Tan Jeremy C K, Kuo Melissa X, Coroneo Minas T
*Faculty of Medicine, University of New South Wales, Kensington, Australia;†Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; and‡Ophthalmic Surgeons, Randwick, Australia.
Cornea. 2016 Dec;35(12):1653-1655. doi: 10.1097/ICO.0000000000001035.
To report on a case of autoconjunctival graft compromise after pterygium surgery in a patient on long-term anti-vascular endothelial growth factor (anti-VEGF) therapy, due to the deleterious effects of anti-VEGF agents on ocular wound healing.
A white female in her early eighties presented with large right nasal pterygium, first noted 5 years previously. She also had macular degeneration and had been receiving monthly injections of ranibizumab, which was later switched to aflibercept. She proceeded to have a right nasal pterygium excision with a conjunctival autograft, 9 days after her last dose of intravitreal aflibercept.
Surgery was uneventful; however, at the week 2 postoperative review, there was conjunctival graft dehiscence with melting of the graft and underlying sclera. The patient was administered hyperbaric oxygen treatments, topical antibiotics, steroids, and lubricating eye drops, and aflibercept injections ceased. The scleral melt slowly resolved and her aflibercept was restarted 3 months later.
This case highlights the potential hazards of performing elective surgery in patients on VEGF inhibitors and the need for an appropriate interval between cessation/subsequent restart of anti-VEGF agents and surgery to be established.
报告1例长期接受抗血管内皮生长因子（抗VEGF）治疗的患者在翼状胬肉手术后出现自体结膜移植失败的病例，原因是抗VEGF药物对眼伤口愈合产生了有害影响。
一名80岁出头的白人女性，5年前首次发现右眼鼻侧有巨大翼状胬肉。她还患有黄斑变性，一直在接受每月一次的雷珠单抗注射，后来改用阿柏西普。在最后一次玻璃体内注射阿柏西普9天后，她接受了右眼鼻侧翼状胬肉切除联合自体结膜移植手术。
手术过程顺利；然而，术后第2周复查时，结膜移植片出现裂开，移植片及下方巩膜溶解。给予患者高压氧治疗、局部抗生素、类固醇和润滑眼药水，并停止注射阿柏西普。巩膜溶解逐渐消退，3个月后重新开始注射阿柏西普。
该病例凸显了在接受VEGF抑制剂治疗的患者中进行择期手术的潜在风险，以及确定抗VEGF药物停药/后续重新开始使用与手术之间的适当间隔的必要性。
