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

Abstract

Introduction:

To investigate the ocular surface changes occurring in eyes with recurrent pterygium post-operatively treated with 5-fluorouracil intralesional injections.

Methods:

Retrospective observational study of recurrent pterygium cases treated with weekly intralesional injections of 0.1 mL (5 mg) of 5-fluorouracil (10 injections). Impression cytology samples taken from the lesion, the healthy conjunctivae (inferior, superior, and contralateral to injury), and the cornea before and after treatment were analyzed. Clinical ocular characteristics (including Schirmer’s test and break-up time) were evaluated during treatment.

Results:

A total of 15 eyes were treated, with the mean follow-up of 27 ± 8.7 months (mean ± standard deviation). Prior to treatment initiation, the ocular surface citology over the pterygium was found to be abnormal. No epithelial cells (27%) and a lower goblet cell density (73%) compared to the healthy conjunctivae (p < 0.01) were found. Squamous metaplasia was observed to some degree in the cornea (100%), pterygium (81%) and healthy conjunctivae (73%). Following treatment, pterygium composition had changed: epithelial cell number (100%) and goblet cell density (47%) had increased (p < 0.05). Goblet cell density was also increased in healthy conjunctivae (67%; p < 0.05). The degree of squamous metaplasia decreased in the cornea (67%), pterygium (45%), and healthy conjunctivae (60%; p < 0.05). No adverse effects were reported, recurrence progression was arrested, and conjunctival redness and dry-eye severity level were decreased in all cases (p < 0.01).

Discussion:

The cytology of ocular surface in recurrent pterygium is abnormal. After weekly intralesional 5-fluorouracil injections, it tends to normalize. The 5-fluorouracil compound is a safe and effective treatment to prevent pterygium recurrence.

Keywords

Impression cytology recurrent pterygium 5-fluorouracil subconjunctival injections

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References

Coster

Pterygium–an ophthalmic enigma. Br J Ophthalmol 1995; 79: 304–305.

Paris Fdos

De Farias

Melo

et al . Postoperative subconjunctival corticosteroid injection to prevent pterygium recurrence. Cornea 2008; 27(4): 406–410.

Lam

DSC

Wong

AKK

Fan

DSP

et al . Intraoperative mitomycin C to prevent recurrence of pterygium after excision: a 30-month follow up study. Ophthalmology 1998; 105(5): 901–905.

Pikkel

Porges

Ophir

Halting pterygium recurrence by postoperative 5-fluorouracil. Cornea 2001; 20(2): 168–171.

Prabhasawat

Tesavibul

Leelapatranura

et al . Efficacy of subconjunctival 5-fluorouracil and triamcinolone injection in impending recurrent pterygium. Ophthalmology 2006; 113(7): 1102–1109.

Said

Faraj

Elalfy

et al . Intra-lesional 5 fluorouracil for the management of recurrent pterygium. Eye (Lond) 2013; 27(10): 1123–1129.

Lekhanont

Patarakittam

Thongphiew

et al . Randomized controlled trial of subconjunctival bevacizumab injection in impending recurrent pterygium: a pilot study. Cornea 2012; 31(2): 155–161.

Bekibele

Baiyeroju

Ajayi

BG.

5-fluorouracil vs. beta-irradiation in the prevention of pterygium recurrence. Int J Clin Pract 2004; 58(10): 920–923.

Salomon

Scatorelli

AC.

Cancer chemotherapy. In: Katzung

(ed.) Basic and clinical pharmacology. Los Angeles, CA: Lange Medical Publications, 1987, pp. 667–668.

10.

Rivas

Oroza

Perez-Esteban

et al . Topo-graphical distribution of ocular surface cells by the use of impression cytology. Act Ophthalmol (Copan) 1991; 69(3): 371–376.

11.

Murube

Rivas

Impression cytology on conjunctiva and cornea in dry eye patients establishes a correlation between squamous metaplasia and dry eye clinical severity. Euro J Ophthalmol 2003; 13(2): 115–127.

12.

Lopez-Garcia

Rivas

Garcia-Lozano

Corneal epithelium squamous metaplasia determination as diagnostic factor in limbal deficiency. Arch Soc Esp Oftalmol 2006; 81(5): 281–288.

13.

Tan

Chee

Dear

et al . Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol 1997; 115(10): 1235–1240.

14.

Effron

Grading scales for contact lens complications. Ophthalmic Physiol Opt 1998; 18(2): 182–186.

15.

Maldonado

Cano-Parra

Navea-Tejerina

et al . Inefficacy of low-dose intraoperative fluorouracil in the treatment of primary pterygium. Arch Ophthalmol 1995; 113(11): 1356–1357.

16.

Pherwani

Vakil

Eatamadi

et al . Postoperative subconjunctival 5-fluorouracil in the management of recurring pterygium. Br J Ophthalmol 2007; 91(3): 398–399.

17.

Nelson

JD.

Impression cytology. Cornea 1988; 7: 71–81.

18.

Nelson

Havener

Cameron

JD.

Cellulose acetate impressions of the ocular surface: dry eye states. Arch Ophthalmol 1983; 101: 1869–1872.

19.

Natadisastra

Written

West

et al . Impression cytology for the detection of vitamin A deficiency. Arch Ophthalmol 1987; 105: 1224–1228.

20.

Puangsricharern

Tseng

SCG

. Cytologic evidence of corneal diseases with limbal stem cell deficiency. Ophthalmology 1995; 102: 1476–1485.

21.

Pfulgfelder

Huang

AJW

Feuer

et al . Conjunctival cytologic features of primary Sjögren’s syndrome. Ophthalmology 1990; 97: 985–991.

22.

Pfulgfelder

Tseng

SCG

Yoshino

et al . Correlation of goblet cell density and mucosal epithelial membrane cumin expression with rose Bengal staining in patients with ocular irritation. Ophthalmology 1997; 104: 223–235.

23.

Chan

Liu

Tan

DT.

Ocular surface changes in pterygium. Cornea 2002; 21(1): 38–42.

24.

Julio

Lluch

Pujol

et al . Conjunctival short-term evolution after pterygium excision. Optom Vis Sci 2015; 92(7): 790–795.

25.

Tseng

Chen

Cheng

et al . Impression cytology study of conjunctival epithelial phenotypes on the healing ocular surface after pterygium excision. Cornea 2001; 20(3): 244–250.

26.

Doughty

MJ.

Goblet cells of the normal human bulbar conjunctiva and their assessment by impression cytology sampling. Ocul Surf 2012; 10: 149–169.

27.

Zhang

Lin

et al . Tear function and goblet cell density after pterygium excision. Eye (Lond) 2007; 21: 224–228.

28.

Julio

Lluch

Pujol

et al . Tear osmolarity and ocular changes in pterygium. Cornea 2012; 31: 1417–1421.

29.

Rivas

López-García

Murube

et al . Different conjunctival adaptive response in patients with aqueous-deficient and with mucous-deficient dry eyes. Eur J Ophthalmol 2007; 17(2): 160–170.

30.

Han

Yang

Hyon

et al . Conjunctival metaplasia after pterygium excision and limbal autograft. Optom Vis Sci 2015; 92: 324–328.

31.

Xiao

Sheng

et al . 5-Fluorouracil attenuates dextran sodium sulfate induced acute colitis in mice. Mol Med Rep 2016; 13(3): 2821–2828.