Intra-lesional 5 fluorouracil for the management of recurrent pterygium

Abstract

Aim: Recurrence is the most common complication arising from pterygium surgery. The aim of this study was to investigate the effectiveness of 5 fluorouracil (5FU) in halting the recurrence of pterygium after surgical excision.

Methods: A retrospective review of patients treated for pterygium recurrence was carried out. Patients with recurrent (secondary) pterygium were treated with multiple weekly intra-lesional injections of 0.1-0.2 ml (2.5-5 mg) 5FU post-operatively depending on the size of the recurrence. The treatment was started within 1 month from the date of recurrence. The time from surgery to start of recurrence, previous treatment modalities, and number of recurrences were documented. The number of injections required to induce arrest of progression and/or regression of vascularity and fleshiness of the pterygium and any complications related to 5FU treatment were examined.

Results: Fifteen eyes from 14 patients with recurrent pterygium treated with intra-lesional 5FU injections were analysed. Three of the 15 eyes had undergone a secondary excision and 12 had undergone a primary excision. In all, 93.3% of patients showed regression of the fibrovascular tissue (thickness and vascularity) and arrest of progression following a dose of 0.1-0.2 ml (2.5-5 mg) 5FU. Twelve eyes required three injections or fewer, whereas one patient required eight injections. This beneficial effect was maintained over an average follow-up period of 17 months. No complications from 5FU were observed.

Conclusion: The use of weekly intra-lesional 5FU injections for the treatment of recurrent pterygium is safe and effective in limiting the progression and inducing the regression of recurrent pterygium. The number of injections can be tailored according to clinical need.

Figures

Figure 1

Slit-lamp diffuse images: left column represents pre-injection images of recurrent pterygium and the right column represents the post-injection resolution of the recurrence. (a) (Patient no. 2, left eye) Showing predominant conjunctival recurrence and early corneal recurrence 412 days after primary excision without MMC. (b) (Patient no. 2, left eye) Showing resolution after 8 injections of 5FU. (c) (Patients no. 2 right eye) Showing recurrence of pterygium 55 days after primary excision without MMC. (d) (Patient no. 2, right eye) Image showing resolution after three injections of 5FU. (e) (Patient no. 6) Showing predominant conjunctival recurrence with early corneal recurrence 262 days after primary excision with MMC. (f) (Patient no. 6) Shows resolution of vascularisation and thickness after four injections of 5FU. (g) (Patient no. 12) Showing recurrence of pterygium 69 days after excision of secondary pterygium with MMC. (h) (Patient no. 12) Shows resolution of vascularisation and thickness after three injections of 5FU.

Figure 2

Slit-lamp diffuse images: these images are of patient no. 3. (a) Thick fleshy primary pterygium just before excision with auto-conjunctival grafting and MMC intra-operative application. (b) The appearance of the graft and the reperfusion injury on the fourth post-operative day. (c) Graft diffuse injection and swelling settling down 3 weeks post-operatively. Areas of graft haemorrhage are no more seen. (d) Conjuctival recurrence of the pterygium 39 days post-operatively. (e) The appearance after regression of the recurrent pterygium.