JOURNAL READING

PREVENTION OF RECURRENT
PTERYGIUM WITH TOPICAL
BEVACIZUMAB 0.05% EYE DROPS: A
RANDOMIZED CONTROLLED TRIAL

By:
Raka Aji S.Ked 19360136

Preceptor:
dr. Rahmat Syuhada Sp.M (K)
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 bevacizumab
PURPOS 0.05% when used as an
E 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, where as 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 = 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 = 0.01) (Table III).
DISCUSSION
• 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.
• Bevacizumab is a monoclonal antibody that blocks VEGF-A.
• Previously, 2 different modalities of bevacizumab were investigated for the
treatment of primary pterygia: subconjunctival bevacizumab alone or as an
adjunctive therapy after pterygial excision.
• Two randomized controlled trials 1 case series and 1case report, found that
subconjunctival bevacizumab reduced the symptoms and size sof pterygia, but
the effect was temporary and not clinically relevant.
• Furthermore, Razeghinejadetal andShenasietal reported that subconjunctival
bevacizumab used as an adjunctive therapy after primary pterygial surgery did
not significantly prevent recurrence of pterygia, eventhough the treatment was
well tolerated. The reason for this may be because of the short term temporary
effect of the drug
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 bevacizumab 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.