Antibiotic Eyedrops Halt an Aggressive Ocular Growth
What the . . . ?” Bryant Centofanti suddenly stopped shaving and sidled in for a closer look at the reddish oddity he’d glimpsed in the inner corner of his left eye. What he discovered there was a fine, transparent film, maybe three cells thick, that looked like it was growing over the surface of the eye. At first Centofanti dismissed it, hoping the whatever-it-was would resolve on its own. When it didn’t—and in fact seemed to be enlarging—the electrical engineer headed for his eye doctor.
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| Esen Akpek monitors Bryant Centofanti for signs of recurrence. |
It was the first time Centofanti had ever heard of a pterygium, a nonmalignant vascular membrane that takes root as the wide end of a wedge (the growth’s name comes from the Greek word for wing) and then unpredictably advances like an arrowhead toward the pupil. Thought to be caused by excessive exposure to the sun’s ultraviolet rays, pterygia are more common in hot, dry climates closer to the equator but do occur in about 15 percent of the U.S. population.
For Centofanti, the advice was watch and wait. Many pterygia progress at a snail’s pace, becoming a problem only if they reach the cornea, where they begin to distort vision. Centofanti initially seemed to have a slow grower. But after three years of observing its relentless march toward his pupil, he realized it had to go.
Once they’re removed, in a relatively simple outpatient procedure performed with the patient sedated and given local anesthesia, 80 percent of pterygia don’t return. Centofanti, however, proved to be among the minority whose growths recur with a vengeance. Two months following the operation, his had already attained nearly half its original size; four weeks after that, it was at the edge of his cornea. Worse, he now seemed to be out of treatment options. Because the first excision had also thinned his cornea, another surgery would risk his sight.
Fortunately for Centofanti, his ophthalmologist referred him to Esen Akpek, who’s been testing a novel method for using the antibiotic mitomycin. More commonly used as chemotherapy for eye-surface malignancies, the drug also can be placed directly into the tissue bed for a few minutes immediately after a pterygium is removed. The problem, says Akpek, director of ocular surface diseases at the Wilmer Eye Institute, is that although mitomycin indeed halts the high rate of cell division that characterizes a recurring pterygium, its standard application can also melt the sclera, the cornea, or both.
To avoid such outcomes, Akpek is the first to use a very dilute solution of mitomycin as eyedrops. And instead of prescribing the drops when a pterygium is removed, she watches for signs of regrowth. Then her regimen is two weekly cycles of four applications daily interspersed with a week off.
Although Akpek is proceeding slowly—“I want to be sure of the long-term effects”—her first patient is four and a half years out with excellent results.
And like the others treated with her eyedrops, Centofanti is amazed at how quickly they worked. His aggressively re-growing pterygium began receding after the first week. Now, a year later, he says, “the thing is totally deactivated.”
