1. Efficacy of Subconjunctival Bevacizumab
Injection in Primary and Recurrent Pterygia
Olivia L. Lee, MD
Michael R. Banitt, MD
Justin Anderson, MD
Carolyn Shih, MD
David C. Ritterband, MD
New York Eye and Ear Infirmary
ASCRS-ASOA 2008 Symposium & Congress
April 4-9, 2008
No Relevant Financial Relationships with Commercial Interests

2. Background
Fibroangiogenic growth factors have been identified in pathologic specimens of pterygia
VEGF is a potent angiogenic factor and has been shown to be highly expressed in vascular endothelium, epithelial and stromal cells of pterygium tissue compared to normal conjunctiva
Bevacizumab, a humanized monoclonal antibody to VEGF, has become a common treatment option for neovascular age-related macular degeneration and neovascular glaucoma

3. Purpose
To report the efficacy of subconjunctival bevacizumab injection in regression of vascularity of recurrent pterygia.
To report the safety of subconjunctival bevacizumab injection in recurrent pterygia

4. Methods
This IRB approved prospective pilot study included 11 eyes of 11 patients
Inclusion criteria: over the age of 18 with recurrent fibrovascular growth onto limbus and/or cornea following pterygium excision without regression on topical steroid treatment for at least 2 weeks
Single injections of subconjunctival bevacizumab 1.25mg/0.05ml given into the body of the pterygium adjacent to the limbus
Slit lamp photos taken prior to and 2 and 4 weeks following injection
Pterygia were evaluated photographically by two independent, masked cornea specialists and graded on a 0 to 10 scale of increasing vascularity

5. Progressive Change in Pterygium Vascularity Scores
Results
Progressive Change in Pterygium Vascularity Scores
Bevacizumab group
p value
Baseline
4.6 +/- 2.13
Baseline to week 2
3.5+/- 2.28
(improvement)
0.006
Baseline to week 4
5.1 +/- 2.53
(exacerbation)
0.236
Statistically significant improvement in vascularity scores noted 2 weeks following injection of Bevacizumab.
No statistically significant change in vascularity scores between baseline and 4 weeks following injection.
No relevant adverse side effects observed in this series.

6. Results
Two weeks following bevacizumab injection, 63.6% were graded as having less vascularity
By 4 weeks, only 28.6% had a vascularity score lower than their pre-injection level

7. Recurrent pterygium in a 43 yo M who received bevacizumab injection
Before injection
2 weeks after injection
4 weeks after injection

8. 60 yo F with early recurrent pterygial tissue below conjunctival autograft
Before injection
2 weeks after injection
4 weeks after injection

9. Conclusions
While this pilot study did not show any lasting effect of bevacizumab on vascularity of recurrent pterygia, it is one of the first to report the use of subconjunctival injection for this indication.
Single injections of bevacizumab at a concentration of 1.25mg/0.05ml result in improvement in vascularity noted at two weeks following injection. However, this effect is transient as there is no statistically significant change from baseline noted by 4 weeks.
It is likely that the dose and/or frequency of bevacizumab used in this study is not adequate to show a permanent improvement in vascularity of recurrent pterygia.
Further investigation is required to determine whether subconjunctival injection(s) of bevacizumab is of clinical value in the treatment of recurrent pterygium, either in alone or in conjunction with established modes of therapy.

10. Acknowledgments
Evelyn Icasiano, MD
Jayrag Patel, MD
Robert Massini