Cargando…
How to minimize pterygium recurrence rates: clinical perspectives
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. Se...
Autores principales: | , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251440/ https://www.ncbi.nlm.nih.gov/pubmed/30538417 http://dx.doi.org/10.2147/OPTH.S186543 |
_version_ | 1783373123005972480 |
---|---|
author | Nuzzi, Raffaele Tridico, Federico |
author_facet | Nuzzi, Raffaele Tridico, Federico |
author_sort | Nuzzi, Raffaele |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6251440 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-62514402018-12-11 How to minimize pterygium recurrence rates: clinical perspectives Nuzzi, Raffaele Tridico, Federico Clin Ophthalmol Review 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. Dove Medical Press 2018-11-19 /pmc/articles/PMC6251440/ /pubmed/30538417 http://dx.doi.org/10.2147/OPTH.S186543 Text en © 2018 Nuzzi and Tridico. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Review Nuzzi, Raffaele Tridico, Federico How to minimize pterygium recurrence rates: clinical perspectives |
title | How to minimize pterygium recurrence rates: clinical perspectives |
title_full | How to minimize pterygium recurrence rates: clinical perspectives |
title_fullStr | How to minimize pterygium recurrence rates: clinical perspectives |
title_full_unstemmed | How to minimize pterygium recurrence rates: clinical perspectives |
title_short | How to minimize pterygium recurrence rates: clinical perspectives |
title_sort | how to minimize pterygium recurrence rates: clinical perspectives |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251440/ https://www.ncbi.nlm.nih.gov/pubmed/30538417 http://dx.doi.org/10.2147/OPTH.S186543 |
work_keys_str_mv | AT nuzziraffaele howtominimizepterygiumrecurrenceratesclinicalperspectives AT tridicofederico howtominimizepterygiumrecurrenceratesclinicalperspectives |