翼状胬肉是一种与紫外线有关的疾病,其特征是异常,翼形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佐剂来改善这种情况。本系统综述全面总结了5-氟尿嘧啶(5-FU)作为翼状胬肉治疗的抗代谢药的有效性和安全性。对六个数据库的电子搜索进行评估,确定了34项临床研究,这些研究报告了原发性5-FU使用的复发结果,即将复发和复发性翼状胬肉。5-FU的体外和体内研究显示了人细胞中剂量和持续时间依赖性的细胞抑制作用和细胞毒性作用。5-FU相对便宜,可用,易于管理,使其对资源有限的场景具有吸引力。然而,发表的证据表明,裸露巩膜技术的复发率为11.4-60%,结膜旋转瓣3.5-35.8%,3.7-9.6%的结膜自体移植物用于术中局部5-FU,术前和术中注射14-35.8%。这种欠佳的疗效使5-FU作为翼状胬肉手术的佐剂的作用受到质疑,作者不建议使用它。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复发的翼状胬肉的进展更有希望,成功率为87.2-100%和75-100%,分别。此外,5-FU作为一种治疗方式,没有手术,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,讨论了环孢菌素和抗VEGF药物。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有导致巩膜变薄的倾向,角膜毒性,和移植物相关并发症。需要进行额外的随访研究以阐明最佳剂量,频率,持续时间,和5-FU注射的长期安全性。如果在翼状胬肉的管理中使用5-FU,应该小心,在选定的患者和警惕的长期监测。
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.