Management of Patients of Recurrent Pterygium by Intralesional Injection of 5 Fluorouracil

Abstract

Background: Management of recurrent pterygium using intralesional injection of 5-fluorouracil (5-FU) is an emerging technique aimed at reducing recurrence and inflammation without the need for repeated surgical intervention.

Objective: To manage the patients of recurrent pterygium by intralesional injection of 5 fluorouracil.

Methodology: This prospective study was conducted at Teaching Hospital, Loralai from 1st January 2023 to 30^th June 2023 and 100 patients (100 eyes) including recurrent pterygium on clinical diagnosis were enrolled. The primary outcomes of the study were progression arrest, reduction of redness/lesion vascularity and secondary outcomes were cosmetic benefits, improvement of redness, irritability as well as astigmatism effects. A comprehensive eye examination was performed as baseline. Following the injections, visual acuity was evaluated, corneal topography was performed. All injections were administered in the outpatient clinic using a slit lamp. Ten minutes prior to the procedure, topical anesthesia (1% w/v tetracaine minims, Bausch & Lomb, UK) and 5% w/v povidone iodine eye drops (Bausch & Lomb, UK) were instilled. A pre-loaded 1 ml syringe containing 0.3 ml of 5FU (2.5 mg per 0.1 ml) was used to inject 0.1–0.2 ml (equivalent to 2.5–5 mg of 5FU) into the body of the pterygium using a 30-gauge needle. The formation of a bleb confirmed intra-lesional delivery of the drug. After the injections, 1–2 drops of 0.5% chloramphenicol were applied topically and continued four times daily for three days post-injection. All patients had 24-hour access to an emergency eye care service and could contact the investigators with any concerns during the study.

Results: The mean age of the patients was 55.1±3.5 years with 60% males and 40% females. The progression arrest was noticed in 100% cases. However, 4 cases presented recurrence and later had to opt surgical interventions. The pterygium length was reduced in 60% cases with a mean difference of vector magnitude up to 0.10mm. Optical coherence tomography (OCT) measurements showed a reduction in pterygium thickness in 85% of patients, while the remaining patients exhibited no change. Among the patients who demonstrated a reduction in clinical grade, 90% showed an improvement of one grade, while 10% improved by two grades. The mean clinical grade decreased from 2.313 before the injection to 1.630 after the injection (P < 0.001; 95% CI: 0.368–1.007). The pterygium length was clinically graded as reduced in 65% cases while it remains in same grade in 35% ofcases. The photographic images of the patients showed reduction in the vascularity of the eye and redness with the injections.

Conclusion: The application of intralesional 5 fluorouracil injections is significantly effective in recurrent cases, only 25% cases recurrence.

Keywords: Management, Recurrent Pterygium, Intralesional injection, 5 Fluorouracil