JOURNAL READING

PREVENTION OF RECURRENT PTERYGIUM WITH

TOPICAL BEVACIZUMAB 0.05% EYE DROPS: A
RANDOMIZED CONTROLLED TRIAL

BALAI KESEHATAN INDRA MASYARAKAT Disusun oleh :

FAKULTAS KEDOKTERAN UNIVERSITAS ISLAM SULTAN AGUNG Fawzia Haura Fathin, S.Ked
SEMARANG 2017 Pembimbing :
dr. Desti Hendrastuti, Sp. M
INTRODUCTION
Pterygium is a degenerative and proliferative fibrovascular disorder of the ocular
surface, usually a triangular or wing shaped tissue, extending from the conjunctiva onto
the cornea.

Various adjunctive measures are applied to prevent recurrence of pterygia after

excision, including medical and surgical methods.

Bevacizumab inhibits proliferation of endothelial cells and formation of new blood

vessels, the drug was suggested as a potential adjunctive treatment after pterygial
excision
 To assessed the
efficacy and
tolerability of topical
PURPOSE bevacizumab 0.05%
when used as an
adjunctive therapy
after excision of
primary pterygia.
METHODS

Design • Randomized Controlled Trial

• Department of Ophtalmology,
Place King Chulalongkorn Memorial
Hospital
Inclution Criteria :

• Patients diagnosed with primary pterygia and

scheduled for a pterygial excision with the use of
the bare sclera technique were enrolled
consecutively.

Exclution Criteria :

• Patients with corneal melt, corneal epitheliopathy,

and abnormal healing of a corneal epithelial
wound, and those who were pregnant, lactating, or
allergic to bevacizumab or steroids were excluded.
The bevacizumab The control group
group (10eyes,10patients)
(12eyes,12patients) • Received normal saline
• Received bevacizumab eye drops 4 times daily
0.05 % eye drops for 3 months.

All patients and an outcomes assessor were

blinded to the treatment assignments.
 RESULT & DISCUSSION
The outcomes assessor was masked before data analysis. Three months
after medications were started, most patients in the bevacizumab group
had a grade 1 recurrence, whereas most patients in the placebo group
had a grade 2 recurrence. One and 3 patients in the bevacizumab and
the placebo groups, respectively, developed true recurrence (grade4).
The recurrence rates between the groups did not differ significantly (P
¼ 0.29). Four (33.33%) and 9 (90.00%) patients in the bevacizumab
and placebo groups, respectively, had conjunctival and cornea
recurrences (grades2–4). The recurrence rates for grades 2 to 4
differed significantly between the groups (P ¼ 0.01) (Table III).
Recurrence of pterygia is a major complication after
pterygium surgery. Although the pathogenesis for recurrent
pterygia was studied widely, the mechanism remains
unknown. The typical degenerative connective tissue changes
seen in primary pterygia are absent in the histologic findings
in recurrent pterygia. Recurrent pterygia often have more
exuberant fibrovascular growth. Many growth factors,
including VEGF, fibroblast growth factor, platelet-derived
growth factor, transforming growth factor-β, and tumor
necrosis factor-α were found in pterygial tissues and are
believed to play a key role in the formation of the
fibrovascular tissue in recurrent pterygia.
Bevacizumabisamonoclonalantibodythatblocks VEGF-
A.Previously,2different modalitiesofbevacizu- mab
wereinvestigatedforthetreatmentofprimary
pterygia:subconjunctivalbevacizumabaloneorasan adjunctive
therapyafterpterygialexcision.Tworandom- ized controlledtrials,12,13 1
caseseries,14 and 1case report,15
foundthatsubconjunctivalbevacizumabre- duced
thesymptomsandsizesofpterygia,butthe effectwastemporaryand not
clinicallyrelevant.12–15 Furthermore,Razeghinejadetal16
andShenasietal17 reportedthatsubconjunctivalbevacizumabusedasan
adjunctive therapyafterprimarypterygialsurgerydidnot significantly
preventrecurrenceofpterygia,eventhough
thetreatmentwaswelltolerated.Thereasonforthismay be
becauseoftheshort-termtemporaryeffectofthedrug
LIMITATIONS
The limitations of this study were the
small number of patients and the short
follow-up period. Moreover, until now
no standard regimens for both the
concen- trations and frequencies of the
drugs have been used. The various
concentrations and regimens of bevaci-
zumab eye drops used to prevent
pterygial recurrence should be studied
to address these limitations.
 CONCLUSIONS
Topical bevacizumab 0.05 %, as an adjunctive treatment after pterygial
excision for 3 months, tended to lower the combined rate of conjunctival and
corneal recurrences compared with placebo.

However, the rates of corneal recurrence at 3 months did not differ

significantly between topical bevacizumab 0.05 % and placebo. No
significant local and systemic side effects developed in association with
instillation of topical bevacizumab.
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