Effect of pre-op subconjuntival injection of bevacizumab in pterygium surgery Young Jeung Park, M.D. Ph.D. Jong Wook Lee, M.D. Kyoo Won Lee, M.D. Ph.D.

Slides:

Advertisements

Similar presentations

Grand Rounds Peripheral Exudative Hemorrhagic Chorioretinopathy

Advertisements

COMBINED SUTURELESS AMNIOTIC MEMBRANE TRANSPLANTATION WITH NARROW STRIP CONJUNCTIVAL AUTOGRAFT FOR PTERYGIUM Meltem Yagmur MD Nese Cetin MD T. Reha Ersoz.

Therapeutic Penetrating Keratoplasty in Fungal Keratitis: Prospective Study Sonika Gupta Consultant Ophthalmology Max Eye Care New Delhi, India Author.

CATARACT SUEGRY AND DIABETES Indications of surgery: 1) Visual loss 2)Surveillance of retinopathy 3)Laser therapy.

Use of Autologous Fascia Lata in Management of Necrotizing Scleritis following Bare Sclera Pterygium Excision Hatem Kobtan MD FRCS (Ed) (Glasg) Dina koptan.

Verteporfin Photodynamic Therapy in Patients with Corneal Neovascularization Rodrigo Bolanos MD 1, Alexandra Pena MD 1, Guillermo Dewit MD 1, Judith Sandra.

Photodynamic Therapy with Verteporfin Combined with Ranibizumab for Corneal Neovascularization Alexandra Peña, MD 1 ; Alejandro Navas, MD, MSc 2 ; Enrique.

J.Talajic, K. Miszkiewicz, L. Racine, M. Harissi-Dagher The authors have no financial interest in the subject matter of this poster. Fibrin Glue versus.

Cornea and Refractive Surgeon Maxivision Eye Hospitals

Richard Y. Hwang 1, PhD; Dan Gauthier 2, PhD; Dana Wallace 1, MD; Natalie A. Afshari 1, MD 1 Department of Ophthalmology, 2 Department of Physics Duke.

Dept. of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany. Outcome after big-bubble deep anterior lamellar keratoplasty.

The Diabetic Retinopathy Clinical Research Network

Results of Sutureless Autograft Transplantation in Primary Pterygium Surgery Authors: Leon-Cabello MJ, MD, PhD Casal-Valino M, MD Garcia-Hinojosa J, MD,

Ten-year Clinicopathological Review Of Ocular Surface Squamous Neoplasia In An Ophthalmological Center In Mexico City Lucero Pedro-Aguilar, M. D. Alvarez-Melloni.

Recurrence of the pterygium after excision: What factors do relate it? Hong Kyun Kim Dept. of Ophthalmology Kyungpook National University School of medicine.

The authors have no financial interest

Cheil Eye Hospital Young Jeung Park, MD Jong Wook Lee, MD

Corneal CXL in Children With Progessive Keratoconus Author do not have any financial interest in the surgical procedure or the medicines used in this study.

Subconjunctival Bevacizumab and Fluorometholone to resolve infectious keratitis and decrease corneal neovascularisation: randomized trial Authors Prakashchand.

CC Teng Effect of Subconjunctival Bevacizumab on Pterygiums Christopher C. Teng, MD 1,2 Lawrence Jacobson, MD 1 1 New York University School of Medicine.

Eun Chul Kim, M.D., Man Soo Kim, M.D. Department of Ophthalmology & Visual Science, College of Medicine, Catholic University of Korea, Seoul, Korea The.

Effect of Corneal Thickness on Selective Laser Trabeculoplasty to Decrease Intraocular Pressure as Primary or Secondary Treatment of Glaucoma ASCRS 2010.

Indications for and Outcomes of Therapeutic Penetrating Keratoplasty Sonika Gupta Consultant Ophthalmology Max Eye Care New Delhi, India Author has no.

“Tuck In” Lamellar Keratoplasty (TILK) for Post-Keratoplasty Corneal Ectasia involving the Corneal Periphery Vishal Jhanji, MD 1,2 Jacqueline Beltz, MBBS,

Michael A. Morris, MD PGY-3 Ophthalmology Resident Scott & White Eye Institute Temple, TX  Authors have no financial interests.

Pattern of Pain and Analgesic use after Collagen Crosslinking for Progressive Keratoconus Ramon Coral Ghanem, MD, PhD. Renan Ferreira Oliveira, MD. Vinicius.

Subtenon’s Anesthesia in Pterygium Excision with Conjunctival Autograft Michael R. Gagnon, M.D. Clinical Instructor, Stanford University Valley EyeCare.

V Dilraj Grewal MD SPS Grewal MD Rajeev Jain, MD G S Brar MD Evaluation of Sub-Conjunctival Bevacizumab as an antiproliferative agent in Glaucoma Filtering.

Effect of Race on Selective Laser Trabeculoplasty  1st author has no financial interest in the subject matter of this poster.  2nd and 3rd co-authors.

REFRACTIVE OUTCOMES WITH TORIC ICL IMPLANTS CHIEF AUTHOR: Dr. D.RAMAMURTHY CO – AUTHOR: Dr. R.CHITRA The authors have no financial interest in the subject.

The Effect of Corneal Anterior Surface Eccentricity on Astigmatism after Cataract Surgery Choul Yong Park MD 1 Sung Jun Lee MD 1 Prabjot Channa MD 2 Roy.

Evaluation of Efficacy and Safety of Intracorneal Ring Segment (Intacs SK) in Keratoconus Abdulrahman Al-Muammar, MD, FRCSC I have no financial interest.

Evaluation of Corneal Tomography in Primary Pterygium Sahil Goel, MD (Presenting Author), Murugesan Vanathi MD *The authors have no financial interests.

Ki-Cheol Chang, MD Department of Ophthalmology, Dankook University Hospital, South Korea Financial disclosure : Author has no commercial associations.

CASE III NEOVASCULAR GLAUCOMA. Patient History 68 year old white female. Ocular History: CRAO, Medical history: Diabetes Renal Problems.

Effect of East Asian Race on Selective Laser Trabeculoplasty ASCRS 2011 Minerva Kim Johns Hopkins University Lawrence F. Jindra, MD Columbia University.

Effect of Refractive State on Selective Laser Trabeculoplasty ASCRS 2011 Kevin Lai Stony Brook University School of Medicine Elaine M. Miglino Floral Park.

Corneal Tattooing with Amniotic Membrane Woo Chan Park M.D., Won Yeol Ryu M.D. Dept. of Ophthalmology, College of Medicine, Dong-A University Busan, Korea.

Two Cases of Subconjunctival Bevacizumab Injection to Prevent Bleb Failure after Trabeculectomy Dongwook Lee, Min Ahn, In-Cheon You, Daegyu Lee Chonbuk.

Yonca Aydin Akova MD, Leyla Erkanli Asena MD

ANTI-VEGF Recent Advances in DR. VEGF- Vascular Endothelial Growth factor is an important growth factor for angiogenesis and is necessary for normal angiogenesis.

Hongseok Yang, MD Department of Ophthalmology, Ajou University School of medicine, Suwon, Korea The author has no financial interest.

UC Davis Long-Term Outcomes of the Boston Type I Keratoprosthesis Jennifer Li, M.D., Mark Greiner, M.D. Ana Carolina Vieira, M.D. Mark Mannis, M.D. University.

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.

First 25 Descemet Membrane Endothelial Keratoplasty (DMEK) Outcomes for an Experienced DSAEK Surgeon Authors: Victoria Epstein, MS.,DO, Josh Wallsh, MS-III,

Spatial Differences in Blood vs. Lymphatic Growth into the Cornea Amir Reza Hajrasouliha MD, Zahra Sadrai MD, Reza Dana MD, MPH, MSc. Schepens Eye Research.

Effect of Previous Argon Laser Trabeculoplasty on Selective Laser Trabeculoplasty ASCRS 2011 Lawrence F. Jindra, MD Columbia University Winthrop University.

BRVO. Present by Sattar Heidari MD General ophthalmologist.

Liquifaction Method and Extent of Posterior Capsule Opacification: Two-Year Follow-up Marie Kalfertova, Mariya Burova, Pavel Rozsival, Nada Jiraskova Nada.

Management of corneal perforations and deep ulcers with patch grafts Dariusz Dobrowolski¹, Edward Wylęgała¹ ׳ ², Dorota Tarnawska¹, Dominika Janiszewska¹.

EFFICACY OF SUBCONJUCTIVAL BEVACIZUMAB ASSOCIATED TO MITOMYCIN-C ON GLAUCOMA FILTERING SURGERY. Juan Carlos Mesa-Gutiérrez, MD, PhD, FEBOphth, FICOphth.

Blood Reflux In Schlemm’s Canal Of Normal Cataract Patients: Simple Way To Identify The Trabecular Meshwork With Healthy Collector Channel Masahiro Maeda1,

Early Surgery versus Conventional Treatment for Infective Endocarditis

Comparison of Endothelial Cell Loss After Phacoemulsification Performed by Third Year Residents and Anterior Segment Surgeons Alexandra Braunstein, MD.

Blood Reflux In Schlemm’s Canal Of Normal Cataract Patients: Simple Way To Identify The Trabecular Meshwork With Healthy Collector Channel Masahiro Maeda1,

Bevacizumab and corneal patology

VI World Cornea Congress, Boston April 7-9, 2010.

Preoperative Characteristics

Vascular Endothelial Growth Factor VEGF and p53 Expression in Tunisian Patients with Pterygium: Immunohistochemical Analysis O Beltaief, Kh Errais, I Ammous,

Efficacy of Subconjunctival Bevacizumab

Erdr1 Attenuates Dermatophagoides farina Body Extract-Induced Atopic Dermatitis in NC/Nga Mice Kyung Eun Kim, Myung Jin Jung, Younkyung Houh, Tae Sung.

January 16, 2019.

Cheil Eye Hospital , Daegu, Korea

Surgical Result of Pterygium Extended Removal + Fibrin Glue Assisted Amniotic Membrane Transplantation (P.E.R.F.A.M.T) Wei-Li Chen, MD, PhD Associate.

Extracorporeal shock wave therapy ameliorates secondary lymphedema by promoting lymphangiogenesis Masayuki Kubo, PhD, Tao-Sheng Li, MD, PhD, Takahiro.

The Effect of Bevacizumab and Ranibizumab Injection

Winthrop University Hospital

Young Jeung Park, M.D. Ph.D. Won Suk Choi, M.D.

Presentation transcript:

Effect of pre-op subconjuntival injection of bevacizumab in pterygium surgery Young Jeung Park, M.D. Ph.D. Jong Wook Lee, M.D. Kyoo Won Lee, M.D. Ph.D. Financial Disclosure ： All authors declares no financial interest Cheil Eye Hospital, Daegu, Korea

Background Vascular Endothelial Growth Factor (VEGF) - Mediator cytokine of pathological angiogenesis Angiogenesis in pterygiumAngiogenesis in pterygium - Angiogenic stimulators↑, inhibitors↓  the formation and progression of pterygium Application of anti-VEGF therapy  Inducing regression of blood vessels in pterygium  Pterygial recurrence ↓

The Effects of the Subconjunctival Injection of bevacizumab (Avastin ® ) in Recurrent Pterygium 1.The maximum effect of subconjunctival injection of pterygium lasted less than 1 month. 2.In ICG, the thickness of conjunctival blood vessels decreased(30.14%).  The subconjunctival injection of bevacizumab 0.2cc was effective for recurrent pterygium 2008 ASCRS poster presentation J. Korean Ophthalmol Soc Dec 49(12):

Purpose To evaluate the effects of pre-op subconjunctival injection of bevacizumab in pterygium surgery.

Methods Bevacizumab group: 25 eyes / Control group: 25 eyes Bevacizumab group: Bevacizumab subconjunctival injection (0.2cc): 1~2 weeks pre-op Excision of pterygium and superior conjuntivolimbal autograft Followed up at 1 st week, 2 nd week, 4 th week, and every month thereafter. Bevacizumab groupControl group Recurrent pterygium Primary pterygium Recurrent pterygium Primary pterygium N7187 M:F3:411:72:513:5 Age52.4± ± ± ±9.8 Pterygium grade3333 Follow-up period24.86± ± ± ±2.59 Demography

Evaluation 1. Grades of vascularity & Immunohistochemistry for VEGF of tissues obtained from pterygium surgery. 2. Degree of edema in conjuntivolimbal autograft. 3. Ocular and systemic complications. Pictures of grades of vascularity - observed for vessel diameter and vessel density. - Values per picture: (A)=1.0, (B)=1.5, (C)=2.0, (D)=2.5, (E)=3.0 A = 1 B = 1.5 C = 2.0 D = 2.5 E = 3.0 Standard LM (x100, H&E stain) The scoring system of graft edema 0: no edema, equal in thickness to normal conjuntiva 1: mild edema, graft edema within x1 of the corneal thickness under slit-lamp exam. 2: moderate edema, between 1~3 3: severe edema, graft edema above x2 of the corneal thickness under slit-lamp exam. Fisher exact test

Comparison vascularization of pterygium tissue obtained from pterygium surgery Bevacizumab groupControl group Pre- avastinAfter-avastin Notice the marked decrease in vascularization grade in group with bevacizumab treatment compared to the control group.

Average vascular grading score BevacizumabControlP N(recurrent/primary)25(7/18) Vascular grading score (mean±SD) 1.97± ± Immunohistochemistry for VEGF of pterygium tissue form pterygium surgery Control groupbevacizumab group (B) represents stronger stain concentration at the apical epithelium, indicating denser concentration of VEGF.

Comparison of the graft edema presented at conjuntivolimbal autograft The bevacizumab group exhibits more persistent, and significant graft edema on 2 nd month follow up after surgery

A-1 A-2 B-1 B-2 Two Cases of persistent post-surgical graft edema (Bevacizumab group) (A, B-1) shows severe graft edema 3 months after surgery. (A, B-2) shows normal connection between graft vessels and recipient vessels on ICG anterior segment angiography Authors hypothesize that the graft edema may be due to suppression of lymphangiogenesis induced by bevacizumab.

Complications Any pterygial recurrence: none Other ocular & systemic complication: none

1. Vascular grading comparison: bevacizumab group/control group : 1.97±0.68/2.16± Pre-op bevacizumab injection group presented lower VEGF stain. → Subconjunctival injection of bevacizumab on pterygium region is effective in reducing the vascular thickness and oncurrence of VEGF in the histologic pterygium region. 3. Persistent auto-graft edema observed at the 8th week post op compared to the control group. → Bevacizumab inhibit lymphangiogenesis as well as angiogenesis. → The delay of surgical wound healing must be put into consideration when using bevacizumab before pterygium surgeries. Conclusions