Eyeworld

82 | EYEWORLD | MARCH 2020 C ORNEA References 1. Hacioglu D, Erdol H. Develop- ments and current approaches in the treatment of pterygium. Int Ophthalmol. 2017;37:1073–1081. 2. Katircioglu YA, et al. Compar- ison of two techniques for the treatment of recurrent pterygium: amniotic membrane vs. conjunc- tival autograft combined with mitomycin C. Semin Ophthalmol. 2015;30:321–7. 3. Kenyon KR, et al. Conjunc- tival autograft transplantation for advanced and recurrent pterygium. Ophthalmology. 1985;92:1461–70. 4. Sangwan VS, et al. Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency. Br J Ophthalmol. 2012;96:931–4. 5. Mittal V, et al. Successful management of severe unilateral chemical burns in children using simple limbal epithelial transplan- tation (SLET). Br J Ophthalmol. 2016;100:1102–8. 6. Mittal V, et al. Primary simple limbal epithelial transplantation along with excisional biopsy in the management of extensive oc- ular surface squamous neoplasia. Cornea. 2016;35:1650–1652. 7. Hernandez-Bogantes E, et al. Minor ipsilateral simple limbal epithelial transplantation (mini- SLET) for pterygium treatment. Br J Ophthalmol. 2015;99:1598– 600. Relevant disclosures Trinh: None A layer of amnion was placed over the cornea, bare sclera, and down to the excised pterygium, secured with fibrin glue and Vic- ryl sutures. The harvested limbal pieces were secured with glue over the amniotic membrane, and a bandage contact lens was placed over the eye at the end of the surgery. Case series The case series included 10 patients in total (five male and five female patients), ages 23–79 years with a slight preponderance for Cauca- sian background. All of the patients had prior pterygia; 80% of patients had two or more prior pterygia with one patient having had five prior pterygium excisions. Average pterygium height was 6.38 mm and average width was 4.64 mm. All were graded as having moderate to severe elevation and severity and 40% had more than 75% involvement of the cornea. All of the patients were followed for at least 6 months (average 6–38 months). Postop there was a transient rise in IOP that responded to medical treatment in 50% of patients and was attributed to topical steroid response. At 6 months follow-up there was one recurrence in the one patient with the highest number of pterygium excisions (five). BCVA improvement was modest and likely related to the pre-existing astigmatism and scar- ring from prior pterygium surgery. Two patients had restoration of the limbal stem cell niche such that they were able to support a penetrat- ing keratoplasty to improve vision by removing corneal scarring. "In more aggressive or recurrent pterygia, SLET may be a more effective option than conjunctival autograft alone to address both pterygium recurrence and repopulation of the depleted limbal stem cell niche," Dr. Trinh said. "SLET is a novel surgical option for the treat- ment of recurrent pterygia. The beauty of this procedure is that it allows the good unaffected eye to be preserved as many of these patients prefer not to have their 'good' eye touched. The procedure addresses a key pathological process in pterygium development and should be con- sidered in aggressive and recurrent cases." continued from page 80 with unhealthy nerves who could benefit. These include patients with zoster, trigeminal nerve injuries, or diabetes. "Right now, we don't have many specific treatments for those patients," Dr. Galor said. "This opens up the possibility of a new pathway that may be applied therapeu- tically." Based on animal data, VEGF B appears to have particular therapeutic potential. Dr. Galor views it as a target for patients who have neurotrophic keratitis, a difficult condition to treat. "Our study suggests that anti-VEGF agents may have an effect on corneal nerves, suggesting that VEGF is a neurotrophic factor," she said. As for concerns about anti-VEGF usage, clinically these were not seen in the study, Dr. Galor noted. "But if that patient had trauma, would they be slower to heal because of their repeated anti-VEGF injections?" she wondered. "We don't know, but we hypothesize that this may be the case." Dr. Goldhardt agreed with the concern over a possible connection with delayed healing. Going forward, Dr. Galor hopes to con- tinue research in this area, specifically studying subclinical parameters and looking for clinical manifestations of anti-VEGF injections. continued from page 81

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