Articles

Subconjunctival Bevacizumab Injection in Treatment of Pterygium

Abstract

This study determined the clinical effect of subconjunctival administration of bevacizumab in patients with primary and recurrent pterygium. The study was an off-label, single-dosing, interventional case series involving 22 patients with primary and recurrent pterygium. They received subconjunctival bevacizumab (0.2cc). Pterygium vascularity and thickness was graded. The size of the pterygium (measured by surface area in cm2) was recorded from baseline to 12 weeks, after injection. Treatment-related complications and adverse events were reported. The main outcome of measurements was the change in size, vascularity, thickness, color intensity. There were 15 males (68.2%) and 7 females (31.8%) of 22 patients with a mean age of 45.5 years (SD 11.68 years). One cases didn't cooperate, and excluded. There was a significant difference in the mean surface area of pterygium at different intervals (P < 0.05) and the size of pterygium was reduced. On comparison of the mean pterygium size, there was no significant difference between men and women (P >0.05). There was a significant reduction in the mean pterygium size of patients younger than 45 years in comparison to those older than 45 years after three month (P =0.037), but after 6 months, this difference was not significant (P = 0.338). Average changes in pterygium size for both eyes were not different. The reduction of color intensity in both eyes was significant (P =0.031). Subconjuctival bevacizumab injection is useful in management of patients with primary and recurrent pterygium without significant local or systemic adverse effects.

Kaniski JJ. Clinical Ophthalmology. 3th ed. Pterygium. Butterworth-Heinemann Ltd Publisher 1994. P 96.

Duke-Elders. Systems of Ophthalmology. 5th .ed.Vol. VII. Part I. Diseases of the outer eye. Conjunctival diseases: degenerative and pigmentary changes. London. Henry Kipton Publisher 1977; P. 568.

Pinkerton OD, Hokman Y, Shigemura LA. Immunologic basis for the pathogenesis of pterygium. Am J Ophthalmol 1984; 98: 2256.

Costed D. Pterygium: An ophthalmic enigma. Brit J Ophthalmol 1995; 74:304-5.

Karukonda SR, Thompson HW, Beuerman RW, Lam DS, Wilson R, Chew SJ, Steinemann TL. Cell cycle kinetics in pterygium at three latitudes. Brit J Ophthalmol 1995; 79:313-7.

Hagon and Zimmerman. Ophthalmic pathology ed. II. Conjunctival degenerations. Copy right by W.B. Saunders Company 1962; P. 252.

Di Girolamo N, Chui J, Coroneo MT, Wakefield D. Pathogenesis of pterygia: role ofcytokines, growth factors, and matrix metalloproteinases. Prog Retin Eye Res 2004; 23: 195-228.

Di Girolamo N, Coroneo MT, Wakefield D. Active matrilysin (MMP-7) in human pterygia: potential role in angiogenesis. Invest Ophthalmol Vis Sci 2001; 42: 1963-8.

van Setten G, Aspiotis M, Blalock TD, Grotendorst G, Schultz G. Connective tissue growth factor in pterygium: simultaneous presence with vascular endothelial growth factor-possible contributing factor to conjunctival scarring. Graefes Arch Clin Exp Ophthalmol 2003; 241: 135-9.

Solomon A, Grueterich M, Li DQ , Meller D, Lee SB, Tseng SC.Overexpression of insulin-like growth factorbinding protein-2 in pterygium body fibroblasts. Invest Ophthalmol Vis Sci 2003; 44: 573-80

Maini R, Collison DJ, Maidment JM, Davies PD, Wormstone IM. Pterygial derived fibroblasts express functionally active histamine and epidermal growth factor receptors. Exp Eye Res 2002; 74: 237-44.

Marcovich AL, Morad Y, Sandbank J, Huszar M, Rosner M, Pollack A, Herbert M, Bar-Dayan Y. Angiogenesis in pterygium: morphometric and immunohistochemical study. Curr Eye Res 2002; 25: 17-22.

Lee DH, Cho HJ, Kim JT, Choi JS, Joo CK. Expression of vascular endothelial growth factor and inducible nitric oxide synthase in pterygia. Cornea 2001; 20: 738-42.

Gebhardt M, Mentlein R, Schaudig U, Pufe T, Recker K,,Nölle B, Al-Samir K, Geerling G, Paulsen FP. Differential expression of vascular endothelial growth factor implies limbal origin of pterygia. Ophthalmology 2005; 112: 1023-30.

Jin J, Guan M, Sima J, Gao G, Zhang M, Liu Z, Fant J, Ma JX. Decreased pigment epithelium derived factor and increased vascular endothelial growth factor levels in pterygia. Cornea 2003; 22: 473-7.

Hirst LW. The treatment of pterygium. Surv Ophthalmol 2003; 48(2):145–80.

Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, Berlin J, Baron A, Griffing S, Holmgren E, Ferrara N, Fyfe G, Rogers B, Ross R, Kabbinavar F. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004; 350: 2335-42.

Michels S, Rosenfeld PJ, Puliafito CA, Marcus EN, Venkatraman AS. Systemic bevacizumab (Avastin) therapyfor neovascular age-related macular degeneration: twelve-week results of anuncontrolled open-label clinical study. Ophthalmology 2005; 112: 1035-47.

Rosenfeld PJ, Moshfeghi AA, Puliafito CA. Optical coherence tomography findingsafter an intravitreal injection of bevacizumab (Avastin) for neovascular agerelated macular degeneration. Ophthalmic Surg Laser Imaging 2005; 36: 331-5.

Avery RL, Pieramici DJ, Rabena MD. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology 2006; 113: 363-72.

Tan DTH, Chee SP, Dear KBG, Lim ASM. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol 1997; 115: 1235-40.

Chowers I, Pe'er J, Zamir E, Livni N, Ilsar M, Frucht-Pery J. Proliferative activity and p53 expression inprimary and recurrent pterygia. Ophthalmology 2001; 108: 985-988.

Asregadoo, E.R. Surgery, Thio-TEPA and corticosteroid in the treatment of pterygium. Am J Ophthalmol 1972; 74:960.

Hirst LW, Sebban A, Chant D. Pterygium recurrence time. Ophthalmology 1994; 101:755-8

Manzano RP, Peyman GA, Khan P, Carvounis PE, Kivilcim M, Ren M, Lake JC, Chévez-Barrios P. Inhibition of experimental corneal neovascularisation by bevacizumab (Avastin). Br J Ophthalmol 2007 ;91(6):804-7.

Hosseini H, Nejabat M, Khalili MR. Bevacizumab (Avastin) as a potential novel adjunct in the management of pterygia. Med Hypotheses 2007; 69:925–7.

Aspiotis M, Tsanou E, Gorezis S, Ioachim E, Skyrlas A, Stefaniotou M, Malamou-Mitsi V. Angiogenesis in pterygium: study of microvessel density, vascular endothelial growth factor, and thrombospondin-1. Eye (Lond) 2007;21(8):1095-101.

Nagy JA, Dvorak AM, Dvorak HF. VEGF-A and the induction of pathological angiogenesis. Annu Rev Pathol 2007;2:251-75.

Hosseini H, Nejabat M, Mehryar M, Yazdchi T, Sedaghat A, Noori F. Bevacizumab inhibits corneal neovascularization in an alkali burn induced model of corneal angiogenesis. Clin Experiment Ophthalmol 2007;35(8):745-8.

Bock F, Onderka J, Dietrich T, Bachmann B, Kruse FE, Paschke M, Zahn G, Cursiefen C. Bevacizumab as a potent inhibitor of inflammatory corneal angiogenesis and lymphangiogenesis. Invest Ophthalmol Vis Sci 2007Jun;48(6):2545-52.

Bahar I, Kaiserman I, McAllum P, Rootman D, Slomovic A. Subconjunctival bevacizumab injection for corneal neovascularization in recurrent pterygium. Curr Eye Res 2008; 33(1):23-8.

Tsai YY, Chiang CC, Bau DT, Cheng YW, Lee H, Tseng SH, Tsai FJ. Vascular endothelial growth factor gene 460 polymorphism is associated with pterygium formation in female patients. Cornea 2008; 27:476–9.

Hurmeric V, Mumcuoglu T, Erdurman C, Kurt B, Dagli O, Durukan AH. Effect of subconjunctival bevacizumab (Avastin) on experimental corneal neovascularization in guinea pigs. Cornea 2008; 27:357–62.

Kim TI, Kim SW, Kim S, Kim T, Kim EK. Inhibition of experimental corneal neovascularization by using subconjunctival injection of bevacizumab (Avastin). Cornea 2008; 27:349–52.

Papathanassiou M, Theodossiadis PG, Liarakos VS,Rouvas A, Giamarellos-Bourboulis EJ, Vergados IA.Inhibition of corneal neovascularization by subconjunctival bevacizumab in an animal model. Am J Ophthalmol 2008; 145:424–31.

Manzano RP, Peyman GA, Khan P, Carvounis PE, Kivilcim M, Ren M, Lake JC, Chévez-Barrios P. Inhibition of experimental corneal neovascularisation by bevacizumab (Avastin).Br J Ophthalmol 2007;91:804–7.

Kim SW, Ha BJ, Kim EK, Tchah H, Kim TI. The effect of topical bevacizumab on corneal neovascularization. Ophthalmology 2008; 115(6):e33-e38.

Dastjerdi MH, Al-Arfaj KH. Topical Bevacizumab in the Treatment of Corneal Neovascularization. Arch Ophtalmol 2009;127(4): 381-9.

Anthony F, Ruben Lim Bon S, Harvey S. Subconjunctival injection of bevacizumab for treatment of pterygium 2009;34(1): 44-50.

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Keywords
Subconjunctival injection Bevacizumab Pterygium

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How to Cite
1.
Besharati MR, Manaviat MR, Souzani A. Subconjunctival Bevacizumab Injection in Treatment of Pterygium. Acta Med Iran. 1;49(3):179-183.