This prospective, randomized pilot study investigated the efficacy and safety of subconjunctival bevacizumab injection for the treatment of impending recurrent pterygium. The authors describe this as a grade 3 lesion after pyterygium excision, which is more likely to progress to recurrence. The results indicate that a single subconjunctival bevacizumab injection seems to only partially and transiently decrease conjunctival vascularization for this indication in a dose-dependent manner. This treatment does not reduce symptoms of irritation, cause regression or reduce the recurrence rate. They suggest that combining subconjunctival bevacizumab with other drugs may provide greater benefits.
They believe this to be the first randomized controlled study on the efficacy of subconjunctival bevacizumab injection for impending recurrent pterygium. The study randomized 80 patients (80 eyes) with this condition into four groups: a control group, and treatment groups that received a single intralesional injection of 1.25 mg, 2.5 mg or 3.75 mg of bevacizumab. Severity of impending recurrent pterygium was graded by photographic assessment at baseline, three days, one week, and 2, 4, 8 and 12 weeks after treatment.
They found that a single subconjunctival bevacizumab dose is efficacious in reducing conjunctival vascularization in impending recurrent pterygium compared with baseline. Nevertheless, the favorable effect was incomplete and temporary. The effects of 1.25 mg, 2.5 mg, and 3.75 mg of bevacizumab seemed to last no longer than one, two, and four weeks after treatment, respectively. However, the difference in duration of action among the doses did not reach statistical significance.
True recurrence was found in 62 patients, with no statistically significant difference among the groups. There were no serious ocular or systemic adverse events.
The authors conclude that despite having an inhibitory effect on angiogenesis, subconjunctival bevacizumab injection offered no advantages for lessening the thickness and size of the lesion. The study also indicated that a single-dose injection is unlikely to reduce the recurrence rate for impending recurrent pterygium. They say that repeat injections or higher doses of bevacizumab may be required to achieve better outcomes.