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Antiangiogene Therapie bei Pterygiumrezidiven

Antiangiogenic therapy for pterygium recurrence

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Zusammenfassung

Einleitung

Das Pterygium ist als ein trianguläres, fibrovaskuläres, hyperplastisch proliferatives Degenerationsgewebe definiert. Obwohl die Pathogenese noch nicht eindeutig geklärt ist, gibt es Hinweise, dass VEGF eine entscheidende Rolle bei dessen Entwicklung spielt. Trotz unterschiedlicher chirurgischer Ansätze bleibt bis heute die z. T. hohe postoperative Rezidivneigung ein ungelöstes Problem. Bevacizumab ist ein humaner monoklonaler Antikörper gegen „vascular endothelial growth factor“ (VEGF), der in der Ophthalmologie als Off-Label Behandlung vitroretinaler Erkrankungen angewendet wird. Wir berichten über die Anwendung von Bevacizumab zur Prävention bei multipel rezidivierenden Pterygien.

Material und Methoden

An unserer Klinik wurden 5 Augen (4 Patienten), nach Exzision eines Pterygiumrezidivs adjuvant mit Bevacizumab-Augentropfen (25 mg/ml) 2- bis 8-mal täglich für 5 bis 24 Wochen behandelt. Der Median der Nachbeobachtungszeit lag bei 12 Monaten (minestens 3 Monate, maximal 14 Monate). Die Patienten wurden präoperativ sowie bei jedem Kontrolltermin mittels Spaltlampe untersucht.

Ergebnisse

Der Visus verbesserte sich bei 3 Augen um mindestens 1 Zeile. Ein Auge zeigte keine Rezidivzeichen und 2 Augen lediglich eine Bindehauthyperämie (Rezidivstadium 1). Bei 1 Auge zeigte sich bei der letzten Kontrolle fibroblastisches Bindehautgewebe (Rezidivstadium 2) und bei 1 Auge ein frühes Rezidiv mit Hornhautbeteiligung, einschließlich einer Hornhautstippung. Während der gesamten Beobachtungszeit wurden keine schweren dauerhaften Komplikationen beobachtet.

Diskussion

Angesichts des zuvor sehr hohen Rezidivdrucks in unserem Patientenkollektiv bewerten wir die beschriebenen ersten mittelfristigen Ergebnisse nach topischer Applikation von VEGF-Inhibitoren als eine vielversprechende nebenwirkungsarme Möglichkeit zur Verhinderung von Rezidiven.

Abstract

Purpose

A pterygium is defined as a fibrovascular and hyperplastic proliferative degeneration tissue of the limbus. Although the pathogenesis is not yet clearly understood there are indications that vascular endothelial growth factor (VEGF) may play a significant role in the development. Despite various surgical approaches recurrence remains the major postoperative problem. Bevacizumab is a human monoclonal antibody against VEGF. Its antiangiogenic effect is used in ophthalmology as an off-label treatment for retinal disease. We report about the use of Bevacizumab eye drops to prevent repeated recurrence of pterygia.

Materials and methods

In our clinic 5 eyes (4 patients) were treated with topical Bevacizumab eye drops (25 mg/ml) 2–8 times per day for 5–24 weeks as an adjunct after excision of recurrent pterygia and conjunctival autograft. Patients were examined preoperatively and over a follow-up period ranging from 3–14 months (median 12 months).

Results

Visual acuity improved in 3 out of 5 eyes and in 1 eye no pterygium recurrence was noted. Two eyes showed conjunctival hyperemia (stage 1 recurrence) and one eye showed fibrosis of the limbus (stage 2 recurrence). In one eye an early recurrence with corneal vascularisation and superficial punctate keratopathy was observed (stage 3 recurrence). No serious permanent complications were observed.

Conclusions

Considering the previously multiple recurrences in our patients we think that these first clinical mid-term follow-up experiences support the use of topical VEGF inhibitors in recurrent pterygia.

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Literatur

  1. Akinci A, Zilelioglu O (2007) Comparison of limbal-conjunctival autograft and intraoperative 0,02% mitomycin-C for treatment of primary pterygium. Int Ophthalmol 27(5):281–285

    Article  PubMed  Google Scholar 

  2. Avisar R, Avisar I, Bahar I, Weinberger D (2008) Effect of mitomycin C in pterygium surgery on corneal endothelium. Cornea 27(5):559–561

    Article  PubMed  Google Scholar 

  3. Bahar I, Kaiserman I, Lange AP et al (2009) The effect of mitomycin C on corneal endothelium in pterygium surgery. Am J Ophthalmol 147(3):447–452

    Article  PubMed  CAS  Google Scholar 

  4. Bahar I,Kaiserman I, Slomovic A et al (2008) Subcunjunctival Bevacizumab injection for corneal Neovascularisation in recurrent pterygium. Curr Eye Res 33(1):23–28

    Article  PubMed  CAS  Google Scholar 

  5. Barba KR, Samy A, Lai C et al (2000) Effect of topical anti-inflammatory drugs on corneal and limbal wound healing. J Cataract Refract Surg 26(6):893–897

    Article  PubMed  CAS  Google Scholar 

  6. Bock F, König Y, Kruse FE et al (2008) Bevacizumab (Avastin®) eye drops inhibit corneal neovascularisation. Graefes Arch Clin Exp Ophthalmol 246:281–284

    Article  PubMed  CAS  Google Scholar 

  7. Bock F, Onderka J, Rummelt C et al (2009) Safety profile of topical VEGF-neutraliziation at the cornea. Invest Ophthalmol Vis Sci Jan 17 (Epub ahead of print)

  8. Chase JL (2008) Clinical use of anti-vascular endothelial growth factor monoclonal antibodies in metastatic colorectal cancer. Pharmacotherapy 28(11 Pt 2):23–30

    Article  Google Scholar 

  9. Cernák M, Markovic O, Cernák A (2008) The treatment of the rubeosis of the iris and the neovascular glaucoma in proliferative diabetic retinopathy by means of anti-VEGF. Cesk Slov Ophthalmol 64(6):234–236

    Google Scholar 

  10. Chang CT, Chen YL, Lee SH et al (1989) The inhibition of prostaglandin E1-induced corneal neovascularization by steroid eye drops. Taiwan Yi Xui Hui Za Zhi 88(7):707–711

    CAS  Google Scholar 

  11. Coroneo MT, Di Girolamo N, Wakefield D (1999) The pathogenesis of Pterygia. Curr Opin Ophthalmol 10(4):282–288

    Article  PubMed  CAS  Google Scholar 

  12. Crăiţoiu S, Ciprian L, Rodica M et al (2008) Etiopathogenic aspects in development and evolution of pterigyum. Oftalmologia 52(2):29–34

    PubMed  Google Scholar 

  13. Cursiefen C, Bock F, Horn FK et al (2009) GS-101 antisence oligonucleotide eye drops inhibit corneal neovascularization: Interim results of a randomized phase II trial. Ophthalmology (in press)

  14. Diaz L, Villegas VM, Emanuelli A, Izquierdo NJ (2008) Efficacy and safety of intraoperative mitomycin C as adjunct therapy for pterygium surgery. Cornea 27(10):1119–1121

    Article  PubMed  Google Scholar 

  15. Donald T, Tan H, Edward J (2002) Ocular Surface Disease Medical and Surgical Management, Springer Verlag, Kapitel 6 Pterygium 65–91

  16. DiGirolamo et al (2006) UVB-Mediated induction of cytokines and growth factors in pterygium epithelial cells involves cell surface receptors and intracellular signalling. Invest Ophhalmol Vis Sci 47(6):2430–2437

    Article  Google Scholar 

  17. Fernandes M, Sangwan VS, Bansal AK et al (2005) Outcome of pterygium surgery: Analysis over 14 years. Eye 19(11):1182–1190

    Article  PubMed  CAS  Google Scholar 

  18. Gan L, Fagerholm P, Palmblad J (2004) Vascular endothelial growth factor (VEGF) and its receptor VEGFR-2 in the regulation of corneal neovascularization and wound healing. Acta Ophthalmol Scand 82(5):557–563

    Article  PubMed  CAS  Google Scholar 

  19. Gebhard M, Mentlein R, Geerling G, Paulsen FP (2005) Differential expression of vascular endothelial growth factor implies the limbal origin of pterygia. Ophthalmology 112(6):1023–1030

    Article  Google Scholar 

  20. Lemercier G, Cornand G, Burckhart MF (1978) A Pinguecula et pterygion: Etude histopathologique et ultrastructurale Path. Virchows Arch Anat Histol 379(4):321–333

    Article  CAS  Google Scholar 

  21. Hille K, Höh K, Gross A, Ruprecht KW (1996) Prospective study of surgical therapy of pterygium: Bare sclera technique vs. free conjunctiva-limbus transplant. Ophthalmology 93(3):224–226

    CAS  Google Scholar 

  22. Hoban BP, Collin HB (1986) Effects of salicylate and steroid on neutrophil migration and corneal blood vessel growth. Am J Optom Physiol Opt 63(4):271–276

    PubMed  CAS  Google Scholar 

  23. Butche J Mr, Austin M, McGalliard J, Bourke RD (1994) Bilateral cataracts and glaucoma induced by long term use of steroid eye drops. BMJ 309(6946):43

    Google Scholar 

  24. Mackenzie FD, Hirst LW, Battistutta D, Green A (1992) Risk analysis in the development of pterygia. Ophthalmology 99(7):1056–1061

    PubMed  CAS  Google Scholar 

  25. Moraczewski AL, Lee RK, Palmberg PF et al (2008) Outcomes of treatment of neovascular glaucoma with intravitreal bevacizumab. Br J Ophthalmol (Epub)

  26. Moshfeghi AA, Rosenfeld PJ, Puliafito CA et al (2006) Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration: Twenty-four-week results of an uncontrolled open-label clinical study. Ophthalmology 113(11):2002, 1–12

    Article  PubMed  Google Scholar 

  27. Prabhasawat et al (1997) Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Ophthalmology 104(6):974–985

    PubMed  CAS  Google Scholar 

  28. Priyanka P. Doctor, MD, (Ophth.), Bhat PV, MD, Foster CS, MD (2008) Subkonjunctival Bevacizumab for Corneal Neovascularization. Cornea 27(9):992–995

    Article  Google Scholar 

  29. Rosenfeld PJ, Schwartz SD, Blumenkranz MS et al (2005) Maximum tolerated dose of a humanized anti-vascular endothelial growth factor antibody fragment for treating neovascular age-related macular degeneration. Ophthalmology 112(6):1048–1053

    Article  PubMed  Google Scholar 

  30. Rosenfeld PJ, Moshfeghi AA, Puliafito CA (2005) Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration. Ophthalmic Surg Laser Imaging 36(4):331–335

    Google Scholar 

  31. Sánchez-Thorin JC, Rocha G, Yelin JB (1998) Meta-analysis on the recurrence rates after bare sclera resection with and without mitomycin C use and conjunctival autograft placement in surgery for primary pterygium. Br J Ophthalmol 82(6):661–665

    Article  PubMed  Google Scholar 

  32. Scappaticci FA, Fehrenbacher L, Cartwright T et al (2005) Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab. J Surg Oncol 91(3):173–180

    Article  PubMed  CAS  Google Scholar 

  33. Sebban A, Hirst LW (1991) Pterygium reccurence rate at the Princess Alexandra Hospital. Aust NZ J Ophthalmol 19(3):203–206

    Article  CAS  Google Scholar 

  34. Theobald S (1887) The Pathogenesis of Pterygium. Trans Am Ophthalmol Soc 537–541

  35. Viveiros MM, Schellini SA, Rogato S et al (2006) Fibroblasts from primary and recurrent pterygia and Tenon’s capsule in cell culture. Arq Bras Oftalmol 69(1):57–62

    Article  PubMed  Google Scholar 

  36. Wu PC, Chen YJ (2009) Intravitreal injection of bevacizumab for myopic choroidal neovascularization: 1-year follow-up. Br Ophthalmol 93(2):150–154

    Article  Google Scholar 

  37. Wu PC, Kuo HK, Tai MH, Shin SJ (2009) Topical Bevacizumab eyedrops for limbal-conjunctival neovascularisation in impending recurrent pterygium. Cornea 28(1):103–104

    Article  PubMed  Google Scholar 

  38. Ziemssen F, Bartz-Schmidt KU, Grisanti S (2006) (Neben-) Wirkungen der VEGF-Inhibition. Ophthalmologe 103(6):484–492

    Article  PubMed  CAS  Google Scholar 

  39. Bachmann BO, Bock F, Wiegand SJ et al (2008) Promotion of graft survival by vascular endothelial growth factor a neutralization after high-risk corneal transplantation. Arch Ophthalmol 126(1)71–77

    Google Scholar 

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  1. Klinik für Augenheilkunde, Universitätsaugenklinik, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland

    S. Leippi, F. Grehn &  G. Geerling

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  1. S. Leippi
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  2. F. Grehn
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  3. G. Geerling
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Correspondence to G. Geerling.

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Teile dieses Beitrages wurden als Referat anlässlich der 106. Tagung der Deutschen Ophthalmologischen Gesellschaft in Berlin vorgestellt.

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Leippi, S., Grehn, F. & Geerling, G. Antiangiogene Therapie bei Pterygiumrezidiven. Ophthalmologe 106, 413–419 (2009). https://doi.org/10.1007/s00347-009-1936-y

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