Top

Graefe's Archive for Clinical and Experimental Ophthalmology

Published in:

01-07-2020 | Bevacizumab | Cornea

Efficacy of bevacizumab injection after pterygium excision and limbal conjunctival autograft with limbal fixation suture

Authors: Hee Kyung Yang, Yun Ji Lee, Joon Young Hyon, Kwang Gi Kim, Sang Beom Han

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 7/2020

Abstract

Purpose

To determine the efficacy of subconjunctival bevacizumab injection after pterygium excision with limbal conjunctival autograft and limbal fixation suture.

Methods

This retrospective study included a total of 150 eyes of 150 patients with primary pterygium who received three different procedures after pterygium excision, i.e., 49 eyes with limbal conjunctival graft (group A), 48 eyes with limbal conjunctival autograft with limbal fixation suture (group B), and 53 eyes with limbal conjunctival autograft with limbal fixation suture followed by bevacizumab injection (group C). Image analysis was performed using preoperative anterior segment photographs to measure parameters including relative length, relative width, relative area, and vascularity index of pterygium. Recurrence of pterygium was determined at 1 year after surgery, and outcomes were compared between the 3 groups. Risk factors related to recurrence were evaluated using univariate and multivariate analyses.

Results

Recurrence rates after 1 year were 18.4% (9/49), 8.3% (4/48), and 1.9% (1/53) in groups A, B, and C, respectively (P = 0.004). Multivariate analysis showed that patients in group C had significantly reduced risk of recurrence compared with those in group A (P = 0.009), whereas the risk of recurrence was not significantly different between groups A and B (P = 0.227) and groups B and C (P = 0.068), respectively. Among various parameters, higher vascularity index had significant correlation with increased risk of recurrence (P = 0.008).

Conclusions

Bevacizumab injection after limbal conjunctival autograft and limbal fixation suture may effectively reduce recurrence after pterygium excision. The vascularity of pterygium was associated with a higher risk of recurrence.

Errais K, Bouden J, Mili-Boussen I, Anane R, Beltaif O, Meddeb Ouertani A (2008) Effect of pterygium surgery on corneal topography. Eur J Ophthalmol 18:177–181PubMed

Demirok A, Simsek S, Ozdemir M, Turkiye V (2005) Effect of pterygium surgery on corneal topography. Cornea 24:505–506PubMed

Bahar I, Loya N, Weinberger D, Avisar R (2004) Effect of pterygium surgery on corneal topography: a prospective study. Cornea 23:113–117PubMed

Tomidokoro A, Miyata K, Sakaguchi Y, Samejima T, Tokunaga T, Oshika T (2000) Effects of pterygium on corneal spherical power and astigmatism. Ophthalmology 107:1568–1571PubMed

Ozer A, Yildirim N, Erol N, Yurdakul S (2009) Long-term results of bare sclera, limbal-conjunctival autograft and amniotic membrane graft techniques in primary pterygium excisions. Ophthalmologica 223:269–273PubMed

Young AL, Leung GY, Wong AK, Cheng LL, Lam DS (2004) A randomised trial comparing 0.02% mitomycin C and limbal conjunctival autograft after excision of primary pterygium. Br J Ophthalmol 88:995–997PubMedPubMedCentral

Han SB, Yang HK, Hyon JY, Wee WR (2015) Conjunctival metaplasia after pterygium excision and limbal autograft. Optom Vis Sci 92:324–328PubMed

Oguz H, Kilitcioglu A, Yasar M (2006) Limbal conjunctival mini-autografting for preventing recurrence after pterygium surgery. Eur J Ophthalmol 16:209–213PubMed

Frau E, Labetoulle M, Lautier-Frau M, Hutchinson S, Offret H (2004) Corneo-conjunctival autograft transplantation for pterygium surgery. Acta Ophthalmol Scand 82:59–63PubMed

10.

Al Fayez MF (2002) Limbal versus conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 109:1752–1755PubMed

11.

Miyai T, Hara R, Nejima R, Miyata K, Yonemura T, Amano S (2005) Limbal allograft, amniotic membrane transplantation, and intraoperative mitomycin C for recurrent pterygium. Ophthalmology 112:1263–1267PubMed

12.

Han SB, Hyon JY, Hwang JM, Wee WR (2012) Efficacy and safety of limbal-conjunctival autografting with limbal fixation sutures after pterygium excision. Ophthalmologica 227:210–214PubMed

13.

Torres-Gimeno A, Martinez-Costa L, Ayala G (2012) Preoperative factors influencing success in pterygium surgery. BMC Ophthalmol 12:38PubMedPubMedCentral

14.

Hu Q, Qiao Y, Nie X, Cheng X, Ma Y (2014) Bevacizumab in the treatment of pterygium: a meta-analysis. Cornea 33:154–160PubMed

15.

Lekhanont K, Patarakittam T, Thongphiew P, Suwan-apichon O, Hanutsaha P (2012) Randomized controlled trial of subconjunctival bevacizumab injection in impending recurrent pterygium: a pilot study. Cornea 31:155–161PubMed

16.

Ozgurhan EB, Agca A, Kara N, Yuksel K, Demircan A, Demirok A (2013) Topical application of bevacizumab as an adjunct to recurrent pterygium surgery. Cornea 32:835–838PubMed

17.

Han SB, Jeon HS, Kim M, Lee SJ, Yang HK, Hwang JM, Kim KG, Hyon JY, Wee WR (2016) Quantification of astigmatism induced by pterygium using automated image analysis. Cornea 35:370–376PubMed

18.

Han SB, Jeon HS, Kim M, Lee SJ, Yang HK, Hwang JM, Kim KG, Hyon JY, Wee WR (2016) Risk factors for recurrence after pterygium surgery: an image analysis study. Cornea 35:1097–1103PubMed

19.

Park IK, Chun YS, Kim KG, Yang HK, Hwang JM (2013) New clinical grading scales and objective measurement for conjunctival injection. Invest Ophthalmol Vis Sci 54:5249–5257PubMed

20.

Yang HK, Han SB, Hwang JM (2014) Diclofenac versus fluorometholone after strabismus surgery in children. Br J Ophthalmol 98:734–738PubMed

21.

Tsim NC, Young AL, Jhanji V, Ho M, Cheng LL (2015) Combined conjunctival rotational autograft with 0.02% mitomycin C in primary pterygium surgery: a long-term follow-up study. Br J Ophthalmol 99:1396–1400PubMed

22.

Kandavel R, Kang JJ, Memarzadeh F, Chuck RS (2010) Comparison of pterygium recurrence rates in Hispanic and white patients after primary excision and conjunctival autograft. Cornea 29:141–145PubMed

23.

Koranyi G, Artzen D, Seregard S, Kopp ED (2012) Intraoperative mitomycin C versus autologous conjunctival autograft in surgery of primary pterygium with four-year follow-up. Acta Ophthalmol 90:266–270PubMed

24.

Hirst LW, Sebban A, Chant D (1994) Pterygium recurrence time. Ophthalmology 101:755–758PubMed

25.

Lee DH, Cho HJ, Kim JT, Choi JS, Joo CK (2001) Expression of vascular endothelial growth factor and inducible nitric oxide synthase in pterygia. Cornea 20:738–742PubMed

26.

Chao SC, Hu DN, Yang PY, Lin CY, Yang SF (2011) Overexpression of urokinase-type plasminogen activator in pterygia and pterygium fibroblasts. Mol Vis 17:23–31PubMedPubMedCentral

27.

Liu W, Sha X, Wen Y, Zhao W, Luo W, Hua Z (2014) Effect of Avastin on the migration and invasion of pterygium fibroblasts. Eye Sci 29:214–218PubMed

28.

Gumus K, Karakucuk S, Mirza GE, Akgun H, Arda H, Oner AO (2014) Overexpression of vascular endothelial growth factor receptor 2 in pterygia may have a predictive value for a higher postoperative recurrence rate. Br J Ophthalmol 98:796–800PubMed

29.

Detorakis ET, Zaravinos A, Spandidos DA (2010) Growth factor expression in ophthalmic pterygia and normal conjunctiva. Int J Mol Med 25:513–516PubMed

30.

Lin H, Luo L, Ling S, Chen W, Liu Z, Zhong X, Wu C, Chen W, Liu Y (2013) Lymphatic microvessel density as a predictive marker for the recurrence time of pterygium: a three-year follow-up study. Mol Vis 19:166–173PubMedPubMedCentral

31.

Tan DT, Chee SP, Dear KB, Lim AS (1997) Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol 115:1235–1240PubMed

32.

Teng CC, Patel NN, Jacobson L (2009) Effect of subconjunctival bevacizumab on primary pterygium. Cornea 28:468–470PubMed

33.

Nava-Castaneda A, Olvera-Morales O, Ramos-Castellon C, Garnica-Hayashi L, Garfias Y (2014) Randomized, controlled trial of conjunctival autografting combined with subconjunctival bevacizumab for primary pterygium treatment: 1-year follow-up. Clin Exp Ophthalmol 42:235–241PubMed

34.

Nava-Castaneda A, Ulloa-Orozco I, Garnica-Hayashi L, Hernandez-Orgaz J, Jimenez-Martinez MC, Garfias Y (2015) Triple subconjunctival bevacizumab injection for early corneal recurrent pterygium: one-year follow-up. J Ocul Pharmacol Ther 31:106PubMedPubMedCentral

35.

Zeng W, Liu Z, Dai H, Yan M, Luo H, Ke M, Cai X (2017) Anti-fibrotic, anti-VEGF or radiotherapy treatments as adjuvants for pterygium excision: a systematic review and network meta-analysis. BMC Ophthalmol 17:211PubMedPubMedCentral

36.

Sun Y, Zhang B, Jia X, Ling S, Deng J (2018) Efficacy and safety of bevacizumab in the treatment of pterygium: an updated meta-analysis of randomized controlled trials. J Ophthalmol 2018:4598173PubMedPubMedCentral

37.

Shenasi A, Mousavi F, Shoa-Ahari S, Rahimi-Ardabili B, Fouladi RF (2011) Subconjunctival bevacizumab immediately after excision of primary pterygium: the first clinical trial. Cornea 30:1219–1222PubMed

38.

Razeghinejad R, Banifatemi M, Hosseini H (2013) The effect of different doses of subconjunctival bevacizumab on the recurrence rate of excised primary pterygium. Bull Soc Belge Ophtalmol:13–20

39.

Razeghinejad MR, Banifatemi M (2014) Subconjunctival bevacizumab for primary pterygium excision; a randomized clinical trial. J Ophthalmic Vis Res 9:22–30PubMedPubMedCentral

40.

Fernandes M, Sangwan VS, Bansal AK, Gangopadhyay N, Sridhar MS, Garg P, Aasuri MK, Nutheti R, Rao GN (2005) Outcome of pterygium surgery: analysis over 14 years. Eye (Lond) 19:1182–1190

41.

Chen PP, Ariyasu RG, Kaza V, LaBree LD, McDonnell PJ (1995) A randomized trial comparing mitomycin C and conjunctival autograft after excision of primary pterygium. Am J Ophthalmol 20:151–160

42.

Mutlu FM, Sobaci G, Tatar T, Yildirim E (1999) A comparative study of recurrent pterygium surgery: limbal conjunctival autograft transplantation versus mitomycin C with conjunctival flap. Ophthalmology 106:817–821PubMed

43.

Lewallen S (1989) A randomized trial of conjunctival autografting for pterygium in the tropics. Ophthalmology 96:1612–1614PubMed

44.

Manning CA, Kloess PM, Diaz MD, Yee RW (1997) Intraoperative mitomycin in primary pterygium excision. A prospective, randomized trial. Ophthalmology 104:844–848PubMed

45.

Sharma A, Gupta A, Ram J, Gupta A (2000) Low-dose intraoperative mitomycin-C versus conjunctival autograft in primary pterygium surgery: long term follow-up. Ophthalmic Surg Lasers 31:301–307PubMed

46.

Singh P, Sarkar L, Sethi HS, Gupta VS (2015) A randomized controlled prospective study to assess the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients. Indian J Ophthalmol 63:779–784PubMedPubMedCentral

47.

Banifatemi M, Razeghinejad MR, Hosseini H, Gholampour A (2011) Bevacizumab and ocular wound healing after primary pterygium excision. J Ocul Pharmacol Ther 27:17–21PubMed

48.

Fallah MR, Khosravi K, Hashemian MN, Beheshtnezhad AH, Rajabi MT, Gohari M (2010) Efficacy of topical bevacizumab for inhibiting growth of impending recurrent pterygium. Curr Eye Res 35:17–22PubMed

49.

Wu PC, Kuo HK, Tai MH, Shin SJ (2009) Topical bevacizumab eyedrops for limbal-conjunctival neovascularization in impending recurrent pterygium. Cornea 28:103–104PubMed

Title: Efficacy of bevacizumab injection after pterygium excision and limbal conjunctival autograft with limbal fixation suture
Authors: Hee Kyung Yang
Yun Ji Lee
Joon Young Hyon
Kwang Gi Kim
Sang Beom Han
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keyword: Bevacizumab
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 7/2020
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-020-04704-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Efficacy of bevacizumab injection after pterygium excision and limbal conjunctival autograft with limbal fixation suture

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2020

Consecutive strabismus after infantile nystagmus syndrome surgery and potential risk factors

Sustainable practice of ophthalmology during COVID-19: challenges and solutions

Feelings, preoperative anxiety, and need for information in patients undergoing intravitreal injections

Baseline clinical features predict visual outcome in young patients with central retinal vein occlusion

Outcome of treatment for neovascular age-related macular degeneration by practice-based ophthalmologists compared with a macula clinic

Is virtual existence our new reality?