Transcript PTERYGIUM AND TOPICAL BEVACIZUMAB: A 2 YEAR FOLLOW …

PTERYGIUM AND TOPICAL
BEVACIZUMAB: A 2 YEAR FOLLOW UP
DR. ADITYA SUDHALKAR,M.S.
DR. ANAND SUDHALKAR,M.S.
The authors have no financial interest in this presentation
INTRODUCTION
 Pterygium: Subconjunctival elastotic degeneration;
 Can be a cosmetic blemish and/or interfere with vision
 Excision is the primary treatment modality; recurrence is often a problem
 Numerous adjuvants suggested for preventing recurrence, including:
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Mitomycin C, 5 FU, triamcinolone
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Irradiation**
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Conjunctival autografts
 Their efficacy however, is variable
 Bevacizumab has been suggested as an off label use*
*Effect of subconjunctival bevacizumab on primary pterygiumTeng CC, Patel NN,
Jacobson L. Cornea. 2009 May;28(4):468-70
*Topical bevacizumab for corneal limbal neovascularisation to prevent impending
recurrence of pterygiumWu PC, Kuo HK, Tai MH, Shin SJ.Cornea. 2009 Jan;28(1):103-4
**Strahlenther Onkol. 2009 Dec;185(12):808-14 Vastradis et al.
*Med Hypotheses. 2007;69(4):925-7. Bevacizumab as a potential novel adjunct in the
management of pterygia
PURPOSE:
 To determine the efficacy and safety of topical
bevacizumab in flurbiprofen as an adjunct to
conjunctival autograft in prevention of
recurrence of primary pterygium
METHODS:
 STUDY DESIGN: Prospective Case Series
 PATIENTS: 17 consecutive patients of primary pterygium, with :
•
No associated systemic or ocular disorder
•
No known predisposition to hypersensitivity reactions
 TREATMENT: Primary pterygium excision with conjunctival autograft; single
surgeon, standardised technique.
 POST OPERATIVE REGIMEN(FOR 4 WEEKS-q.i.d.):
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Antibiotic steroid *eye drops
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Bevacizumab(0.3mg/drop), topically with punctal occlusion-5 minutes
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Flurbiprofen eye drops
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Preservative free artificial tears
 FOLLOW UPS : Post operative days 1, 7, 30, 90, 180, years 1 and 2.
OUTCOME MEASURES:
 Recurrence of pterygium
 Safety of bevacizumab eye drops administered topically
RESULTS:
 MEAN AGE:
43.12+/-3.24years(range-35 to 49 years)
 GENDER DISTRIBUTION: Males: 10; Females 7
 TOPICAL REGIMEN WELL TOLERATED
 NO RECURRENCE TILL THE END OF THE FOLLOW -UP PERIOD
•
Seven patients complained of foreign body sensation; treated with lubricants
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2 had dellen formation, resolved with artificial tears
•
1 had hyperemia of the autograft, resolved with flurbiprofen
ILLUSTRATIVE CASE:
PRE -OPERATIVE
POST OPERATIVE: AT END OF TWO YEARS
DISCUSSION:

Recurrence of pterygium entails further procedures on a patient; excision
can leave a scar

Antimetabolites, irradiation not without side effects

Bevacizumab in an off label use has been shown to be effective in
prevention of recurrence*

Subconjunctival bevacizumab in immediate post operative period might not
prevent neovascularisation which usually occurs later

Multiple subconjunctival* injections potentially hazardous and painful;
*Ann Ophthalmol (Skokie). 2010;42 Spec No:28-30. Multiple subconjunctival injections for advanced primary pterygium
*Cornea. 2011 Feb;30(2):127-9 Fallah et al. Intralesional bevacizumab in decreasing pterygium size.
DISCUSSION:

Administration of topical therapy(bevacizumab+flurbiprofen) with punctal
occlusion did not produce ocular/systemic side effects

Topical therapy gives a prolonged dose of bevacizumab to the autograft

None of the patients showed a recurrence till the end of follow up period

Steroids not a confounding factor as they have not shown to significantly
alter recurrence rates*~
*Cornea. 2010 Feb;29(2):141-5, Comparison of recurrence rates….Kandavel et al
~Ann Ophthalmol. 1985 Jan;17(1):92-5. Pterygium: clinical classification and management in Virgin Islands. Anduze et al.
~East Afr Med J. 1992 Sep;69(9):490-3. Post-operative management of pterygium in Jos, Nigeria--comparison of antibiotics,
steroids and opticrom
REFERENCES:

Pterygium. Etiology, clinical aspects and novel adjuvant therapies].Heindl LM,
Cursiefen C.Ophthalmologe. 2010 Jun;107(6):517-20, 522-4

Safety and efficacy of intraoperative 5-fluorouracil infiltration in pterygium treatment].
Vlezi VG, et al. Arq Bras Oftalmol. 2009 Mar-Apr;72(2):169-73.

Comparative Study of Different β-Radiation Doses for Preventing Pterygium Recurrence.
Yamada T et al. Int J Radiat Oncol Biol Phys. 2010 Oct

Results of treatment with topical mitomycin C 0.02% following excision of primary pterygium.
Rachmiel R et al.Br J Ophthalmol. 1995 Mar;79(3):233-6

Postoperative subconjunctival corticosteroid injection to prevent pterygium recurrence.
Paris Fdos et al.Cornea. 2008 May;27(4):406-10

Dev Ophthalmol. 2010;46:133-9. Scholl et al. Anti vascular growth factors in anterior segment
disease

Cornea. 2009 May;28(4):468-70. Teng et al. Effect of subconjunctival bevacizumab on primary
pterygium
LIMITATIONS:
 Small sample size
 No control group
 Further studies will be required
CONCLUSION
 Topical Bevacizumab appears to be safe and effective in
preventing pterygium recurrence.