Antiangiogenic therapy for pterygium recurrence

• Published in: Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 2009-05, Vol.106 (5), p.413-419
• Main Authors: Leippi, S, Grehn, F, Geerling, G
• Format: Article
• Language: ger
• Subjects: Adult; Aged; Angiogenesis Inhibitors - administration & dosage; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized; Bevacizumab; Female; Humans; Male; Middle Aged; Pterygium - drug therapy; Pterygium - prevention & control; Secondary Prevention; Treatment Outcome; Vascular Endothelial Growth Factor A - antagonists & inhibitors
• ISSN: 1433-0423
• DOI: 10.1007/s00347-009-1936-y

A pterygium is defined as a fibrovascular and hyperplastic proliferative degeneration tissue of the limbus. Although the pathogenesis is not yet clearly understood there are indications that vascular endothelial growth factor (VEGF) may play a significant role in the development. Despite various surgical approaches recurrence remains the major postoperative problem. Bevacizumab is a human monoclonal antibody against VEGF. Its antiangiogenic effect is used in ophthalmology as an off-label treatment for retinal disease. We report about the use of Bevacizumab eye drops to prevent repeated recurrence of pterygia. In our clinic 5 eyes (4 patients) were treated with topical Bevacizumab eye drops (25 mg/ml) 2-8 times per day for 5-24 weeks as an adjunct after excision of recurrent pterygia and conjunctival autograft. Patients were examined preoperatively and over a follow-up period ranging from 3-14 months (median 12 months). Visual acuity improved in 3 out of 5 eyes and in 1 eye no pterygium recurrence was noted. Two eyes showed conjunctival hyperemia (stage 1 recurrence) and one eye showed fibrosis of the limbus (stage 2 recurrence). In one eye an early recurrence with corneal vascularisation and superficial punctate keratopathy was observed (stage 3 recurrence). No serious permanent complications were observed. Considering the previously multiple recurrences in our patients we think that these first clinical mid-term follow-up experiences support the use of topical VEGF inhibitors in recurrent pterygia.