Triple subconjunctival bevacizumab injection for early corneal recurrent pterygium: one-year follow-up

Abstract

Purpose: The aim of the study was to evaluate the effect of 3 subconjunctival bevacizumab injections in patients with an early corneal pterygium recurrence.

Methods: This study was a nonrandomized single center trial. Patients with an early corneal pterygium recurrence were selected. All patients received 3 subconjunctival bevacizumab (2.5 mg/0.1 mL) injections (basal, 2 and 4 weeks) in the recurrence area of the pterygium. The corneal and corneal-conjunctival neovascularization areas and the corneal opacification area of each pterygium were determined using digital slit lamp pictures.

Results: Thirty-eight patients were enrolled into the study; all patients were injected within 3 months of the diagnosed pterygium recurrence. Interestingly, the bevacizumab injections had a significant effect (P<0.05) on the reduction of corneal, corneal-conjunctival area of neovascularization determined as pixels and on the corneal opacification area determined as mm(2) when comparing the basal values, to the values obtained after 15 days, 1 month, 3 months, 6 months, and 12 months after injections.

Conclusions: The vascularized area in all recurrent pterygia and the corneal opacification area with this triple regimen of subconjunctival bevacizumab injections were reduced, which remained until the end of the study. These results suggest that bevacizumab subconjunctival injections could be useful to treat recurrent pterygium.

Figures

FIG. 1.

Slit lamp photograph of a representative patient before the subconjunctival bevacizumab injections. The marked zone with the black line was considered as the corneal neovascularized area and was converted into pixels for further analyses. It can be observed that the marked zone covers only the corneal neovascularized area.

FIG. 2.

Slit lamp photograph of a representative patient before the subconjunctival bevacizumab injections. The marked zone with the black line was considered as the corneo-conjunctival neovascularized area and was converted into pixels for further analyses. It can be observed that the marked zone covers only the corneo-conjunctival neovascularized area.

FIG. 3.

Slit lamp photograph of a representative patient before the suconjunctival bevacizumab injections. The marked zone with the white line was considered as the corneal opacification area and was measured as proposed by VanRoekel. It can be observed that the marked zone encompasses the corneal opacification in front of the neovascularized corneal area.

FIG. 4.

Effect of the bevacizumab injections on the corneal neovascularization area on recurrent pterygia. Corneal neovascularization evaluation was performed at basal time before the first bevacizumab injection. Then, corneal neovascularization evaluation was performed 15 days after the first bevacizumab injection, which coincided with the second bevacizumab injection. Afterward, the corneal neovascularization evaluation time was done 1 month after the first bevacizumab injection, which overlapped with the last bevacizumab injection. Thereafter, the follow-up period continued 3, 6, and 12 months after the first bevacizumab injection. *P<0.05; ***P<0.001.

FIG. 5.

Effect of the bevacizumab injections on the corneo-conjunctival neovascularization area on recurrent pterygia. Neovascularization evaluation was performed at basal time before the first bevacizumab injection. Then, neovascularization evaluation was performed 15 days after the first bevacizumab injection, which coincided with the second bevacizumab injection. Afterward, the neovascularization evaluation time was done 1 month after the first bevacizumab injection, which overlapped with the last bevacizumab injection. Thereafter, the follow-up period continued 3, 6, and 12 months after the first bevacizumab injection. *P<0.05; ***P<0.001.

FIG. 6.

Effect of the bevacizumab injections on the corneal opacification area on recurrent pterygia. The corneal opacification was exclusively performed on those patients who clinically exhibited corneal opacification. Corneal opacification evaluation was performed at basal time before the first bevacizumab injection. Then, corneal opacification evaluation was performed 15 days after the first bevacizumab injection, which coincided to the second bevacizumab injection. Afterward, the corneal opacification evaluation time was done 1 month after the first bevacizumab injection, which overlapped with the last bevacizumab injection. Thereafter, the follow-up period continued 3, 6, and 12 months after the first bevacizumab injection. * P<0.05; *** P<0.001.

FIG. 7.

Representative slit lamp photographs of a patient who significantly improved in the clinical neovascularization and corneal opacification after the 3 subconjunctival injections. (A) Preinjection photograph; (B) 15 days after the first injection; (C) 1 month after the first injection; (D) 3 months after the first injection; (E) 6 months after the first injection; (F) 1 year after the first injection. Note that bevacizumab treatment induced reduction on neovascularization and on corneal opacification processes.