Abstract
Purpose Studies investigating efficacy and safety of bevacizumab in pterygium have increased and reported controversial results. Thus, we updated this meta-analysis to clarify the issue. Methods Studies were selected through search of the databases Embase, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from their inception up until June 2017. The pooled risk ratio (RR) and 95% confidence interval (CI) were calculated for recurrence and complication rates by using random effects model. Results 1045 eyes in 18 randomized controlled trials (RCTs) enrolled. Overall, the pooled estimate showed a statistically significant effect of bevacizumab on the reduction of recurrence (RR 0.74, 95% CI 0.56–0.97, P=0.03). Subgroup analyses presented significant results beneficial to bevacizumab (primary pterygium group, RR 0.53, 95% CI 0.33–0.83, P=0.006; conjunctival autograft group, RR 0.48, 95% CI 0.25–0.91, P=0.02; and follow-up longer than 12 months group, RR 0.36, 95% CI 0.13–0.99, P=0.05). No statistically significant difference was observed in complication rates. Conclusions Application of bevacizumab showed a statistically significant decrease in recurrence rate following removal of primary pterygia, or in cases with conjunctival autograft, or with follow-up longer than 12 months, while complications were not increased.
Highlights
Pterygium is one of the most common ocular surface diseases, which is characterized by the fibrovascular conjunctiva tissue proceeding from the bulbar conjunctiva towards the cornea
The result was not been consistently supported by another 9 new randomized controlled trials (RCTs) published after 2014 [26,27,28,29,30,31,32,33,34]. e conclusion might be altered by the addition of 9 new studies. erefore, we performed an additional meta-analysis to further evaluate the impact of bevacizumab on the recurrence and complication rates in the treatment of pterygium
Subgroup analysis for the recurrence rate based on the pterygium types showed a statistically significant decrease in recurrence rate in the primary pterygium group (RR 0.53, 95% confidence interval (CI) 0.33–0.83, P 0.006; Pheterogeneity 0.21, I2 25%), while not in the recurrent pterygium group (RR 1.00, 95% CI 0.93–1.07, P 0.91; Pheterogeneity 0.55, I2 0%) (Figure 2)
Summary
Pterygium is one of the most common ocular surface diseases, which is characterized by the fibrovascular conjunctiva tissue proceeding from the bulbar conjunctiva towards the cornea. Many randomized controlled trials (RCTs) were performed to assess the safety and efficacy of bevacizumab in management of pterygium, showing conflicting conclusions [17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34]. A meta-analysis of 9 RCTs was conducted in 2014 [35], and the result showed that topical or subconjunctival bevacizumab had no statistically significant effect on preventing pterygium recurrence. Erefore, we performed an additional meta-analysis to further evaluate the impact of bevacizumab on the recurrence and complication rates in the treatment of pterygium The result was not been consistently supported by another 9 new RCTs published after 2014 [26,27,28,29,30,31,32,33,34]. e conclusion might be altered by the addition of 9 new studies. erefore, we performed an additional meta-analysis to further evaluate the impact of bevacizumab on the recurrence and complication rates in the treatment of pterygium
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