Subconjunctival bevacizumab injections in the management of impending recurrent pterygium

Abstract

Purpose : To evaluate the effect of subconjunctival injections of bevacizumab on ocular discomfort and cosmetic appearance in eyes with an impending recurrent pterygium after surgical excision.

Methods : Retrospective chart review of four patients treated at the Miami Veteran’s Affairs Medical Center. Subconjunctival bevacizumab (0.1ml) was administered based on persistent bulbar hyperemia in the area of the autograft 1 month (n=1) or 3 months post-op (n=3). The number of injections administered was based on clinical response with one subject receiving one injection and the other three receiving three injections, one month apart. Ocular discomfort scores were assessed before and after treatment. Cosmetic outcomes were assessed via clinical photos taken before and after treatment.

Results : The median age was 55.5 years (range 33-72), three were male and one was female; two patients were Caucasian, and two self-identified as Hispanic. All patients initially underwent pterygium excision with conjunctival autograft; three with concomitant 0.02% Mitomycin C and three with amniotic membrane placement over the autograft for primary pterygium (n=2), recurrent pterygium (n=1), or pseudo-pterygium after trauma (n=1). Ocular discomfort scores improved in all individuals after bevacizumab injections with improved symptoms of irritation and foreign body sensation. Bulbar hyperemia resolved in 3 eyes (two primary and one recurrent pterygium) with no pterygium recurrence and excellent cosmetic outcomes noted after 3 months of follow up. The patient with a pseudo-pterygium experienced a recurrence despite 3 bevacizumab injections, and the lesion appeared similar to that noted pre-operatively on 3 months follow up after the last injection. One patient was on concomitant use of steroids at the time of bevacizumab treatment.

Conclusions : Subconjunctival injections of bevacizumab improved bulbar hyperemia in individuals with impending recurrence after pterygium removal. However, injections did not prevent recurrence in a case of pseudo-pterygium secondary to ocular trauma.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.