An update on the surgical management of pterygium and the role of loteprednol etabonate ointment

John D Sheppard,1 Arnulfo Mansur,2 Timothy L Comstock,3 John A Hovanesian4 1Virginia Eye Consultants, Norfold, VA, USA; 2Airala's Laser and Cataract Institute, Miami, FL, USA; 3Bausch and Lomb, Inc., Rochester, NY, USA; 4Harvard Eye Associates, Laguna Hills, CA, USAAbstract: Pterygium, a su...

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Autores principales:	Sheppard JD, Mansur A, Comstock TL, Hovanesian JA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/f455995f31d3432bae0aae91bc53c118
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spelling	oai:doaj.org-article:f455995f31d3432bae0aae91bc53c1182021-12-02T02:49:41ZAn update on the surgical management of pterygium and the role of loteprednol etabonate ointment1177-5483https://doaj.org/article/f455995f31d3432bae0aae91bc53c1182014-06-01T00:00:00Zhttp://www.dovepress.com/an-update-on-the-surgical-management-of-pterygium-and-the-role-of-lote-a17205https://doaj.org/toc/1177-5483 John D Sheppard,1 Arnulfo Mansur,2 Timothy L Comstock,3 John A Hovanesian4 1Virginia Eye Consultants, Norfold, VA, USA; 2Airala's Laser and Cataract Institute, Miami, FL, USA; 3Bausch and Lomb, Inc., Rochester, NY, USA; 4Harvard Eye Associates, Laguna Hills, CA, USAAbstract: Pterygium, a sun-related eye disease, presents as wing-shaped ocular surface lesions that extend from the bulbar conjunctiva onto the cornea, most commonly on the nasal side. Pterygia show characteristic histological features that suggest that inflammation plays a prominent role in their initial pathogenesis and recurrence. Appropriate surgery is the key to successful treatment of pterygia, but there is also a rationale for the use of anti-inflammatory agents to reduce the rate of recurrence following surgery. Multiple surgical techniques have been developed over the last two millennia, but these initially had little success, due to high rates of recurrence. Current management strategies, associated with lower recurrence rates, include bare sclera excision and various types of grafts using tissue glues. Adjunctive therapies include mitomycin C and 5-fluorouracil, as well as the topical ocular steroid loteprednol etabonate, which has been shown to have a lower risk of elevated intraocular pressure than have the other topical ocular steroids. Here, the surgical management of pterygium is presented from a historical perspective, and current management techniques, including the appropriate use of various adjunctive therapies, are reviewed, along with an illustrative case presentation and a discussion of the conjunctival forceps designed to facilitate surgical management. Despite thousands of years of experience with this condition, there remains a need for a more thorough understanding of pterygium and interventions to reduce both its incidence and postsurgical recurrence. Until that time, the immediate goal is to optimize surgical practices to ensure the best possible outcomes. Loteprednol etabonate, especially the ointment formulation, appears to be a safe and effective component of the perioperative regimen for this complex ocular condition, although confirmatory prospective studies are needed.Keywords: mitomycin C, recurrence, surgical management, 5-fluorouracil, pterygium, loteprednol etabonateSheppard JDMansur AComstock TLHovanesian JADove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 1105-1118 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Sheppard JD Mansur A Comstock TL Hovanesian JA An update on the surgical management of pterygium and the role of loteprednol etabonate ointment
description	John D Sheppard,1 Arnulfo Mansur,2 Timothy L Comstock,3 John A Hovanesian4 1Virginia Eye Consultants, Norfold, VA, USA; 2Airala's Laser and Cataract Institute, Miami, FL, USA; 3Bausch and Lomb, Inc., Rochester, NY, USA; 4Harvard Eye Associates, Laguna Hills, CA, USAAbstract: Pterygium, a sun-related eye disease, presents as wing-shaped ocular surface lesions that extend from the bulbar conjunctiva onto the cornea, most commonly on the nasal side. Pterygia show characteristic histological features that suggest that inflammation plays a prominent role in their initial pathogenesis and recurrence. Appropriate surgery is the key to successful treatment of pterygia, but there is also a rationale for the use of anti-inflammatory agents to reduce the rate of recurrence following surgery. Multiple surgical techniques have been developed over the last two millennia, but these initially had little success, due to high rates of recurrence. Current management strategies, associated with lower recurrence rates, include bare sclera excision and various types of grafts using tissue glues. Adjunctive therapies include mitomycin C and 5-fluorouracil, as well as the topical ocular steroid loteprednol etabonate, which has been shown to have a lower risk of elevated intraocular pressure than have the other topical ocular steroids. Here, the surgical management of pterygium is presented from a historical perspective, and current management techniques, including the appropriate use of various adjunctive therapies, are reviewed, along with an illustrative case presentation and a discussion of the conjunctival forceps designed to facilitate surgical management. Despite thousands of years of experience with this condition, there remains a need for a more thorough understanding of pterygium and interventions to reduce both its incidence and postsurgical recurrence. Until that time, the immediate goal is to optimize surgical practices to ensure the best possible outcomes. Loteprednol etabonate, especially the ointment formulation, appears to be a safe and effective component of the perioperative regimen for this complex ocular condition, although confirmatory prospective studies are needed.Keywords: mitomycin C, recurrence, surgical management, 5-fluorouracil, pterygium, loteprednol etabonate
format	article
author	Sheppard JD Mansur A Comstock TL Hovanesian JA
author_facet	Sheppard JD Mansur A Comstock TL Hovanesian JA
author_sort	Sheppard JD
title	An update on the surgical management of pterygium and the role of loteprednol etabonate ointment
title_short	An update on the surgical management of pterygium and the role of loteprednol etabonate ointment
title_full	An update on the surgical management of pterygium and the role of loteprednol etabonate ointment
title_fullStr	An update on the surgical management of pterygium and the role of loteprednol etabonate ointment
title_full_unstemmed	An update on the surgical management of pterygium and the role of loteprednol etabonate ointment
title_sort	update on the surgical management of pterygium and the role of loteprednol etabonate ointment
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/f455995f31d3432bae0aae91bc53c118
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An update on the surgical management of pterygium and the role of loteprednol etabonate ointment

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