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5-Fluorouracil in primary, impending recurrent and recurrent pterygium: Systematic review of the efficacy and safety of a surgical adjuvant and intralesional antimetabolite
The Ocular Surface ( IF 6.4 ) Pub Date : 2022-08-09 , DOI: 10.1016/j.jtos.2022.08.002
Brendon W H Lee 1 , Amitouj S Sidhu 2 , Ian C Francis 2 , Minas T Coroneo 2
Affiliation  

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.



中文翻译:

5-氟尿嘧啶治疗原发性、即将复发和复发性翼状胬肉:系统评价手术辅助和病灶内抗代谢物的疗效和安全性

翼状胬肉是一种与紫外线相关的疾病,其特征是异常的、翼状的和活跃的伤口愈合过程。对于外科医生或患者来说,没有什么比翼状胬肉的复发更令人沮丧的了,并且已经研究了各种辅助剂来改善这种情况。该系统评价全面总结了 5-氟尿嘧啶 (5-FU) 作为翼状胬肉管理的抗代谢药物的有效性和安全性。对六个数据库进行电子搜索的评估确定了 34 项临床研究报告了 5-FU 在原发性、即将复发和复发性翼状胬肉中使用的复发结果。5-FU 的体外和体内研究显示剂量和持续时间依赖性细胞抑制和人体细胞中的细胞毒性作用。5-FU 相对便宜、可用且易于管理,使其对资源有限的情况具有吸引力。然而,已发表的证据表明,裸巩膜技术的复发率为 11.4-60%,结膜旋转皮瓣为 3.5-35.8%,结膜自体移植为 3.7-9.6%术中局部 5-FU,术前和术中注射为 14-35.8%。这种次优疗效使 5-FU 作为翼状胬肉手术辅助剂的作用受到质疑,作者不推荐使用它。相比之下,术后病灶内注射 5-FU 以阻止即将复发的翼状胬肉和真正的复发性翼状胬肉的进展更有希望,成功率分别为 87.2-100% 和 75-100%。此外,5-FU 作为一种治疗方式,无需手术,可有效阻止 81.3-96% 的原发性和复发性翼状胬肉的进展。其他治疗,如局部和病灶内皮质类固醇、环孢菌素和抗 VEGF 药物进行了讨论。5-FU 的并发症随着剂量的增加而增加,范围从短暂和可逆到严重和威胁视力。对于翼状胬肉,5-FU 容易导致巩膜变薄、角膜毒性和移植物相关并发症。需要进行额外的延长随访研究,以阐明 5-FU 注射的最佳剂量、频率、持续时间和长期安全性。如果 5-FU 用于翼状胬肉的治疗,则应谨慎用于选定的患者并进行警惕的长期监测。

更新日期:2022-08-09
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