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Subconjunctival R anibizumab for Recurrent P terygium

Subconjunctival R anibizumab for Recurrent P terygium. Authors: Jane Fishler MD, Volkan Hurmeric MD, Anat Galor MD, Sonia H. Yoo MD, Victor L Perez MD The authors of this poster have received research funding from Genentech. Introduction.

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Subconjunctival R anibizumab for Recurrent P terygium

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  1. SubconjunctivalRanibizumab for Recurrent Pterygium Authors: Jane Fishler MD, VolkanHurmeric MD, AnatGalor MD, Sonia H. Yoo MD, Victor L Perez MD The authors of this poster have received research funding from Genentech

  2. Introduction • Several studies have shown an elevated level of VEGF in pterygium tissue 5-8 • Perioperative injections of ranibizumab in conjunction with pterygium surgery have been found to be well tolerated 3 • Small case report series found conjunctival vessel regression with administration of Avastin in patients with recurrent pterygium1, 2, 4 • The effect was persistent in 4 out of 5 patients

  3. Purpose of Study Prospective clinical study designed to assess the effect and duration of a single subconjunctival injection of ranibizumab (0.5 mg/0.05 ml) in patients with an early pterygiumrecurrence

  4. Methods • 5 patients with early pterygium recurrence (<6 mo) recruited • Recurrence = presence of corneal vessels at the limbus with concomitant conjunctival hyperemia • Inclusion criteria: >18 years old, ability to consent • Exclusion criteria: history of recurrent pterygium or glaucoma surgery • All patients received one subconjunctival injection adjacent to the abnormal vessels at the limbus • Patients were seen at day 1, week 1, month 1, 3 and 6 after the injection • Digital slit lamp photos were taken at each visit. Slit lamp pictures were analyzed using Photoshop 5.5

  5. Methods Step 1: Limbus was outlined at baseline images and was not modified for the follow up images Step 2: The area of corneal neovascularization was outlined on each subsequent visit and the area of change was calculated

  6. Outcome Measures 1. Change in conjunctival hyperemia • The appearance of the conjunctiva hyperemia was graded according to the scale developed by the Cornea and Contact Lens Research Unit 9 2. Change in corneal blood vessel area 3. Secondary outcome levels included adverse events, patient satisfaction and the need to repeat surgery

  7. Results Hyperemia: • A decrease in hyperemia was noted in all patients on post injection day (PID) #1 • 3 patients had regression of hyperemia back to baseline at different time points • The remaining 2 patients had rebound hyperemia but to a lesser degree

  8. Patient #4 Pre-injection Post-injection day 1 Post-injection day 7 Post-injection month 1 Post-injection month3 Post-injection month6

  9. Results: Neovascularization Change in Corneal Vessel Area • No immediate effects were noted • 3 patients with significant increase in area of neovascularization • 2 by month #1 and 1 by month #6 • No significant change in neovascularization in 2 patients

  10. Patient # 1 Secondary Effects: No adverse events were noted Patients noted a decrease in hyperemia initially but also reported that the hyperemia returned No patients have undergone surgical removal of the pterygium recurrence

  11. Conclusions • A decrease in conjunctival hyperemia was noted after one anti-VEGF injection • Retina literature supports multiple injections necessary to sustain the effects of therapy • Our study did not find significant regression of corneal neovascularization

  12. References 1. Teng CC, Patel NN, Jacobson L. Effect of subconjunctivalbevacizumab on primary pterygium. Cornea 2009;28:468-70. 2. Wu PC, Kuo HK, Tai MH, Shin SJ. Topical bevacizumabeyedrops for limbal-conjunctivalneovascularization in impending recurrent pterygium. Cornea 2009;28:103-4. 3. Galor A, Yoo S, Piccoli F, Schmitt A, Chang V, MD VLP. Phase I study of subconjunctivalranibizumab in patients with primary pterygium undergoing pterygium surgery. American Journal of Ophthalmology. 2010 Jun;149(6):926-931. 4. Mansour AM. Treatment of inflamed pterygia or residual pterygial bed. Br J Ophthalmol 2009;93:864-5. 5. Jin J, Guan M, Sima J, et al. Decreased pigment epithelium-derived factor and increased vascular endothelial growth factor levels in pterygia. Cornea 2003;22:473-7. 6. Lee DH, Cho HJ, Kim JT, Choi JS, Joo CK. Expression of vascular endothelial growth factor and inducible nitric oxide synthase in pterygia. Cornea 2001;20:738-42. 7. Lee JK, Song YS, Ha HS, et al. Endothelial progenitor cells in pterygium pathogenesis. Eye 2007;21:1186-93. 8. Mauro J, Foster CS. Pterygia: pathogenesis and the role of subconjunctivalbevacizumab in treatment. SeminOphthalmol 2009;24:130-4. 9. Sorbara L, Simpson T, Duench S, Schulze M, Fonn D. Comparison of an objective method of measuring bulbar redness to the use of traditional grading scales. Cont Lens Anterior Eye 2007;30:53-9. 10. VanRoekel RC, Bower KS, Burka JM, Howard RS. Anterior segment measurements using digital photography: a simple technique. Optom Vis Sci 2006;83:391-5. 11. Manzano RP, Peyman GA, Khan P, et al. Inhibition of experimental corneal neovascularisation by bevacizumab (Avastin). Br J Ophthalmol 2007;91:804-7. 12. Hurmeric V, Mumcuoglu T, Erdurman C, Kurt B, Dagli O, Durukan AH. Effect of subconjunctivalbevacizumab (Avastin) on experimental corneal neovascularization in guinea pigs. Cornea 2008;27:357-62.

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