September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Supra-Tenon’s Excision of Pterygium with 0.1ml Adjunctive Bevacizumab (STEP 0.1): A Novel Recurrence-Free Technique of Pterygium Surgery
Author Affiliations & Notes
  • Sayan Basu
    Cornea and Anterior Segment, L V Prasad Eye Institute, Hyderabad, India
    Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, India
  • Ritin Goyal
    Cornea and Anterior Segment, L V Prasad Eye Institute, Hyderabad, India
  • Abhishek Hoshing
    Cornea and Anterior Segment, L V Prasad Eye Institute, Hyderabad, India
  • Dilip K Mishra
    Ocular Pathology Laboratory, L V Prasad Eye Institute , Hyderabad, India
  • Vivek Dave
    Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, India
  • Footnotes
    Commercial Relationships   Sayan Basu, None; Ritin Goyal, None; Abhishek Hoshing, None; Dilip Mishra, None; Vivek Dave, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 3496. doi:
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      Sayan Basu, Ritin Goyal, Abhishek Hoshing, Dilip K Mishra, Vivek Dave; Supra-Tenon’s Excision of Pterygium with 0.1ml Adjunctive Bevacizumab (STEP 0.1): A Novel Recurrence-Free Technique of Pterygium Surgery. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3496.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The main concern with pterygium excision is the fear of recurrence. We hypothesized that since recurrence is essentially fibrosis induced by bare-sclera excision, it can be eliminated by preserving the Tenon’s capsule during excision and by using adjunctive Bevacizumab.

Methods : This was a retrospective study of 30 eyes of 30 patients with primary nasal pterygium who underwent supra-Tenon’s excision of pterygium with 0.1ml adjunctive Bevacizumab (STEP 0.1) under topical anesthesia. In this novel technique, the neck of the pterygium was incised, separating the head from the body by releasing the attachments between the Tenon’s capsule and conjunctiva. The head was stripped off the cornea and a polygonal Tenon’s sparing surface defect was created that extended from the tip of the excised head on the corneal side to the palisades at the limbus and further onto the recessed conjunctival margin nasally. Bevacizumab, 0.1ml, was then injected sub-conjunctivally. The primary outcome measures were the incidence of recurrence and the improvement in cosmetic appearance, assessed by two independent observers. Secondary outcome measures were change in visual acuity and complications. The post-operative healing pattern was also studied clinically and in-vivo by using ultra-high resolution optical coherence tomography (UHR-OCT) imaging.

Results : Median follow-up was six months (range: 3 to 12 months). No corneal, limbal or conjunctival recurrence was noted in any case. Cosmetic appearance scores improved from poor to fair in all cases, pre-operatively, to good in 66.7% and excellent in 33.3%, post-operatively (P<0.0001). Best corrected visual acuity remained unchanged (P=0.87) and sub-conjunctival haemorrhage was the most common complication seen. No serious or sight-threatening complications were noted. Clinically, fluorescein staining showed complete closure of the surface defect within 10-14 days. UHR-OCT imaging revealed that the surface re-epithelization occurred from the limbus towards the conjunctiva without any evidence of sub-conjunctival fibrosis.

Conclusions : STEP 0.1 is effective in restoring cosmesis without the risk of recurrence in patients with primary pterygias. STEP 0.1 obviates the need for grafts, sutures or glue and can potentially simplify the management of primary pterygia by making surgery easier, safer and more predictable.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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