Adjuvant Use of Cyclosporine A in the Treatment of Primary Pterygium: A Systematic Review and Meta-Analysis

Zhang, Qing; Bao, Ning; Liang, Kun; Tao, Liming

doi:10.1097/ico.0000000000001542

Cited by 19 publications

(14 citation statements)

References 30 publications

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“…CsA is an anti-inflammatory and immunosuppressive drug, which can help to significantly reduce pterygium recurrence when used in the postoperative time. 150 , 151 Ibáñez et al used adjuvant CsA at a 0.10% concentration, which differed from other studies that used CsA at a 0.05% concentration with no significant differences. 152 Moreover, adjuvant use of CsA in the treatment of pterygium was superior when compared with patients receiving only excisional surgery.…”

Section: Adjuvant Therapiesmentioning

confidence: 95%

“… 152 Moreover, adjuvant use of CsA in the treatment of pterygium was superior when compared with patients receiving only excisional surgery. 151 , 153 , 154…”

Section: Adjuvant Therapiesmentioning

confidence: 99%

“…However, the current limited evidence can only suggest that CsA is useful to significantly reduce recurrence rates when compared with simple pterygium excision, whereas the adjuvant use of CsA may not reduce the risk of pterygium recurrence when combined with conjunctival autografting or rotational flap. 151 …”

Section: Adjuvant Therapiesmentioning

confidence: 99%

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How to minimize pterygium recurrence rates: clinical perspectives

Nuzzi¹,

Tridico²

2018

OPTH

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The main treatment for pterygium is surgical removal. However, pterygium surgery is concerned with high rates of postoperative recurrence. Predicting factors of recurrence are not fully understood, yet, but they probably depend on a multitude of patient-related, clinical, and/or surgical factors. Several adjuvant treatments have been proposed to reduce postoperative pterygium recurrence, including different antimetabolites, antiangiogenetic factors, and radiation therapy. The purpose of this review is to collect the current evidence regarding application and limits of different therapeutic approaches for preventing postoperative recurrence of pterygium, giving insights and perspectives for better management of this disease. In the light of the current evidence, pterygium surgery cannot disregard wound coverage with conjunctival autografting or rotational flap combined with adjuvant treatments. The rotational flap technique is associated with shorter surgical time rates and prevents graft displacement and necrosis, given its vascular pedicle. Amniotic membrane may still be reserved in case of great conjunctival defects or insufficient conjunctiva. Repeated subconjunctival antivascular endothelial growth factor injections can be considered as an effective and safe adjuvant treatment. Moreover, management of postoperative pain is crucial. Innovative treatment strategies will probably target different molecular pathways, considering recent findings regarding pterygium pathogenesis, to improve better understanding and develop universally shared guidelines. Great importance shall be dedicated to the identification of novel molecular biomarkers and favoring factors of recurrence, in order to achieve a customized surgical treatment for each patient and obtain maximal reduction of postoperative recurrence.

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Section: Adjuvant Therapiesmentioning

confidence: 95%

“… 152 Moreover, adjuvant use of CsA in the treatment of pterygium was superior when compared with patients receiving only excisional surgery. 151 , 153 , 154…”

Section: Adjuvant Therapiesmentioning

confidence: 99%

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How to minimize pterygium recurrence rates: clinical perspectives

Nuzzi¹,

Tridico²

2018

OPTH

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“…Pterygium recurs, most commonly, during the first 4-6 months after surgery, and 97% of recurrences occur within the first year [1,2,3]. The above recent meta-analyses have summarized the effects of several adjuvant treatments (conjunctival autograft, mitomycin C (MMC), ciclosporin A, autologous blood, anti-VEGF agents, beta therapy and their combinations) for pterygium.…”

Section: Introductionmentioning

confidence: 99%

“…Fonseca et al [1] have found the combination of conjunctival autograft and ciclosporin to be the best treatment to prevent recurrence after primary pterygium surgery, whereas others found intraoperative MMC to be the best adjuvant treatment. However, overall recurrence rates remain rather high (11-38%) [1,2]. Previously, we have reported on recurrence rates after various surgical techniques for pterygium at immediate (1-3 months) and up to 12 months follow-up points [4].…”

Section: Introductionmentioning

confidence: 99%

Relationship of the recurrence after pterygium surgery with the presence of HSV, EBV, CMV, HPV, and BRAFV600E mutation

Rykov¹,

Usenko²,

Mogilevskyy³

et al. 2018

Oftalmol Zh

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Background: Previously, we have reported on associations of pterygium with the presence of herpes simplex virus (HSV), Epstein Barr virus (EBV), cytomegalovirus (CMV), human papillomavirus (HPV), and the BRAF V600E somatic point. The current study attempted to examine the relationship between the recurrence during 1 year after pterygium surgery and the presence of these factors. Purpose: To identify the relationship between (a) recurrence rates after various surgical techniques for pterygium and (b) the presence of herpes viruses (HSV, EBV, and CMV), HPV 6, 11, 16 and 18 and BRAF V600E mutation. Materials and Methods: Two hundred and three patients (232 eyes) with a history of pterygium surgery underwent examination. They were divided into five groups based on the method of surgical treatment: Group 1 (the McReynolds transplantation only) of 49 eyes; Group 2 (the McReynolds transplantation, with adjuvant MMC 0.02% applied to the cornea for 30 sec) of 41 eyes; Group 3 (the technique of Arlt) of 49 eyes; Group 4 (the technique of Arlt, with adjuvant MMC 0.02% applied to the cornea for 30 sec) of 46 eyes; Group 5 of 47 eyes that were treated with our technique of pterygium excision involving the growth plate, with conjunctival autoplasty and adjuvant MMC 0.02%. Real-time PCR with PCR kits from DNK Tekhnologiya (Russia) were used to identify HSV, EBV, CMV, and HPV. PCR amplification was performed in a DT-lite real-time PCR system (DNK Tekhnologiya). Mutation detection was performed using TaqMan Mutation Detection Assays (Thermo Fisher Scientific) in a Real-Time PCR System 7500 (Applied Biosystems, USA). Results: Changing from traditional surgical methods (the McReynolds or Arlt method, alone or with adjunctive mitomycin C) to our methodology for pterygium decreased the recurrence rate at 1 year after pterygium surgery by 17.0% (or 2.1-fold), from 31.9% to 14.9% (χ2 = 5.32; р = 0.021). There was a common trend regarding the relationship between the presence of BRAF V600 mutation and pterygium recurrence in the groups: in the groups with traditional surgical methods, the recurrence rate in BRAFV600 mutation-positive patients varied from 73.3% to 81.2%, whereas the recurrence rate in BRAF V600 mutation-negative patients varied from 4.2% to 10.7% (p < 0.001). The mutation increased the risk of a recurrence within a year after pterygium surgery approximately 35.7-fold (OR=35.72; 95% CI, 15.71-81.24). Changing from traditional surgical methods to our methodology for pterygium decreased the recurrence rate at 1 year after pterygium surgery in BRAFV600 mutation-positive patients by 39.8% (or 2.1-fold), from 77.3% to 37.5% (χ2 = 116.92; р < 0.01). Statistical analysis found no relationship between the distribution of recurrences among the groups, and presence of either individual viruses or their combinations (p > 0.1 for all cases). Conclusion: The presence of HSV, EBV, CMV, HPV, and/or BRAF V600 mutation in pterygium tissue is a risk factor for recurrence after surgical treatment.

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