JUN 09, 2014
This prospective study found that treating pterygia with either one or two doses of bevacizumab reduces recurrence compared with autograft alone. These findings support in part the hypothesis that angiogenic factors, such as VEGF, are increased in pterygium.
Researchers investigated the efficacy and safety of subconjunctival bevacizumab as an adjuvant therapy for primary pterygium in 49 patients. After excision and conjunctival autograft, each patient was randomized to receive either a single 2.5 mg/0.1 mL dose of subconjunctival bevacizumab immediately after surgery; a double 2.5 mg/0.1 mL injection, one immediately after surgery and the second 15 days after surgery; or no injection.
Bevacizumab-treated patients showed conjunctival autograft ischemia 24 hours postoperatively, which disappeared by the first postoperative month. Single- vs. double-dosage has no significant effect on outcomes, and recurrences were found only in patients who didn’t receive bevacizumab (P < 0.04).
Conjunctival autograft ischemia was found in almost 50 % of the bevacizumab-treated patients and was topographically situated adjacent to the site of bevacizumab injection, involving nearly 30 % of the area of the conjunctival autograft. Interestingly, the ischemia gradually disappeared over time and was totally absent in the first follow-up month in all bevacizumab-treated patients.
Contrary to the authors’ expectations, the second bevacizumab injection at day 15 did not generate any additional positive or negative effects on either ischemia or recurrence rate. This result suggests that single intraoperative subconjunctival bevacizumab injection is sufficient as an adjuvant to treat primary pterygium. They write that the possibility that the first bevacizumab injection diminished the vessels in an active growth phase cannot be ruled out; it’s possible that anti-VEGF agents may only be effective in cases with vessels in an active growth phase.