Efficacy and safety of subconjunctival bevacizumab for recurrent pterygium

Purpose: To evaluate the clinical outcome(s) and complication(s) of subconjunctival bevacizumab treatment in patients with recurrent pterygium. Methods: This prospective case series included patients who had undergone pterygium surgery and were diagnosed with recurrent pterygium. All patients received one subconjunctival injection of 0.5 mL of bevacizumab (2.5 mg/0.1 mL). The main outcome was the change in size and clinical appearance. The clinical appearance of the pterygium was graded according to Tan and colleagues. The horizontal size of the pterygium (from limbus to apex) was recorded from baseline to 2 months after injection. Treatment-related complications and adverse events were reported. Results: We included 36 eyes of 36 patients (18 males) with a mean age of 58.75 ± 10.98 years. Totally, 30.6% patients developed recurrent pterygium in both eyes (only the worst eye was treated), with 47.2% developing it in the left eye and 22.2% in the right eye. More than half the patients (58.3%) had a family history of pterygium. There was a significant difference in the size of pterygium at different intervals (P<0.05). Approximately two-thirds (66.7%) of patients presented with hyposphagma on the 2nd day after subconjunctival application; this value decreased to 30.6% by day 7 and to 0% at 1 month. Most patients (69.4%) exhibited amelioration of irritative symptoms within 2 days, 88.9% after 7 days, and 97.2% after 1 month. Conclusions: Subconjunctival bevacizumab injection is useful for the management of patients with recurrent pterygium, with no significant local or systemic adverse effects

Is Bevacizumab Effective in Inhibiting the Growth of Recurrent Pterygium?

Objective: The objective of this selective EBM review is to determine whether or not Bevacizumab is an effective treatment in inhibiting the growth of recurrent pterygium. Study Design: Review of three published, English language randomized controlled trials published in 2010, 2012, and 2013. Data Sources: Three randomized controlled trials measuring the efficacy of Bevacizumab to inhibit the growth of recurrent pterygium were found using PubMed and OVID databases. Outcome(s) Measured: The severity and progression of pterygium recurrence as well as corneal neovascularization were the main outcomes measured. Conjunctival injection, thickness, and size of the fibrovascular tissue were examined in subjects using ophthalmic evaluation including visual acuity testing, applanation tonometry, lit-lamp biomicroscopic examination, slit-lamp photography, indirect ophthalmoscopy, and corneal photographs. Results: In the study by Fallah, all groups failed, meaning fibrovascular tissue stretched onto the cornea. However, the mean duration for invasion of cornea in study group patients was significantly longer than for control group patients. The study by Lekhanont showed that Bevacizumab significantly transiently decreased the conjunctival injection. However, true recurrence was found in 62 of 80 patients with no statistically significant difference among the groups. In the study by Ozgurhan, pterygium recurrence was not noted in any patients in the study group, but was noted in 2 of 22 eyes in the control group. Moreover, corneal neovascularization was noted in 5 of 22 eyes in the control group but in none of the patients of the study group. Conclusion: The results of two of the randomized trials showed that Bevacizumab delays the recurrence of impending recurrent pterygium, but does not completely inhibit it. One of the randomized trials showed that Bevacizumab was an effective therapy for reducing recurrent pterygium and corneal neovascularization, but results were not statistically significant. Overall consistency was not provided and the data was inconclusive. All trials were limited due to small sample size and lack of follow-up studies

Treatment of Corneal Neovascularization Using Anti-VEGF Bevacizumab

Purpose. To evaluate antiangiogenic effect of local use of bevacizumab (anti-VEGF antibody) in patients with corneal neovascularization. Methods. Patients were divided into two groups. All patients suffered from some form of corneal neovascularization (NV). Patients in group A received 0.2–0.5 mL of bevacizumab solution subconjunctivally (concentration 25 mg/mL) in a single dose. Group A included 28 eyes from 27. Patients in group B applied bevacizumab eye drops twice daily (concentration 2.5 mg/mL) for two weeks. Group B included 38 eyes from 35 patients. We evaluated the number of corneal segments affected by NV, CDVA, and the incidence of complications and subjective complaints related to the treatment. The minimum follow-up period was six months. Results. By the 6-month follow-up, in group A the percentage reduction of the affected peripheral segments was 21.6% and of the central segments was 9.6%; in group B the percentage reduction of the central segments was 22.7% and of the central segments was 38.04%. In both groups we noticed a statistically significant reduction in the extent of NV. Conclusion. The use of bevacizumab seems to be an effective and safe method in the treatment of corneal neovascularization, either in the subconjunctival or topical application form

Terapia auxiliar com o tranilast pré-operatório na cirurgia do pterígio primário com um ano de seguimento

Purpose: To determine the efficacy of tranilast as an adjunctive therapy in conjunctival autograft. Methods: Twenty-nine patients were randomly allocated to the Tranilast Group (n=15) or the Control Group (n=14). The Tranilast Group received a subconjunctival injection of 0.5% tranilast 30 days prior to surgery. Conjunctival autograft was performed in both groups using fibrin sealant and 0.02% subconjunctival mitomycin C at the end of the surgery. After the resection of the pterygium, immunohistochemistry was performed with 100 cells to identify epithelial cells positive for transforming growth factor-β (TGF-β). Subjective symptoms were evaluated using a 5-point scale, and the recurrence rate was assessed. Results: Both groups showed improvements in their symptoms and similar clinical results. Compared with the Control Group, the Tranilast Group failed to show a decreased recurrence rate (p=0.59). However, the number of epithelial cells expressing TGF-β was lower in the Tranilast Group (5 cells; 95% CI: 2.56-13.15; Control Group, 16 cells, 95% CI: 11.53-24.76; p=0.01). Minimal but reversible complications, including glaucoma secondary to corticosteroids and granuloma, occurred during the study. Conclusion: Tranilast was effective in decreasing the number of pterygium epithelial cells expressing TGF-β.Objetivo: Determinar a eficácia do tranilast, como terapia auxiliar no transplante autólogo de conjuntiva. Métodos: Vinte e nove pacientes foram randomizados em dois grupos: Grupo Tratado (15) e Grupo Controle (14). Trinta dias antes da cirurgia, o Grupo Tratado recebeu uma injeção subconjuntival de tranilast a 0,5%. O transplante autólogo de conjuntiva foi realizado em ambos os grupos, usando-se a cola de fibrina e a mitomicina 0,02% subconjuntival, ao final da cirurgia. Cada paciente foi examinado por 12 meses de acompanhamento. A imuno-histoquímica foi realizada, mediante um total de 100 células, a fim de que se contassem as células epiteliais positivas, para o fator de crescimento transformador beta (TGF-β), após a cirurgia do pterígio. Os sintomas subjetivos foram avaliados usando-se uma escala de cinco pontos, e a taxa de recorrência foi avaliada. Resultados: Os 2 grupos apresentaram melhora dos sintomas e com resultados clínicos similares. Quando comparado com o Grupo Controle, o Grupo Tratado falhou em mostrar uma diminuição da taxa de recorrência (p=0,59). Entretanto o número de células epiteliais expressando o TGF-β foi menor no Grupo Tratado (5 células; 95% CI=2,56-13,15; Grupo Controle, 16 células; 95% CI: 11,53-24,76, p=0,01). Complicações mínimas, mas reversíveis, ocorreram durante o estudo, incluindo glaucoma secundário ao uso de corticoide e granuloma. Conclusão: O tranilast foi efetivo em diminuir o número células epiteliais do pterígio expressando o TGF-β.Faculdade de Medicina de São José do Rio Preto Department of SurgeryFaculdade de Medicina de São José do Rio Preto Department of PathologyUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of OphthalmologyUniversity of São Paulo Department of OphthalmologyFaculdade de Medicina de São José do Rio Preto Deparftment of Anatomy, Histology and EmbryologyUNIFESP, EPM, Department of OphthalmologySciEL

A pilot study of intralesional ranibizumab on pterygium vascularity, size and recurrence rate

Introduction: Pterygium is a common eye disorder in Malaysia due to the country’s location near to the equator. Recent study has found that vascular endothelial growth factor (VEGF) is present in great amount in pterygium epithelium especially in its head compared to normal conjunctiva suggesting that VEGF is involved in the angiogenesis and proliferative fibrovascular growth of pterygium. Thus, anti-VEGF has been proposed as an off-label adjunct to pterygium surgery. Objective: To evaluate the vascularity and size of primary pterygium after intralesional ranibizumab injection and the recurrence rate following sutureless pterygium surgery. Methodology: Patients presenting for primary pterygium excision who fulfilled our inclusion and exclusion criteria were identified. They were then randomised into treatment and control groups. Treatment group was injected with intralesional ranibizumab (0.3 mg/0.03 mL) 1 week prior to surgery. Anterior segment photographs were taken before and 1 week after the injection. Changes in pterygium vascularity (percentage of pterygium area covered by vessels) and size (percentage of cornea area covered by pterygium) were measured using image analysis software, Image J. 1 week after ranibizumab injection, both treatment and control groups underwent pterygium excision and conjunctiva autograft adhesion with fibrin glue. Patients were followed-up for 1 year to monitor for recurrence and complication. Results: 36 patients (18 each group) completed the study. Mean change in pterygium vascularity was 1.48 (4.65)% while pterygium size was 0.28 (2.71) %. Both reductions were not statistically significant (p = 0.195 and 0.672 respectively). Recurrence rate in treatment group was 22.2% (n = 4) while controlled group was 16.7% (n = 3). Recurrence rate between groups was not statistically significant (p > 0.950). Conclusion: Single intralesional injection of ranibizumab (0.3 mg/0.03 mL) did not reduce the pterygium vascularity and size significantly in 1 week time. Pre-operative intralesional ranibizumab did not reduce pterygium recurrence rate

Corneal Melting Two Weeks after Pterygium Excision with Topical Mitomycin C: Successfully Treated with Lamellar Keratoplasty and Amnion Membrane Transplantation

PURPOSE: To report the management of a case of corneal melting two weeks after pterygium excision with intraoperative topical mitomycin C (MMC). METHODS: Case report. RESULTS: A 57-year-old male was referred to our Department for therapy of rapidly progressive corneal melting two weeks after primary pterygium surgery with MMC (0.2 mg/ml) in September 2009. Initial treatment consisted of topical and systemic immunosuppression along with topical antibiotics. Eight days after presentation, the patient underwent successful lamellar keratoplasty and amnion membrane transplantation. Subconjunctival injection of triamcinolone (40 mg/ml) and topical bevacizumab were used to manage the increased fibrovascular activity around the site of the former pterygium. CONCLUSION: Topical use of MMC during pterygium surgery may be related to serious postoperative complications such as progressive inflammatory corneal melting. The etiology may be multifactorial, which is related to MMC-induced inflammation and/or induced apoptosis. A therapeutic option is the described combination of systemic and local anti-inflammatory treatment along with lamellar keratoplasty and amniotic membrane transplantation. Adjunctive therapy may be needed if recurrence occurs

Effect of Triamcinolone Acetonide Injection on Pterygium Recurrence in Postoperative Subconjunctival Patients

Pterygium is an eye disorder characterized by fibrovascular tissue from the bulbar conjunctiva encroaching on the cornea. Inflammation has been suggested to play a role in the pathogenesis of pterygium, indicated by elevated levels of anti-inflammatory cells and markers. Triamcinolone acetonide is a steroid commonly used to treat eye diseases. This study evaluated the effects of anti-inflammatory triamcinolone acetonide injection after the pterygium surgery. This study included 71 eyes of 71 patients. The patients were divided into two groups: triamcinolone and control group. Each eye received a subconjunctival triamcinolone injection of 2.5 mg/ 0.1 ml or no after pterygium surgery with bare sclera technique. The infusion was done around the excision area. Before and after the surgery, the ocular pressure was evaluated. Topical steroid antibiotics and oral analgesics were administrated. The outcomes were assessed one day, week, three weeks, and one month after surgery under slit-lamp examination and noncontact tonometry. The evaluated outcomes were the presence of fibrovascular tissue and intraocular pressure. This study was done by a surgeon and assisted by a nurse. There are 71 eyes in this study; 10 eyes are lost during follow-up. The 61 eyes were divided into 28 triamcinolone and 33 control group. The recurrence of pterygium was found in 2 (39. 3%) of the triamcinolone group and in (10.7%) of the control group (p=0.16). Eight eyes showed increased ocular pressure, and one patient developed granuloma. Subconjunctival triamcinolone injection after pterygium surgery did not significantly reduce pterygium recurrence

Management of Primary Pterygium with Intralesional Bevacizumab (AVASTIN) Injection

Objective: To determine the management of primary Pterygium with intralesional Bevacizumab (AVASTIN) Injection. Study Design: Quasi-Experimental Study Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Oct 2019 to Mar 2020. Methodology: Sixty patients of Primary Pterygium with Grades 1, 2, and 3 were included. Pre-Intralesional injection evaluation includes the Ocular surface disease Index (OSDI), grading of Pterygium and ophthalmic examination, refraction,slit lamp bimicroscopy, fundoscopy, tonometry, and corneal topography. After four weeks of intralesional injection,reassessment was done. Results: A total of 60 participants with the mean age of the participants was 44.06±14.83 years were included in the study. In 26(43.3%) patients, grittiness, epiphora, redness, and photophobia were reported, and 16(26.6%) patients reported blurring of vision that improved in 100% of patients after intralesional injections. There was statistical significance (p-value ≤0.05) in means of K1, Sim K astigmatism, Surface asymmetry index, Surface Regularity Index, Grade of Pterygium, and Ocular surface disease index before and after the intralesional injection of Bevacizumab. However, no significant difference was recorded in Uncorrected Visual Acuity, Best Corrected Visual Acuity, and K2 parameters in pre and post-injection states (p-value ≥0.05).Only 7(11.6%) patients reported subconjunctival haemorrhage after the procedure. Conclusions: Treatment of Primary Pterygium with intralesional Bevacizumab injection successfully improves symptoms,Ocular Surface Disease Index, and reduces corneal astigmatism with minimum complications