity of MMC@MSNs-LDL to normal fibroblasts with or without VEGF stimulation was significantly lower than that of traditional MMC (cell viability: 75.6 ± 4.4% vs 36.0 ± 1.5%, respectively, P < 0.001; 84.7 ± 5.5% vs 35.7 ± 1.3%, P < 0.001). The binding of fluorescently labeled MMC@MSNs-LDL in fibroblasts was assessed using confocal fluorescence microscopy. The uptake of targeted nanoparticles in fibroblasts was time dependent and saturated at 6 h. VEGF-activated pterygium fibroblasts showed more uptake of MMC@MSNs-LDL than normal fibroblasts with or without VEGF activation (both P < 0.001). Our data strongly suggest that MMC@MSNs-LDL had an effective antiproliferative role in activated pterygium fibroblasts, with reduced toxicity to normal fibroblasts compared to traditional application of MMC. LDL-mediated drug delivery might have great potential in the management of pterygium recurrence.
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Affiliation(s)
- Mengliang Wu
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, School of Shanghai Medicine, Fudan University, Shanghai, 200031, PR China
| | - Shangfeng Wang
- Department of Chemistry, State Key Laboratory of Molecular Engineering of Polymers, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials and iChem, Fudan University, Shanghai, 200433, PR China
| | - Yan Wang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, School of Shanghai Medicine, Fudan University, Shanghai, 200031, PR China
| | - Fan Zhang
- Department of Chemistry, State Key Laboratory of Molecular Engineering of Polymers, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials and iChem, Fudan University, Shanghai, 200433, PR China.
| | - Tingting Shao
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, School of Shanghai Medicine, Fudan University, Shanghai, 200031, PR China.
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Ahmed SN, Shahid SM, Nanavaty MA. Delayed Onset Scleromalacia and Conjunctival Bleb Formation Following Intraoperative Mitomycin C Application during Conjunctival Melanoma Excision. Vision (Basel) 2020; 4:vision4020024. [PMID: 32384819 PMCID: PMC7356894 DOI: 10.3390/vision4020024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose: To present a case of delayed onset scleromalacia and conjunctival bleb formation one year after conjunctival melanoma excision with intraoperative use of mitomycin-C (MMC) and double-freeze-thaw technique. Methods: Case report. Results: A 69-year-old woman had a conjunctival melanoma excised by the ‘no touch technique’ with intraoperative application of 0.02% MMC for 3 min on bare sclera, freeze-thaw cryotherapy and amniotic membrane transplant performed elsewhere. Three months later, she presented to us with a red, sore and painful right eye. Examination revealed severe scleritis. She was treated with lubricants and oral steroids for 6 weeks. She settled well with no recurrence of melanoma. At one year, she developed scleromalacia and conjunctival blebs in the inferonasal quadrant of right eye. She remains under closer observation as she is at high risk of perforation. Conclusion: Caution should be exercised with intraoperative use of MMC on bare sclera during excision and cryotherapy of conjunctival melanoma. As published in the literature, when using MMC, it is recommended to use the lowest dose topically in the form of eye drops in the postoperative period for the shortest time to avoid any sight-threatening complications.
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Affiliation(s)
- Syed Naqib Ahmed
- Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK;
| | | | - Mayank A. Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
- Correspondence:
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Sustained subconjunctival drug delivery systems: current trends and future perspectives. Int Ophthalmol 2020; 40:2385-2401. [DOI: 10.1007/s10792-020-01391-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/15/2020] [Indexed: 12/17/2022]
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Phelps PO, Abariga SA, Cowling BJ, Selva D, Marcet MM. Antimetabolites as an adjunct to dacryocystorhinostomy for nasolacrimal duct obstruction. Cochrane Database Syst Rev 2020; 4:CD012309. [PMID: 32259290 PMCID: PMC7138426 DOI: 10.1002/14651858.cd012309.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nasolacrimal duct obstruction (NLDO) is a condition that results in the overflow of tears (epiphora) or infection of the nasolacrimal sac (dacryocystitis). The etiology of acquired NLDO is multifactorial and is not fully understood. Dacryocystorhinostomy (DCR) is the surgical correction of NLDO, which aims to establish a new drainage pathway between the lacrimal sac and the nose. The success of DCR is variable; the most common cause of failure is fibrosis and stenosis of the surgical ostium. Antimetabolites such as mitomycin-C (MMC) and 5-fluorouracil (5-FU) have been shown to be safe and effective in reducing fibrosis and improving clinical outcomes in other ophthalmic surgery settings (e.g. glaucoma and cornea surgery). Application of antimetabolites at the time of DCR has been studied, but the utility of these treatments remains uncertain. OBJECTIVES Primary objective: To determine if adjuvant treatment with antimetabolites improves functional success in the setting of DCR compared to DCR alone. Secondary objectives: To determine if anatomic success of DCR is increased with the use of antimetabolites, and if the surgical ostium is larger in participants treated with antimetabolites. SEARCH METHODS We searched the Cochrane Register for Controlled Trials (CENTRAL) (which contains the Cochrane Eye and Vision Trials Register) (2019, Issue 9), Ovid MEDLINE, Embase.com, PubMed, LILACS (Latin American and Caribbean Health Sciences Literature database), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic searches. We last searched the electronic databases on 6 September 2019. SELECTION CRITERIA We only included randomized controlled trials. Eligible studies were those that compared the administration of antimetabolites of any dose and concentration versus placebo or another active treatment in participants with NLDO undergoing primary DCR and reoperation. We only included studies that had enrolled adults 18 years or older. We also included studies that used silicone intubation as part of the DCR procedure. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened the search results, assessed risk of bias, and extracted data from the included studies using an electronic data collection form. MAIN RESULTS We included 31 studies in the review, of which 23 (1309 participants) provided data relating to our primary and secondary outcomes. Many of the 23 studies evaluated functional success, while others also assessed our secondary outcomes of anatomic success or ostium size, or both. Study characteristics Participant characteristics varied across studies, with the age of participants ranging from 30 to 70 years. Participants were predominantly women. These demographics correspond to those most frequently affected by nasolacrimal duct obstruction. Almost all of the studies utilized MMC as the antimetabolite, with only one using 5-FU. We assessed most trials as at unclear risk of bias for most domains. Conflicts of interest were not frequently reported, although the antimetabolites used are generic medications, and studies were not likely to be conducted for financial interest. Findings Twenty studies provided data on the primary outcome of functional success, of which 7 (356 participants) provided data at 6 months and 14 (909 participants) provided data beyond 6 months. At six months, the results showed no evidence of effect of antimetabolite on functional success (risk ratio (RR) 1.12, 95% confidence interval (CI) 0.98 to 1.29; low-certainty evidence). Beyond six months, the results favored the antimetabolite group (RR 1.15, 95% CI 1.07 to 1.25; moderate-certainty evidence). Fourteen studies reported data on the secondary outcome of anatomic success, of which 4 (306 participants) reported data at 6 months and 12 (831 participants) provided data beyond 6 months. Results at six months showed no evidence of effect of antimetabolite on anatomic success (RR 1.02, 95% CI 0.95 to 1.11; low-certainty evidence). Beyond six months, participants in the antimetabolite group were more likely to achieve anatomic success than those receiving DCR alone (RR 1.09, 95% CI 1.04 to 1.15; moderate-certainty evidence). At six months and beyond six months follow-up, two studies reported mean change in ostium size. We did not conduct meta-analysis for the various follow-up periods due to clinical, methodological, and statistical heterogeneity. However, point estimates from these studies at six months consistently favored participants in the antimetabolite group (low-certainty evidence). Beyond six months, while point estimates from one study favored participants in the antimetabolite group, estimates from another study showed no evidence of a difference between the two groups. The certainty of evidence at both time points was low. Adverse events Adverse events were rare. One study reported that one participant in the MMC group experienced delayed wound healing. Other studies reported no significant adverse events related to the application of antimetabolites. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that application of antimetabolites at the time of DCR increases functional and anatomic success of DCR when patients are followed for more than six months after surgery, but no evidence of a difference at six months, low-certainty of evidence. There is low-certainty evidence that combining antimetabolite with DCR increases the size of the lacrimal ostium at six months. However, beyond six months, the evidence remain uncertain. Adverse effects of the application of antimetabolites were minimal.
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Affiliation(s)
- Paul O Phelps
- NorthShore University HealthSystemDepartment of Surgery2050 Pfingsten Rd.Suite 280GlenviewILUSA60026
- University of ChicagoDepartment of OphthalmologyChicagoIllinoisUSA60637
| | - Samuel A. Abariga
- Johns Hopkins Bloomberg School of Public HealthEpidemiology615 N. Wolfe StreetBaltimoreMarylandUSA
| | - Benjamin J Cowling
- University of Hong KongDivision of Epidemiology and Biostatistics, School of Public Health624‐627, 6/F, Core F, Cyberport 3, 100 Cyberport RoadCyperportHong Kong00000
| | - Dinesh Selva
- University of AdelaideSouth Australian Institute of OphthalmologyLevel 8, Health Sciences Building 16/910AdelaideAustralia5000
| | - Marcus M Marcet
- University of Hong KongDepartment of OphthalmologyRm 301, Blk B, Cyberport 4, 100 Cyberport RoadCyberportHong Kong00000
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Seavers A, Robson D, Weingarth JM. Successful use of topical mitomycin C for the treatment of a putative neoplastic vascular mass on the nictitating membrane of a dog. Aust Vet J 2020; 98:164-167. [PMID: 31919837 DOI: 10.1111/avj.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 11/27/2022]
Abstract
A nine-year-old female desexed Great Dane presented with a painful, proliferative, soft red putative neoplastic vascular mass on the nictitating membrane. Three 7-day cycles of the topical cytotoxic drug mitomycin C 0.04%, applied four times daily to the lesion using a low-dose alternate-week pulse therapy, brought about rapid remission of the lesion. The lesion was still in remission at time of euthanasia some 13 months later.
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Affiliation(s)
- A Seavers
- Oak Flats Veterinary Clinic, Oak Flats, New South Wales, 2529, Australia
| | - D Robson
- Dermatology Department, Melbourne Veterinary Specialist Centre, Glen Waverly, Victoria, 3150, Australia
| | - J M Weingarth
- Oak Flats Veterinary Clinic, Oak Flats, New South Wales, 2529, Australia
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Suman S, Kumar A. Intraoperative mitomycin C and cryotherapy as adjunct therapy for recurrent lobular capillary haemangioma of conjunctiva. BMJ Case Rep 2020; 13:13/1/e233438. [DOI: 10.1136/bcr-2019-233438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Recurrence of lobular capillary haemangioma of conjunctiva after surgical excision is rare but sometimes it may be difficult to manage multiple recurrences. A 31-year-old female patient presented with recurrent polypoid conjunctival lobular capillary haemangioma. Excisional biopsy was performed, followed by eye drop mitomycin C 0.04% four times a day for 1 week postoperatively. She reported again after 3 months with recurrence of vascular elongated nodular lesion. Excision of the mass with application of mitomycin C 0.02% intraoperatively for 1 min and cryotherapy using double thaw technique of the peripheral conjunctival margin was done. The histopathological examination confirmed the recurrence of lobular capillary haemangioma. On review, 1 year after treatment there was no evidence of recurrence. A combined use of cryotherapy and intraoperative mitomycin C as adjunctive therapy after surgical excision can successfully prevent further recurrence without any adverse effect.
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Low-Dose Mitomycin C Decreases the Postoperative Recurrence Rate of Pterygium by Perturbing NLRP3 Inflammatory Signalling Pathway and Suppressing the Expression of Inflammatory Factors. J Ophthalmol 2019; 2019:9472782. [PMID: 31827916 PMCID: PMC6885197 DOI: 10.1155/2019/9472782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 01/20/2023] Open
Abstract
A pterygium is generally believed to be a chronic inflammatory lesion caused by external stimuli that develops from the conjunctiva and grows onto the cornea. Simple bare sclera excision is the most commonly used method to treat pterygium. However, the high postoperative recurrence rate of pterygium remains a persistent challenge. Mitomycin C (MMC) is an antineoplastic antibiotic that inhibits DNA, RNA, and protein synthesis. In recent years, although MMC has proven useful for the treatment of pterygium, its application has been controversial because of its clear toxicity and the possibility of ocular complications. In the current study, we prospectively recruited patients to receive or not receive a local injection of MMC (0.4 mg/ml). Follow-up was conducted with the patients to determine the postoperative recurrence rate of pterygium and/or to observe any ocular complications. The remarkable results demonstrated that MMC can decrease the postoperative recurrence rate of pterygium without leading to serious eye complications. Further results indicated that MMC can inhibit the activation of the NLRP3 inflammatory signalling pathway and thus downregulate the expression of downstream molecules, including IL-18 and IL-1β. MMC also reduced the expression of inflammatory factors TGF-β1, VEGF, and IL-6. In addition to influencing these factors, MMC suppressed neovascularization and the proliferation of corneal fibroblasts to effectively reduce the recurrence rate of pterygium. Taken together, our results provide a theoretical basis for the development of prevention and treatment strategies for pterygium and suggest that MMC is highly effective as an adjunctive treatment after excision of primary pterygia.
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A histopathological study of lacrimal puncta in patients with primary punctal stenosis. Graefes Arch Clin Exp Ophthalmol 2019; 258:201-207. [DOI: 10.1007/s00417-019-04514-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/07/2019] [Accepted: 10/14/2019] [Indexed: 11/27/2022] Open
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Kam KW, Young AL. Fifteen-year results of a randomized controlled trial comparing 0.02% mitomycin C, limbal conjunctival autograft, and combined mitomycin C with limbal conjunctival autograft in recurrent pterygium surgery. Graefes Arch Clin Exp Ophthalmol 2019; 257:2683-2690. [PMID: 31650270 DOI: 10.1007/s00417-019-04499-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 09/26/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare the long-term outcomes of recurrent pterygium surgery between three different techniques. METHODS We performed a 15-year follow-up study of a randomized controlled study on surgical management of recurrent pterygium. Group 1 received limbal conjunctival autograft (LCAU); group 2 received intraoperative mitomycin C (MMC) 0.02% for 5 min; and group 3 received combined LCAU + MMC 0.02% for 5 min. Consecutive patients enrolled in the original study (from April 2001 to March 2003) were invited back for a detailed clinical examination to document the long-term outcomes. The main outcome measures included the recurrence rate, residual conjunctival bed status, and complications from any of the surgical methods. RESULTS Sixty-two patients were recruited in the original study. Eight patients had passed away and 12 patients were uncontactable or not responded. One patient who had bilateral operations refused to return for follow-up and one eye had insufficient data for analysis. Finally, 40 eyes of 40 patients were included for analyses. One eye developed a recurrence over 15 years and none required a tertiary pterygium operation. The patient received LCAU for a temporal recurrent pterygium developed a 2.2-mm recurrence. CONCLUSIONS All three techniques yielded favorable outcomes for patients with recurrent pterygium. The use of LCAU was associated with better cosmetic outcome.
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Affiliation(s)
- Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. .,Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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Infectious keratitis after pterygium surgery. Eye (Lond) 2019; 34:986-988. [PMID: 31649345 DOI: 10.1038/s41433-019-0639-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 08/24/2019] [Accepted: 10/06/2019] [Indexed: 11/08/2022] Open
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Gupta VP, Sanghi S, Rohatgi J, Dhaliwal U. Outcomes of preoperative intrapterygial injection of mitomycin C for pterygium excision with and without inferior conjunctival flap. Oman J Ophthalmol 2019; 12:171-176. [PMID: 31902992 PMCID: PMC6826598 DOI: 10.4103/ojo.ojo_129_2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aimed to report the comparison of recurrence rate and complications of intrapterygial injection of mitomycin C (MMC) 1 month before bare sclera excision of pterygium with and without conjunctival flap from the inferior bulbar conjunctiva. METHODS This prospective interventional study enrolled 60 patients of pterygia from November 2010 to June 2012. All eyes received 0.1 ml (0.02%) of intrapterygial MMC injection 1 month preoperatively. Patients were divided into two groups of 30 each: Group 1 - bare scleral excision (BSE) and Group 2 - BSE with conjunctival flap from the inferior bulbar conjunctiva to cover the bare sclera. Chi-square test, Fisher's exact test, and unpaired t-test were used for statistical analysis. RESULTS The mean age was 40.6 ± 12.8 years and 36.9 ± 10.9 years in Group 1 and 2, respectively, (P = 0.2329). There were 11 (36.7%) males and 19 (63.3%) females in Group 1 and 7 (23.3%) males and 23 (76.7%) females in Group 2 (P = 0.101). The recurrence rate was 0% in Group 1 and 3.3% (1 eye) in Group 2 (P = 1.00). Postoperatively, scleral whitening occurred in 6 (20%) eyes in Group 1 and none in Group 2 (P = 0.015). CONCLUSION Both techniques, BSE alone or with conjunctival flap from the inferior bulbar conjunctiva 1 month after intrapterygial MMC, resulted in negligible (0%-3.3%) recurrence of pterygium. Conjunctival flap significantly reduced (0%) the postoperative complication of scleral whitening. This is the first report of efficacy of conjunctival flap in reducing scleral whitening after intrapterygial MMC.
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Affiliation(s)
- Ved Prakash Gupta
- Department of Ophthalmology, University College of Medical Sciences, G. T. B. Hospital, Delhi, India
| | - Shekhar Sanghi
- Department of Ophthalmology, University College of Medical Sciences, G. T. B. Hospital, Delhi, India
| | - Jolly Rohatgi
- Department of Ophthalmology, University College of Medical Sciences, G. T. B. Hospital, Delhi, India
| | - Upreet Dhaliwal
- Department of Ophthalmology, University College of Medical Sciences, G. T. B. Hospital, Delhi, India
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Tube Shunt Revision With Excision of Fibrotic Capsule Using Mitomycin C With and Without Ologen—a Collagen Matrix Implant: A 3-Year Follow-up Study. J Glaucoma 2019; 28:989-996. [DOI: 10.1097/ijg.0000000000001371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eisenmann K, Zeman F, Helbig H, Gamulescu MA, Barth T. Ergebnisse der Pterygiumchirurgie nach verschiedenen Operationstechniken – Ist die Exzision mit einfachem Bindehautverschluss noch lege artis? Ophthalmologe 2019; 117:359-365. [DOI: 10.1007/s00347-019-00968-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mai W, Chen M, Huang M, Zhong J, Chen J, Liu X, Deng J, Yang X, Ye W, Zhang R, Zhou Q, Zhang D. Targeting platelet-derived growth factor receptor β inhibits the proliferation and motility of human pterygial fibroblasts. Expert Opin Ther Targets 2019; 23:805-817. [PMID: 31385548 DOI: 10.1080/14728222.2019.1653281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Pterygium, a common eye disease with high postoperative recurrence, lacks effective therapeutic strategies. Therefore, it's urgent to identify specific targets to develop rationally targeted molecular drugs for the pterygial therapy. Methods: The cell proliferation and motility were studied in both the primary human pterygial fibroblasts (hPFs) and an ex vivo pterygium model. hPFs transfected with the pCMV3-PDGFRB plasmid, PDGFRB siRNA and CRISPR/Cas9 system were used to determine the role of PDGFR-β in pterygial fibroblasts functions. Western blotting, immunohistochemistry and immunofluorescence were performed to evaluate the expression of the key proteins. Results: PDGFR-β expression in the pterygial stroma and primary hPFs was significantly higher than that in the conjunctiva and human conjunctival fibroblasts. PDGF-BB promoted the proliferation, migration and invasion of hPFs, which can be significantly suppressed by sunitinib via inhibition of the PDGFR-β/extracellular signal-regulated kinase (ERK) pathway. In the ex vivo model, the knockout of PDGFRB and sunitinib treatment blocked the proliferation and motility of fibroblasts in the pterygial stroma via the suppression of PDGFR-β/ERK pathway. Conclusion: This study demonstrates that PDGFR-β may be a potential therapeutic target for pterygium, and inhibition of PDGFR-β by sunitinib is a promising and effective approach for pterygium treatment.
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Affiliation(s)
- Weiqian Mai
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
| | - Minfeng Chen
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
| | - Maohua Huang
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
| | - Jincheng Zhong
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
| | - Jian Chen
- Eye Institute, Jinan University , Guangzhou , China
| | - Xiaoyong Liu
- The First Affiliated Hospital of Jinan University , Guangzhou , China
| | - Juan Deng
- The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Xiaoxi Yang
- The Sixth Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Wencai Ye
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
| | - Rijia Zhang
- The First Affiliated Hospital of Jinan University , Guangzhou , China
| | - Qing Zhou
- The First Affiliated Hospital of Jinan University , Guangzhou , China
| | - Dongmei Zhang
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
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Theotoka D, Morkin MI, Galor A, Karp CL. Update on Diagnosis and Management of Conjunctival Papilloma. EYE AND VISION 2019; 6:18. [PMID: 31236424 PMCID: PMC6580461 DOI: 10.1186/s40662-019-0142-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/24/2019] [Indexed: 02/08/2023]
Abstract
Conjunctival papilloma is an acquired benign squamous cell tumor that can present at any age, but most frequently in the third and fourth decades of life. Papillomas have been associated with human papilloma virus (HPV) infection, usually types 6 and 11. Although histopathological diagnosis remains the gold standard, the advent of newer non-invasive imaging modalities such as optical coherence tomography (OCT) is transforming the way we diagnose and treat ocular surface tumors, including conjunctival papilloma. Management of these lesions can prove a challenge to the treating physician since not all lesions respond to medical and/or surgical therapy and in fact may worsen after surgical manipulation. In this review, the epidemiology, pathophysiology, clinical characteristics, and diagnosis of conjunctival papilloma including the use of OCT are discussed. Indications, efficacy, and side effects of currently available management options are also reviewed to guide the selection of the best treatment approach.
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Affiliation(s)
- Despoina Theotoka
- 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Melina I Morkin
- 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Anat Galor
- 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA.,2Miami Veterans Administration Medical Center, 1201 NW 16th Street, Miami, 33125 FL USA
| | - Carol L Karp
- 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
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Baxter SL, Nguyen BJ, Kinori M, Kikkawa DO, Robbins SL, Granet DB. Identification and Correction of Restrictive Strabismus After Pterygium Excision Surgery. Am J Ophthalmol 2019; 202:6-14. [PMID: 30771334 DOI: 10.1016/j.ajo.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To report the characteristics of patients with restrictive diplopia following pterygium excision and a successful treatment approach for the strabismus. DESIGN Retrospective interventional case series. METHODS This study was set in a single academic institution and included 15 patients with restrictive diplopia after pterygium excision. Patients with any other reason for strabismus were excluded. Patients were evaluated for deficits with special attention to diplopic measures. The intervention was a combined procedure by a strabismologist and oculoplastic surgeon to correct the diplopia. The primary outcome measurements were subjective and objective improvement of diplopia. RESULTS Fifteen patients (mean age = 49 years) who developed diplopia after pterygium excision were included. Mean time to diplopia was 6 months. All patients had limited abduction in the previously operated eye causing esotropia in the abductive field (mean deviation = 18 prism diopters). After intervention, all patients were no longer diplopic in primary gaze. In the abductive field, 11 (73%) patients had residual small angle esotropia (mean = 7 prism diopters) in ipsilateral extreme end-gaze only. Only 2 patients required additional surgical intervention for scar tissue removal. No patients underwent medial rectus recession. CONCLUSIONS Restrictive diplopia is a potential complication after pterygium excision, particularly for patients with a history of recurrent pterygia requiring multiple excisions and previous amniotic membrane graft placement with fibrin glue. However, diplopia after pterygium excision in primary position is surgically correctable with scar tissue removal and ocular surface reconstruction, without needing medial rectus recession. Given the high volume of pterygium excision, awareness of postoperative restrictive strabismus and the potential for correction is critical.
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Del Noce C, Vagge A, Traverso CE. Bleb Needling with Mitomycin C as Adjunctive Therapy in Failing Blebs: A Retrospective Study. Ophthalmic Res 2019; 62:55-60. [PMID: 31071708 DOI: 10.1159/000499129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the effects and complications related to use of mitomycin C (MMC) as an adjunctive therapy in bleb needling. METHODS Retrospective review of the records of patients affected by open-angle glaucoma who underwent a bleb revision as a treatment for failed trabeculectomy. All subjects underwent surgery with a fornix-based approach to incision. Full baseline data for each patient included a comprehensive ocular and medical history, the patient's Snellen visual acuity test results, and Goldmann applanation tonometry test results. Data were reported following observations occurring at 6, 12, 18, 24, and 30 months. In addition, the number and timing of needling with or without MMC subconjunctival injections and any short- and long-term complications were observed. RESULTS We included 101 patients, 56 (55.4%) male and 45 (44.6%) female. The mean age was 69.81 ± 16.19 years (range 28-92). Statistically significant effects of needling and needling and MMC (p values <0.05) in the decrease in intraocular pressure were observed. Three (2.9%) patients presented hypotony at the last follow-up visit. No other complications were observed. CONCLUSIONS Needling bleb revision augmented with the use of MMC appears to be a more useful tool in the management of failing bleb.
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Affiliation(s)
- Chiara Del Noce
- Eye Clinic of Genoa, Policlinic Hospital, IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Aldo Vagge
- Eye Clinic of Genoa, Policlinic Hospital, IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy,
| | - Carlo Enrico Traverso
- Eye Clinic of Genoa, Policlinic Hospital, IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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Abdel-Naby Awad OG, Hasan MM. Topical Mitomycin-C can help as an adjunct to alkaline nasal wash and rifampicin in primary atrophic rhinitis. Am J Otolaryngol 2019; 40:137-142. [PMID: 30670313 DOI: 10.1016/j.amjoto.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Primary atrophic rhinitis (PAR) is a well-known old disease characterized by a roomy nose and extensive crustations. This study was designed to investigate the effect of topical Mitomycin-C as an adjunct to medical treatment with respect to objective and subjective improvement in patients treated with PAR. MATERIAL AND METHODS This prospective randomized controlled study was conducted in a tertiary referral hospital in January 2016 and March 2018. Fifty adult patients aged 18 to 45 with PAR were randomly divided into 2 groups. STUDY GROUP treatment with Mitomycin-C dissolved in an alkaline wash plus rifampicin and control group: only treated with rifampicin and alkaline nasal wash. Subjective scores for the following symptoms: After 12 weeks of treatment, foul smell, anosmia, crusting, epistaxis, and nasal blockade, an objective score of crusting, the status of nasal mucosa, nature of the secretions and condition of nasal cavity were compared between the two groups. RESULTS The degree of crustations (P < 0.0001) and the severity of epistaxis (P < 0.0001) were significantly improved in patients treated with Mitomycin-C dissolved in an alkaline wash (i.e. the study group), and the secretions returned significantly to normal (P < 0.0001). Both groups had significant improvements in both subjective and objective parameters of the assessment. CONCLUSIONS In patients with primary atrophic rhinitis, the use of Mitomycin-C dissolved in an alkaline nasal wash as an adjunct to oral rifampicin can produce a beneficial result than rifampicin and alkaline nasal wash alone.
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Jayantha Kedilaya Y, Chacko A, Poorey VK. Improving the Results of Endonasal Dacryocystorhinostomy with Mitomycin C Application: A Prospective Case-Control Study. Indian J Otolaryngol Head Neck Surg 2018; 70:477-481. [PMID: 30464901 DOI: 10.1007/s12070-018-1498-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
Many surgical advancement paved to surgical success in endonasal endoscopic dacryocystorhinostomy. Mitomycin C is a systemic chemotherapeutic agent derived from Streptomyces caespitosus that inhibits the synthesis of DNA, cellular RNA, and protein by inhibiting the synthesis of collagen by fibroblasts. The objective of the study was to evaluate the advantage of mitomycin C in primary endoscopic endonasal dacryocystorhinostomy without stenting. Randomised case control design. Tertiary academic centre in central India. 112 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups with or without mitomycin C intraoperative application. 112 eyes underwent endoscopic-dacryocystorhinostomy. Additional surgeries were done according to necessity. Mitomycin C was applied in concentration of 0.4 mg/dl for 5 min. Patients were followed up on OPD-basis at the end of 1st week, 1st month, 3rd month and over phone call at end of 1 year. Symptomatic improvement assessed by verbal enquiry and clinically by syringing by ophthalmologist. 8 patients underwent septal surgery in case group and 4 in control group along with 1 concha bullosa correction in the case group (p < 0.05). Nil intraoperative complications (p < 0.05) and nil postoperative complication noted (p < 0.05). Functional and anatomical patency found to be 100% at the end of 1st week in both groups, 96.5% at 3rd month in case group and 96.4% and 92.9% at 1 month and 3 month respectively in control group. Nasal endoscopy of all surgical failures showed restenosis in both case group and control group except 1 patient with granulation in control group. Eventhough intraoperative mitomycin C application is effective in increasing the success rate of endonasal DCR surgery in standard nasolacrimal duct obstruction, and with no significant complications from its use, the study did not show added benefit in the primary endoscopic endoscopic dacryocystorhinostomy without stenting.
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Affiliation(s)
| | - Aneena Chacko
- Department of ENT, Gandhi Medical College, Bhopal, MP 462001 India
| | - V K Poorey
- Department of ENT, Gandhi Medical College, Bhopal, MP 462001 India
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Fernando O, Tagalakis AD, Awwad S, Brocchini S, Khaw PT, Hart SL, Yu-Wai-Man C. Development of Targeted siRNA Nanocomplexes to Prevent Fibrosis in Experimental Glaucoma Filtration Surgery. Mol Ther 2018; 26:2812-2822. [PMID: 30301666 PMCID: PMC6277485 DOI: 10.1016/j.ymthe.2018.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 11/28/2022] Open
Abstract
RNAi induced by double-stranded small interfering RNA (siRNA) molecules has attracted great attention as a naturally occurring approach to silence gene expression with high specificity. The myocardin-related transcription factor/serum response factor (MRTF/SRF) pathway is a master regulator of cytoskeletal gene expression and, thus, represents a promising target to prevent fibrosis. A major hurdle to implementing siRNA therapies is the method of delivery, and we have, thus, optimized lipid-peptide-siRNA (LPR) nanoparticles containing MRTF-B siRNAs as a targeted approach to prevent conjunctival fibrosis. We tested 15 LPR nanoparticle formulations with different lipid compositions, surface charges, and targeting or non-targeting peptides in human conjunctival fibroblasts. In vitro, the LPR formulation of the DOTMA/DOPE lipid with the targeting peptide Y (LYR) was the most efficient in MRTF-B gene silencing and non-cytotoxic compared to the non-targeting formulation. In vivo, subconjunctival administration of LYR nanoparticles containing MRTF-B siRNAs doubled bleb survival in a pre-clinical rabbit model of glaucoma filtration surgery. Furthermore, MRTF-B LYR nanoparticles reduced the MRTF-B mRNA by 29.6% in rabbit conjunctival tissues, which led to significantly decreased conjunctival scarring with no adverse side effects. LYR-mediated delivery of siRNA shows promising results to increase bleb survival and to prevent conjunctival fibrosis after glaucoma filtration surgery.
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Affiliation(s)
- Owen Fernando
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 2PD, UK
| | - Aristides D Tagalakis
- Experimental and Personalised Medicine Section, Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; Department of Biology, Edge Hill University, Ormskirk L39 4QP, UK
| | - Sahar Awwad
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 2PD, UK; UCL School of Pharmacy, London WC1N 1AX, UK
| | - Steve Brocchini
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 2PD, UK; UCL School of Pharmacy, London WC1N 1AX, UK
| | - Peng T Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 2PD, UK
| | - Stephen L Hart
- Experimental and Personalised Medicine Section, Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Cynthia Yu-Wai-Man
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 2PD, UK; King's College London, London SE1 7EH, UK.
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Hirst LW, Battistuta D. Eight-year trends in the Australian surgical approach to pterygium removal. Clin Exp Ophthalmol 2018; 47:15-19. [DOI: 10.1111/ceo.13351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/22/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Lawrence W Hirst
- The Australian Pterygium Centre; Brisbane Australia
- Queensland Eye Institute; South Brisbane Australia
- The University of Queensland; St Lucia Australia
| | - Diana Battistuta
- Institute of Health and Biomedical Innovations, Queensland University of Technology; Kelvin Grove Australia
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Lešin M, Paradžik M, Marin Lovrić J, Olujić I, Ljubić Ž, Vučinović A, Bućan K, Puljak L. Cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery (CAGE CUP): study protocol of a randomised controlled trial. BMJ Open 2018; 8:e020714. [PMID: 29950464 PMCID: PMC6020953 DOI: 10.1136/bmjopen-2017-020714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pterygium is a non-cancerous growth of the conjunctival tissue over the cornea that may lead to visual impairment in advanced stages, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence of pterygium is a frequent problem. It has been previously shown that fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. However, fibrin glue is a biological material and it carries the risk of transmitting infectious agents from pooled and single-donor blood donors and anaphylaxis in susceptible individuals. Cauterisation is another surgical option, and it would be advantageous to know whether cauterisation may be superior surgical option compared with fibrin glue. This protocol describes the rationale and design of the randomised controlled trial (RCT) in which we will compare cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery. METHODS AND ANALYSES This will be a parallel group RCT comparing cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery. Computer-generated randomisation will be used, and allocation concealment will be conducted using sequentially numbered opaque sealed envelopes. Surgeons will not be blinded to the procedures, but participants, other investigators and outcome assessors will be blinded. Adult participants with primary pterygium operated in a tertiary hospital in Split, Croatia, will be included. Primary outcome will be recurrence of pterygium, defined as any regrowth of tissue from the area of excision across the limbus onto the cornea after 180 days. ETHICS AND DISSEMINATION The trial was approved by the ethics review board of the University Hospital Split (500-03/17-01/68). Results will be disseminated at conferences and through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03321201; Pre-results.
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Affiliation(s)
- Mladen Lešin
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Martina Paradžik
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | | | - Ivana Olujić
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Žana Ljubić
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Ana Vučinović
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Kajo Bućan
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Livia Puljak
- Laboratory for Pain Research Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Split, Croatia
- Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
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Hwang HS, Cho KJ, Rand G, Chuck RS, Kwon JW. Optimal size of pterygium excision for limbal conjunctival autograft using fibrin glue in primary pterygia. BMC Ophthalmol 2018; 18:135. [PMID: 29879926 PMCID: PMC5992752 DOI: 10.1186/s12886-018-0790-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In our study we describe a method that optimizes size of excision and autografting for primary pterygia along with the use of intraoperative MMC and fibrin glue. Our objective is to propose a simple, optimizedpterygium surgical technique with excellent aesthetic outcomes and low rates of recurrence and otheradverse events. METHODS Retrospective chart review of 78 consecutive patients with stage III primary pterygia who underwent an optimal excision technique by three experienced surgeons. The technique consisted of removal of the pterygium head, excision of the pterygium body and Tenon's layer limited in proportion to the length of the head, application of intraoperative mitomycin C to the defect, harvest of superior bulbar limbal conjunctival graft, adherence of graft with fibrin glue. Outcomes included operative time, follow up period, pterygium recurrence, occurrences of incorrectly sized grafts, and other complications. RESULTS All patients were followed up for more than a year. Of the 78 patients, there were 2 cases of pterygium recurrence (2.6%). There was one case of wound dehiscence secondary to small-sized donor conjunctivaand one case of over-sized donor conjunctiva, neither of which required surgical correction. There were no toxic complications associated with the use of mitomycin C. CONCLUSION Correlating the excision of the pterygium body and underlying Tenon's layer to the length of the pterygium head, along with the use intraoperative mitomycin C, limbal conjunctival autografting, and fibrin adhesionresulted in excellent outcomes with a low rate of recurrence for primary pterygia.
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Affiliation(s)
- Ho Sik Hwang
- Department of Ophthalmology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Korea
| | - Kyong Jin Cho
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Gabriel Rand
- Department of Ophthalmology, Montefiore Medical Center, Bronx, New York, USA
| | - Roy S Chuck
- Department of Ophthalmology, Montefiore Medical Center, Bronx, New York, USA
| | - Ji Won Kwon
- Department of Ophthalmology, Myongji Hospital, Seonam University College of Medicine, 55 Hwasu-Ro 14, Deokyang-Gu, Goyang-Si, Gyeonggi-Do, 10475, Korea.
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Abstract
PURPOSE The aim of the study was to evaluate the safety and effectiveness of postoperative instillation of Mitomycin C eye drops in patients with recurrent pterygium. METHODS Between October 1993 and November 1994, we operated 12 patients with recurrent pterygium using the conjunctival autografting technique, and after the operation patients instilled 0.02% or 0.04% Mitomycin C eye drops two or four times a day for one or two weeks. RESULTS Early complications were 2 wound dehiscences, 7 corneal epithelial defects, 5 reported eye discomforts and 2 glaucoma. Late, there were 2 recurrences of pterygium after 6 and 9 months, one simplex glaucoma, one cataract and one alopecia areata. CONCLUSIONS In cases of aggressive or severe pterygia, postoperative use of Mitomycin C eye-drops appears to be safe, effective and acceptable, but good surgical technique, careful observation and a long follow-up is indispensable for these patients.
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Affiliation(s)
- A Kraut
- Department of Ophthalmology, University Medical Centre of Ljubljana, Slovenia
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Demirok A, Simsek S, Cinal A, Yasar T. Intraoperative Application of Mitomycin C in the Surgical Treatment of Pterygium. Eur J Ophthalmol 2018; 8:153-6. [PMID: 9793768 DOI: 10.1177/112067219800800306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To investigate the effectiveness of intraoperative mitomycin C in pterygium surgery. Methods The effectiveness of intraoperatively administered mitomycin C and the occurrence of postoperative complications were evaluated in 17 patients with two recurrences of pterygium. The authors employed the “bare-sclera technique” and placed a sterile sponge soaked in a 0.02% mitomycin C solution intraoperatively in the episcleral space for 3 minutes. The control group (15 patients) underwent only surgical excision. Patients were followed for 21 to 30 months. Results The pterygium recurred in one (5.9%) of the 17 patients in group 1 and in six (40%) of the 15 controls. Statistical analysis using Fisher's exact test showed a significant (p=0.027) reduction of recurrences of pterygium in the group treated intraoperatively with mitomycin C. No serious complications or side effects arose during the follow-up period. Conclusions Mitomycin C administered intraoperatively can be considered an effective treatment to improve the success rate after surgical excision.
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Affiliation(s)
- A Demirok
- Yüzüncü Yil Universitesi Tip Fakültesi, Van, Türkey
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