Korean J Ophthalmol.  2015 Dec;29(6):375-381. 10.3341/kjo.2015.29.6.375.

A Comparative Study of Topical Mitomycin C, Cyclosporine, and Bevacizumab after Primary Pterygium Surgery

• Hwang S
• Choi S

• KMID: 2363844
• DOI: http://doi.org/10.3341/kjo.2015.29.6.375

Abstract

PURPOSE
To compare the recurrence rates and complications associated with instillation of topical mitomycin C, cyclosporine, and bevacizumab after primary pterygium surgery.
METHODS
Between July 2013 and June 2014, we performed surgery using the bare sclera method on 132 eyes (132 patients) with primary pterygium. We randomly selected 33 eyes (33 patients) and treated them with artificial tears four times a day for three months, 29 eyes (29 patients) were treated with topical 0.02% mitomycin C four times a day for five days, 34 eyes (34 patients) were treated with topical 0.05% cyclosporine four times a day for three months, and 36 eyes (36 patients) were treated with topical 2.5% bevacizumab four times a day for three months after surgery. We prospectively determined the recurrence rates of pterygium and complications at the six-month follow-up examination.
RESULTS
At six months after surgery, the recurrence rates in each group were as follows: 45.5% (15 eyes) in the control group, 10.3% (three eyes) in the mitomycin C group, 20.6% (seven eyes) in the cyclosporine group, and 41.7% (15 eyes) in the bevacizumab group (p = 0.004). No serious complications, except subconjunctival hemorrhages, were observed in any group.
CONCLUSIONS
Groups receiving topical 0.02% mitomycin C and 0.05% cyclosporine after surgery showed lower recurrence rates than the control group; however, no difference in recurrence rate was observed between the control group and the group receiving topical 2.5% bevacizumab after surgery.

Keyword

Bevacizumab; Cyclosporine; Mitomycin C; Primary pterygium; Recurrence rates

MeSH Terms

Administration, Topical
Aged
Aged, 80 and over
Alkylating Agents/administration & dosage
Angiogenesis Inhibitors/administration & dosage
Bevacizumab/*administration & dosage
Cell Count
Combined Modality Therapy
Cyclosporine/*administration & dosage
Double-Blind Method
Endothelium, Corneal/pathology
Female
Humans
Immunosuppressive Agents/administration & dosage
Male
Middle Aged
Mitomycin/*administration & dosage
Ophthalmic Solutions
Ophthalmologic Surgical Procedures
Prospective Studies
Pterygium/diagnosis/*drug therapy/*surgery
Recurrence
Vascular Endothelial Growth Factor A/antagonists & inhibitors
Alkylating Agents
Angiogenesis Inhibitors
Bevacizumab
Cyclosporine
Immunosuppressive Agents
Mitomycin
Ophthalmic Solutions
Vascular Endothelial Growth Factor A

Reference

1. Todani A, Melki SA. Pterygium: current concepts in pathogenesis and treatment. Int Ophthalmol Clin. 2009; 49:21–30.

2. Chung DS, Cho BJ, Moon NJ. Mitomycin C single soaking during surgery for primary pterygium. J Korean Ophthalmol Soc. 1996; 37:927–933.

3. Turan-Vural E, Torun-Acar B, Kivanc SA, Acar S. The effect of topical 0.05% cyclosporine on recurrence following pterygium surgery. Clin Ophthalmol. 2011; 5:881–885.

4. Bahrassa F, Datta R. Postoperative beta radiation treatment of pterygium. Int J Radiat Oncol Biol Phys. 1983; 9:679–684.

5. Na KS, Kim JY, Choi GJ. A clinical observation on the argon laser effect of the pterygium. J Korean Ophthalmol Soc. 1996; 37:1120–1125.

6. Shenasi A, Mousavi F, Shoa-Ahari S, et al. Subconjunctival bevacizumab immediately after excision of primary pterygium: the first clinical trial. Cornea. 2011; 30:1219–1222.

7. Kawase K, Matsushita H, Yamamoto T, Kitazawa Y. Mitomycin concentration in rabbit and human ocular tissues after topical administration. Ophthalmology. 1992; 99:203–207.

8. Strong B, Farley W, Stern ME, Pflugfelder SC. Topical cyclosporine inhibits conjunctival epithelial apoptosis in experimental murine keratoconjunctivitis sicca. Cornea. 2005; 24:80–85.

9. Ozgurhan EB, Agca A, Kara N, et al. Topical application of bevacizumab as an adjunct to recurrent pterygium surgery. Cornea. 2013; 32:835–838.

10. Yamanouchi U. Scleral changes induced by instillation of mitomycin C. Acta Med Nagasaki. 1983; 28:99–110.

11. Rubinfeld RS, Pfister RR, Stein RM, et al. Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology. 1992; 99:1647–1654.

12. Ibanez M, Eugarrios MF, Calderon DI. Topical cyclosporin A and mitomycin C injection as adjunctive therapy for prevention of primary pterygium recurrence. Ophthalmic Surg Lasers Imaging. 2009; 40:239–244.

13. Stevenson W, Cheng SF, Dastjerdi MH, et al. Corneal neovascularization and the utility of topical VEGF inhibition: ranibizumab (Lucentis) vs bevacizumab (Avastin). Ocul Surf. 2012; 10:67–83.

14. Chen JJ, Ebmeier SE, Sutherland WM, Ghazi NG. Potential penetration of topical ranibizumab (Lucentis) in the rabbit eye. Eye (Lond). 2011; 25:1504–1511.

15. Tan DT, Chee SP, Dear KB, Lim AS. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol. 1997; 115:1235–1240.

16. Prabhasawat P, Barton K, Burkett G, Tseng SC. Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Ophthalmology. 1997; 104:974–985.

17. Song YS, Lee JK, Kim JC. Circulating endothelial progenitor cells and vasculogenic factors in pterygium pathogenesis. J Korean Ophthalmol Soc. 2006; 47:1472–1480.

18. Yalcin Tok O, Burcu Nurozler A, Ergun G, et al. Topical cyclosporine A in the prevention of pterygium recurrence. Ophthalmologica. 2008; 222:391–396.

19. Lazic R, Gabric N. Intravitreally administered bevacizumab (Avastin) in minimally classic and occult choroidal neovascularization secondary to age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2007; 245:68–73.

20. Jorge R, Costa RA, Calucci D, et al. Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE study). Retina. 2006; 26:1006–1013.

21. Motarjemizadeh Q, Aidenloo NS, Sepehri S. A comparative study of different concentrations of topical bevacizumab on the recurrence rate of excised primary pterygium: a short-term follow-up study. Int Ophthalmol. 2015; 05. 06. DOI: 10.1007/s10792-015-0076-4.

22. Suh JS, Choi SK. The effect of subconjunctival bevacizumab injection after primary pterygium surgery. J Korean Ophthalmol Soc. 2013; 54:53–59.

23. Krohne TU, Eter N, Holz FG, Meyer CH. Intraocular pharmacokinetics of bevacizumab after a single intravitreal injection in humans. Am J Ophthalmol. 2008; 146:508–512.

24. Lee JS, Lee SW, Lee SJ, Kim NM. Effects of cyclosporin on pterygium fibroblasts. J Korean Ophthalmol Soc. 2012; 53:466–472.