Management of Primary Pterygium with Intralesional Bevacizumab (AVASTIN) Injection

Article Information

Title: Management of Primary Pterygium with Intralesional Bevacizumab (AVASTIN) Injection

Authors: Irum Mahmood, Muhammad Shahid, Muhammad Awais, Muhammad Manzoor, Abdul Rauf, Zaheer Uddin Babar

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2023

Volume: 73

Issue: 1

Language: English

DOI: 10.51253/pafmj.v73i1.8208

Keywords: BevacizumabOcular surface disease indexPrimary pterygium

Abstract

Objective: To determine the management of primary Pterygium with intralesional Bevacizumab (AVASTIN) Injection.
Study Design: Quasi-Experimental Study
Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Oct 2019 to Mar 2020.
Methodology: Sixty patients of Primary Pterygium with Grades 1, 2, and 3 were included. Pre-Intralesional injection evaluation includes the Ocular surface disease Index (OSDI), grading of Pterygium and ophthalmic examination, refraction,slit lamp bimicroscopy, fundoscopy, tonometry, and corneal topography. After four weeks of intralesional injection,reassessment was done.
Results: A total of 60 participants with the mean age of the participants was 44.06±14.83 years were included in the study. In 26(43.3%) patients, grittiness, epiphora, redness, and photophobia were reported, and 16(26.6%) patients reported blurring of vision that improved in 100% of patients after intralesional injections. There was statistical significance (p-value ≤0.05) in means of K1, Sim K astigmatism, Surface asymmetry index, Surface Regularity Index, Grade of Pterygium, and Ocular surface disease index before and after the intralesional injection of Bevacizumab. However, no significant difference was recorded in Uncorrected Visual Acuity, Best Corrected Visual Acuity, and K2 parameters in pre and post-injection states (p-value ≥0.05).Only 7(11.6%) patients reported subconjunctival haemorrhage after the procedure.
Conclusions: Treatment of Primary Pterygium with intralesional Bevacizumab injection successfully improves symptoms,Ocular Surface Disease Index, and reduces corneal astigmatism with minimum complications.

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Research Objective

To determine the management of primary Pterygium with intralesional Bevacizumab (AVASTIN) Injection.

Methodology

Quasi-experimental study involving 60 patients with primary pterygium (Grades 1, 2, and 3). Pre-injection evaluations included Ocular Surface Disease Index (OSDI), pterygium grading, ophthalmic examination, refraction, slit lamp bimicroscopy, fundoscopy, tonometry, and corneal topography. Intralesional Bevacizumab (0.1 to 0.2ml of 2.5-5mg) was injected into the pterygium body. Reassessment was performed four weeks post-injection. Data analysis used SPSS version 22.00 with paired t-test for continuous variables.

Methodology Flowchart

                        graph TD;
    A["Patient Recruitment 60 patients with primary pterygium"] --> B["Pre-injection Evaluation: OSDI, Grading, Ophthalmic Exam, Refraction, Corneal Topography"];
    B --> C["Intralesional Bevacizumab Injection"];
    C --> D["Post-injection Follow-up 4 weeks"]);
    D --> E["Post-injection Assessment: Re-evaluation of all parameters"];
    E --> F["Data Analysis: SPSS, Paired t-test"];
    F --> G["Conclusion"];

Discussion

Intralesional Bevacizumab (anti-VEGF therapy) is proposed to treat pterygium by inhibiting angiogenesis and neovascularization, which are key factors in pterygium formation and recurrence. The study observed a significant improvement in symptoms, pterygium grade, and corneal astigmatism with minimal complications, supporting its efficacy in managing primary pterygium without surgical intervention.

Key Findings

Intralesional Bevacizumab injection successfully improved symptoms (grittiness, epiphora, redness, photophobia, and blurring of vision) in 100% of patients. There was a statistically significant improvement (p-value < 0.05) in K1, Sim K astigmatism, Surface Asymmetry Index (SAI), Surface Regularity Index (SRI), Grade of Pterygium, and Ocular Surface Disease Index (OSDI) before and after treatment. Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), and K2 parameters showed no significant difference (p-value > 0.05). Only 7 (11.6%) patients reported subconjunctival hemorrhage as a complication.

Conclusion

Treatment of primary Pterygium with intralesional Bevacizumab injection successfully improves symptoms, Ocular Surface Disease Index, and reduces corneal astigmatism with minimum complications.

Fact Check

1. Study Design: The study was a Quasi-Experimental Study.
2. Sample Size: Sixty patients with primary pterygium were included.
3. Complication Rate: 7 (11.6%) patients reported subconjunctival hemorrhage after the procedure.

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