Effectiveness of Sub-Conjunctival Bevacizumab After Pterygium Excision at Armed Forces Institute of Opthalmology

Article Information

Title: Effectiveness of Sub-Conjunctival Bevacizumab After Pterygium Excision at Armed Forces Institute of Opthalmology

Authors: Zahra Arsalan, Omar Zafar, Amjad Akram, Quratulain Zamir

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: 2022

Volume: 72

Issue: 3

Language: English

DOI: 10.51253/pafmj.v72i3.4451

Keywords: Pterygium surgeryCorneaImmuno-modulatorsPterygium recurrenceSub-conjunctival bevacizumab

Abstract

Objective: To determine the effectiveness of sub-conjunctival Bevacizumab after pterygium excision.
Study Design: Quasi-experimental study.
Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi Pakistan, from Aug 2019 to Jan 2020.
Methodology: Thirty-six patients were included and divided into two groups. In group A (n=18), pterygium excision with conjunctival auto-graft was followed by injection of 0.3ml of 7.5mg of Bevacizumab. Patients of Group B (n=18) did not receive any Bevacizumab. All the patients were followed up after 7 days, two weeks, 4weeks and 24 weeks after the start of management. The visual analog score was used for pain assessment, Snellen chart for visual acuity and intraocular pressure was measured with applanation tonometry.
Results: After six months the recurrence rate was less in Group-A (n=3, 16.6%, p=0.005) than Group-B (n=4, 22.2%, p=0.01) The recurred pterygium size was also greater in Group-B (mean=0.27 ± 0.28mm, p=0.006) than Group-A (mean=0.11 ± 0.21mm, p=0.006). Patients of Group-A experienced less pain post-surgery. The intraocular pressures were same in both the groups. Visual acuity improvement was seen in the Group-A (n=11, 61%, p=0.008)) than group B (n=4.22%, p=0.008).
Conclusion: Administration of Bevacizumab under the conjunctiva after pterygium excision may be useful in averting lesion relapse, less post-op pain, and improved visual acuity.

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Research Objective

To determine the effectiveness of sub-conjunctival Bevacizumab after pterygium excision.

Methodology

Quasi-experimental study involving 36 patients with pterygium (Grade 2-4) divided into two groups. Group A (n=18) received pterygium excision with conjunctival auto-graft followed by subconjunctival Bevacizumab injection (0.2ml of 5mg intraoperatively, 0.1ml of 2.5mg after three weeks). Group B (n=18) received pterygium excision with conjunctival auto-graft only. Patients were followed up at 7 days, 2 weeks, 4 weeks, and 24 weeks. Assessments included visual analog score for pain, Snellen chart for visual acuity, and applanation tonometry for intraocular pressure. Recurrence and pterygium size were also measured. Data was analyzed using SPSS version 24.0 with independent sample t-test and chi-square test.

Methodology Flowchart

                        graph TD;
    A["Patient Recruitment 36 patients"] --> B["Divide into Groups"];
    B --> C["Group A: Pterygium Excision + Conjunctival Auto-graft + Bevacizumab"];
    B --> D["Group B: Pterygium Excision + Conjunctival Auto-graft"];
    C --> E["Administer Bevacizumab"];
    D --> F["No Bevacizumab"];
    E --> G["Follow-up Assessments"];
    F --> G;
    G --> H["Data Analysis"];
    H --> I["Conclusion"];

Discussion

The study suggests that subconjunctival Bevacizumab may be effective in reducing pterygium recurrence, decreasing post-operative pain, and improving visual acuity. The findings are supported by other studies that indicate Bevacizumab's role in inhibiting fibroblast migration and vascularization. No significant side effects were observed with the administered dose.

Key Findings

After six months, the recurrence rate was lower in Group-A (16.6%) compared to Group-B (22.2%) (p=0.005). The size of recurred pterygium was smaller in Group-A (mean=0.11 ± 0.21mm) than in Group-B (mean=0.27 ± 0.28mm) (p=0.006). Patients in Group-A experienced less post-operative pain. Intraocular pressures remained the same in both groups. Visual acuity improved in more patients in Group-A (61%) than in Group-B (22%) (p=0.008).

Conclusion

Administration of sub-conjunctival Bevacizumab following pterygium excision may be beneficial in preventing lesion relapse, reducing post-operative pain, and improving visual acuity, with no observed untoward side effects.

Fact Check

1. Recurrence Rate: Group-A had a recurrence rate of 16.6% (3 out of 18 patients), while Group-B had 22.2% (4 out of 18 patients).
2. Visual Acuity Improvement: 61% of patients in Group-A showed visual acuity improvement, compared to 22% in Group-B.
3. Study Duration: The study was conducted from August 2019 to January 2020.

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