Bekibele C O, Baiyeroju A M, Ajayi B G K
Department of Ophthalmology, University College Hospital, Ibadan, Nigeria.
Int J Clin Pract. 2004 Oct;58(10):920-3. doi: 10.1111/j.1742-1241.2004.00007.x.
The aim of this study was to compare 5-fluorouracil (5-FU) with beta-irradiation in the prevention of pterygium recurrence. A retrospective non-randomised review of cases of fleshy pterygium treated with bare scleral excision and adjuvant 5-FU were compared with similar morphologically appearing pterygia, matched for age and sex, treated with bare scleral excision and adjuvant beta-irradiation. All surgeries were carried out at the university college hospital and Ojulowo eye hospital, Ibadan, Nigeria. Twenty-seven eyes of 24 patients who had pterygium excision with adjuvant treatment with 5-FU were compared with 31 eyes of 24 patients who were treated with excision and beta-irradiation. The mean age for the 5-FU group was 46.1 years while that for the beta-irradiation group was 46.9 years. Both sexes were equally represented, 12 males and 12 females. There were seven (25.9%) initial recurrences in the 5-FU group but four of these became atrophic, and therefore, cosmetically acceptable leaving three eyes (11%) with unacceptable recurrent pterygia. The beta-irradiation group, however, had seven (22.5) initial recurrence but five of these became atrophic and fell short of the cornea, leaving two (6.5%) with clinically unacceptable recurrence. The difference was, however, not statistically significant (Zc = 0.74 and p > 0.1). The associated complications were mostly mild in both groups and included cornea opacity of 10 (37%) complications, conjunctivitis of three (11%) complications, sclera granuloma of three (11%) complications and conjunctiva necrosis of one (3.7%) complication for the 5-FU group, and while the beta-irradiation group had corneal opacity of one (3.7%) complication and conjunctivitis of three (11%) complications. The non-statistical significance of a lower-pterigium recurrence rate with use of beta-irradiation for the treatment of fleshy pterygium compared with 5-FU may have been partly due to the small number of patients studied. A randomised-controlled study using a larger sample size is therefore proposed. However, the fact that over half of those with initial recurrence in the 5-FU group became atrophic (and therefore cosmetically acceptable) over time as well as less cost implication in the purchase of 5-FU relative to Strontium-90 association with few and mild complications makes it a desirable adjuvant therapy in depressed economies. However, beta-irradiation still has a place when cost issue is not an inhibiting factor in view of its clinically superior outcome.
本研究的目的是比较5-氟尿嘧啶（5-FU）与β射线照射在预防翼状胬肉复发方面的效果。对采用单纯巩膜切除术联合辅助5-FU治疗的肉质翼状胬肉病例进行回顾性非随机分析，并与年龄和性别匹配、采用单纯巩膜切除术联合辅助β射线照射治疗的形态相似的翼状胬肉病例进行比较。所有手术均在尼日利亚伊巴丹大学学院医院和奥朱洛沃眼科医院进行。将24例接受翼状胬肉切除术并辅助5-FU治疗的患者的27只眼，与24例接受切除术并β射线照射治疗的患者的31只眼进行比较。5-FU组的平均年龄为46.1岁，β射线照射组为46.9岁。男女比例相同，各有12例。5-FU组有7例（25.9%）出现初始复发，但其中4例萎缩，因此在外观上可以接受，仅3只眼（11%）出现不可接受的复发性翼状胬肉。然而，β射线照射组有7例（22.5%）初始复发，但其中5例萎缩且未累及角膜，仅2只眼（6.5%）出现临床上不可接受的复发。然而，差异无统计学意义（Zc = 0.74，p > 0.1）。两组的相关并发症大多较轻，5-FU组10例（37%）并发症为角膜混浊，3例（11%）为结膜炎，3例（11%）为巩膜肉芽肿及1例（3.7%）为结膜坏死；而β射线照射组1例（3.7%）并发症为角膜混浊，3例（11%）为结膜炎。与5-FU相比，采用β射线照射治疗肉质翼状胬肉时翼状胬肉复发率较低但无统计学意义，这可能部分归因于研究的患者数量较少。因此，建议进行一项样本量更大的随机对照研究。然而，5-FU组超过一半的初始复发患者随着时间推移出现萎缩（因此在外观上可以接受），以及相对于锶-90，5-FU购买成本较低且并发症较少且较轻，这使得它在经济不发达地区成为一种理想的辅助治疗方法。然而，考虑到其临床上更优的结果，当成本问题不是限制因素时，β射线照射仍有其应用价值。
