Anti-fibrotic, anti-VEGF or radiotherapy treatments as adjuvants for pterygium excision: a systematic review and network meta-analysis.

Abstract

BACKGROUND:

Anti-fibrotic, anti-VEGF (vascular endothelial growth factor) medications, or radiotherapy, as adjuvant for pterygium surgical procedure, has been suggested for reducing recurrence, but difficulties may be experienced in deciding which treatment to use. The purpose of this study was to compare the efficacies of these different adjuvants for preventing recurrence following pterygium surgery.

METHODS:

We conducted a systematic review to identify randomized controlled trials of patients with primary or recurrent pterygium who received anti-fibrotic, anti-VEGF medication, or radiotherapy as adjuvants in combination with surgical procedure. The surgical procedure contained bare sclera technique or petrygium excision combination with tissue grafting. The primary outcome of this study was recurrence. Direct-comparison and Bayesian network meta-analyses were performed to assess direct and indirect evidence of efficacy.

RESULTS:

We obtained data from 34 randomized controlled trials, representing a total of 2483 patients. Adjuvants included bevacizumab, 5-FU (5-fluorouracil), MMC (mitomycin C), and β-RT (beta-radiotherapy). Compared with placebo, we found distinguishable improvement in recurrence with bevacizumab (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.18-0.80), MMC (0.12, 95% CI 0.06-0.21), and β-RT (0.17, 95% CI 0.04-0.69), but not with 5-FU (0.41, 95% CI 0.12-1.39). MMC significantly reduced recurrence when compared to bevacizumab (0.31, 95% CI 0.13-0.77) and 5-FU (0.28, 95% CI 0.08-0.99). The probability of having the most recurrences after excision was lowest for MMC, followed by bevacizumab and β-RT. Similar results were found in subgroup analyses, including for primary pterygium, and the patients receiving bare sclera technique or conjunctival autograft.

CONCLUSIONS:

Adjuvants such as MMC, bevacizumab, and β-RT could effectively prevent recurrence following pterygium excision. However, their efficacy and acceptability require further clarification in future randomized controlled trials.

• Authors: Wen Zeng, Zengming Liu, Hanjun Dai, Ming Yan, Hong Luo, Min Ke, Xiaojun Cai
• Journal: BMC ophthalmology (BMC Ophthalmol) Vol. 17 Issue 1 Pg. 211 (Nov 25 2017) ISSN: 1471-2415 [Electronic] England
• PMID: 29178848 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Chemical References

• Alkylating Agents
• Angiogenesis Inhibitors
• Antifibrinolytic Agents
• Vascular Endothelial Growth Factor A

Topics

• Alkylating Agents (therapeutic use)
• Angiogenesis Inhibitors (therapeutic use)
• Antifibrinolytic Agents (therapeutic use)
• Chemotherapy, Adjuvant
• Humans
• Ophthalmologic Surgical Procedures (methods)
• Primary Prevention (methods)
• Pterygium (drug therapy, surgery)
• Radiotherapy, Adjuvant (methods)
• Randomized Controlled Trials as Topic
• Recurrence
• Secondary Prevention (methods)
• Vascular Endothelial Growth Factor A