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PTERYGIUM AND TOPICAL BEVACIZUMAB: A 2 YEAR FOLLOW UP

PTERYGIUM AND TOPICAL BEVACIZUMAB: A 2 YEAR FOLLOW UP. DR. ADITYA SUDHALKAR,M.S . DR. ANAND SUDHALKAR,M.S. The authors have no financial interest in this presentation. INTRODUCTION . Pterygium : Subconjunctival elastotic degeneration;

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PTERYGIUM AND TOPICAL BEVACIZUMAB: A 2 YEAR FOLLOW UP

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  1. PTERYGIUM AND TOPICAL BEVACIZUMAB: A 2 YEAR FOLLOW UP DR. ADITYA SUDHALKAR,M.S. DR. ANAND SUDHALKAR,M.S. The authors have no financial interest in this presentation

  2. INTRODUCTION • Pterygium: Subconjunctivalelastotic degeneration; • Can be a cosmetic blemish and/or interfere with vision • Excision is the primary treatment modality; recurrence is often a problem • Numerous adjuvants suggested for preventing recurrence, including: • Mitomycin C, 5 FU, triamcinolone • Irradiation** • Conjunctivalautografts • Their efficacy however, is variable • Bevacizumab has been suggested as an off label use* *Effect of subconjunctivalbevacizumab on primary pterygiumTeng CC, Patel NN, Jacobson L. Cornea. 2009 May;28(4):468-70 *Topical bevacizumab for corneal limbalneovascularisation to prevent impending recurrence of pterygiumWu PC, Kuo HK, Tai MH, Shin SJ.Cornea. 2009 Jan;28(1):103-4 **Strahlenther Onkol. 2009 Dec;185(12):808-14 Vastradis et al. *Med Hypotheses. 2007;69(4):925-7. Bevacizumab as a potential novel adjunct in the management of pterygia

  3. PURPOSE: • To determine the efficacy and safety of topical bevacizumab in flurbiprofen as an adjunct to conjunctivalautograftin prevention of recurrence of primary pterygium

  4. METHODS: • STUDY DESIGN: Prospective Case Series • PATIENTS: 17 consecutive patients of primary pterygium, with : • No associated systemic or ocular disorder • No known predisposition to hypersensitivity reactions • TREATMENT: Primary pterygium excision with conjunctivalautograft; single surgeon, standardised technique. • POST OPERATIVE REGIMEN(FOR 4 WEEKS-q.i.d.): • Antibiotic steroid *eye drops • Bevacizumab(0.3mg/drop), topically with punctal occlusion-5 minutes • Flurbiprofen eye drops • Preservative free artificial tears • FOLLOW UPS :Post operative days 1, 7, 30, 90, 180, years 1 and 2.

  5. OUTCOME MEASURES: • Recurrence of pterygium • Safety of bevacizumab eye drops administered topically

  6. RESULTS: • MEAN AGE: 43.12+/-3.24years(range-35 to 49 years) • GENDER DISTRIBUTION: Males: 10; Females 7 • TOPICAL REGIMEN WELL TOLERATED • NO RECURRENCE TILL THE END OF THE FOLLOW -UP PERIOD • Seven patients complained of foreign body sensation; treated with lubricants • 2 had dellen formation, resolved with artificial tears • 1 had hyperemia of the autograft, resolved with flurbiprofen

  7. ILLUSTRATIVE CASE: PRE -OPERATIVE POST OPERATIVE: AT END OF TWO YEARS

  8. DISCUSSION: • Recurrence of pterygium entails further procedures on a patient; excision can leave a scar • Antimetabolites, irradiation not without side effects • Bevacizumab in an off label use has been shown to be effective in prevention of recurrence* • Subconjunctivalbevacizumab in immediate post operative period might not prevent neovascularisation which usually occurs later • Multiple subconjunctival* injections potentially hazardous and painful; *Ann Ophthalmol (Skokie). 2010;42 Spec No:28-30. Multiple subconjunctival injections for advanced primary pterygium *Cornea. 2011 Feb;30(2):127-9 Fallah et al. Intralesionalbevacizumab in decreasing pterygium size.

  9. DISCUSSION: • Administration of topical therapy(bevacizumab+flurbiprofen) with punctal occlusion did not produce ocular/systemic side effects • Topical therapy gives a prolonged dose of bevacizumab to the autograft • None of the patients showed a recurrence till the end of follow up period • Steroids not a confounding factor as they have not shown to significantly alter recurrence rates*~ *Cornea. 2010 Feb;29(2):141-5, Comparison of recurrence rates….Kandavel et al ~Ann Ophthalmol. 1985 Jan;17(1):92-5. Pterygium: clinical classification and management in Virgin Islands. Anduze et al. ~East Afr Med J. 1992 Sep;69(9):490-3. Post-operative management of pterygium in Jos, Nigeria--comparison of antibiotics, steroids and opticrom

  10. REFERENCES: • Pterygium. Etiology, clinical aspects and novel adjuvant therapies].HeindlLM, CursiefenC.Ophthalmologe. 2010 Jun;107(6):517-20, 522-4 • Safety and efficacy of intraoperative 5-fluorouracil infiltration in pterygium treatment]. VleziVG, et al. ArqBras Oftalmol. 2009 Mar-Apr;72(2):169-73. • Comparative Study of Different β-Radiation Doses for Preventing Pterygium Recurrence. Yamada Tet al. IntJ RadiatOncolBiol Phys. 2010 Oct • Results of treatment with topical mitomycin C 0.02% following excision of primary pterygium.Rachmiel R et al.BrJ Ophthalmol. 1995 Mar;79(3):233-6 • Postoperative subconjunctival corticosteroid injection to prevent pterygium recurrence. Paris Fdoset al.Cornea. 2008 May;27(4):406-10 • DevOphthalmol. 2010;46:133-9. Scholl et al. Anti vascular growth factors in anterior segment disease • Cornea. 2009 May;28(4):468-70. Teng et al. Effect of subconjunctivalbevacizumab on primary pterygium

  11. LIMITATIONS: • Small sample size • No control group • Further studies will be required

  12. CONCLUSION • Topical Bevacizumab appears to be safe and effective in preventing pterygium recurrence.

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