Subconjunctival Injection Of Bevacizumab Research Articles

Comparison of photodynamic therapy with two different parameters combined with subconjunctival injection of bevacizumab for corneal neovascularization

BackgroundTo the best of our knowledge, no studies have been performed to determine the optimal parameters of photodynamic therapy (PDT) combined with subconjunctival injection of bevacizumab for corneal neovascularization. This study aimed to compare the effect of photodynamic therapy with two different sets of parameters combined with subconjunctival injection of bevacizumab for corneal neovascularization. MethodsPatients with stable corneal neovascularization (CNV) unresponsive to conventional treatment (topical steroid) were included in this study. Patients were divided into two groups, receiving PDT with two different sets of parameters (group 1 receiving fluence of 50 J/cm2 at 15 min after intravenous injection of verteporfin with, group 2 receiving fluence of 150 J/cm2 at 60 min after intravenous injection of verteporfin with). Subconjunctival injection of bevacizumab was performed immediately after PDT. All patients were followed for 6 months. Best-corrected visual acuity and intraocular pressure were evaluated, and slit-lamp biomicroscopy as well as digital photography were performed. Average diameter and cumulative length of corneal neovascular were measured to evaluate the corneal neovascularization. ResultsSeventeen patients (20 eyes) were included in this study. At the last visit, the vision was improved in 12 eyes (60 %), steady in 4 eyes (20 %) and worsen in 4 eyes (20 %). The intraocular pressure (IOP) of all patients remained in normal range. A significant decrease in corneal neovascularization was showed in all the eyes after treatment. At 6 months after the combined treatment, the average diameter and cumulative length of vessels significantly decreased to 0.041 ± 0.023 mm (P < 0.05) and 18.78 ± 17.73 mm (P < 0.05), respectively, compared with the pretreatment data (0.062 ± 0.015 mm, 31.48 ± 18.21 mm). The reduction was more remarkable in group 2 compared to group 1.In group 1, the average diameter was 0.062 ± 0.013mm before and 0.056 ± 0.017mm after, the cumulative length of vessels was 38.66 ± 22.55mm before and 31.21 ± 17.30 after. In group 2, the date were 0.061 ± 0.016mm before and 0.029 ± 0.020mm after, 25.60 ± 8.95 mm before and 8.61 ± 8.26 mm. The reported complications included epithelial defect in four eyes, small white filaments in two eyes and corneal epithelial erosion in two eyes. ConclusionThe PDT combined with subconjunctival injection of bevacizumab was effective for the chronic corneal neovascularization. A more promising treatment outcome was observed when PDT was performed at 60 min after intravenous injection of verteporfin with fluence of 150 J/cm2. No serious complications or systemic events were observed throughout the follow-up period.

Suppression of Neovascularization by Topical and Subconjunctival Bevacizumab After High-Risk Corneal Transplantation

To assess the effectiveness of topical and subconjunctival bevacizumab in suppressing vascularization in graft and host bed after high-risk corneal transplantation. Secondary analysis of prospective, randomized, double-blind, placebo-controlled multicentric clinical trial. The study includes patients aged > 18 years who underwent high-risk penetrating keratoplasty, which was defined as corneal vascularization in ≥ 1 quadrants of the corneal graft and host bed, excluding the limbus. Patients were randomized to treatment and control groups. The patients in the treatment group received subconjunctival injection of bevacizumab (2.5 mg/0.1 ml) on the day of the procedure, followed by topical bevacizumab (10 mg/ml) 4 times per day for 4 weeks. The patients in control group received injection of vehicle (0.9% sodium chloride) on the day of procedure, followed by topical vehicle (carboxymethylcellulose sodium 1%) 4 times a day for 4 weeks. Vessel and invasion area of vessels in the corneal graft and host beds. This study included 56 eyes of 56 patients who underwent high-risk corneal transplantation, with equal numbers in the bevacizumab and vehicle (control) treatment groups. The mean age of patients who received bevacizumab was 61.2 ± 15.9 years, and the mean age of those treated with vehicle was 60.0 ± 16.1 years. The vessel area at baseline was comparable in the bevacizumab (16.72% ± 3.19%) and control groups (15.48% ± 3.12%; P= 0.72). Similarly, the invasion areas were also similar in the treatment (35.60% ± 2.47%) and control (34.23% ± 2.64%; P= 0.9) groups at baseline. The reduction in vessel area was significantly higher in the bevacizumab-treated group (83.7%) over a period of 52 weeks compared with the control group (61.5%; P < 0.0001). In the bevacizumab-treated group, invasion area was reduced by 75.8% as compared with 46.5% in the control group. The vessel area was similar at 52 weeks postprocedure in cases of first (3.54% ± 1.21%) and repeat (3.80% ± 0.40%) corneal transplantation in patients who received bevacizumab treatment. In the vehicle-treated patients, the vessel area was significantly higher in repeat (9.76% ± 0.32%) compared with first (8.06% ± 1.02%; P < 0.0001) penetrating keratoplasty. In the bevacizumab treatment group, invasion areas at week 52 were comparable in first (11.70% ± 3.38%) and repeat (11.64% ± 1.74%) procedures, whereas invasion area was significantly higher in repeat (27.87% ± 2.57%) as compared with first (24.11% ± 2.17%) penetrating keratoplasty in vehicle-treated patients. In patients undergoing vascularized high-risk corneal transplantation, bevacizumab is efficacious in reducing vascularization of corneal graft and host bed, thereby reducing the risk of corneal graft rejection in vascularized host beds. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Initial Outcome of Subconjunctival Bevacizumab for Corneal Neovascularization - a Case Series

Introduction : Corneal neovascularization (CNV) has a variety of causes and threatens corneal clarity, thus optimal visual acuity. Conventional medical management includes topical steroids and matrix metalloproteinase inhibitors like doxycycline. Anti-vascular endothelial growth factor (anti-VEGF) agents have demonstrated promise but remain off-label for this indication.&#x0D; Case Illustration : We present three patients with corneal neovascularization varied in etiology who underwent subconjunctival injection of Bevacizumab . Case 1: a-female-69 years old came with blurred vision after had Stephen Johnson Syndrome which affect her cornea. The examination revealed opacification of cornea accompanied by neovascularization at 5 until 9 o’clock position up to edge of pupil in the left. Case 2: a-male-47 years old presented corneal haze with neovascularization almostin all corneal region on background of fungal keratitis. Case 3: a-male-63 years old who underwent penetrating keratoplasty of indication corneal lekoma following an episode of fungal keratitis. There was opacity in all corneal region and neovascularization in 360 degree of limbus. All of these patients showed regression of neovessel after first injection of bevacizumab.&#x0D; Discussion : Corneal neovascularization is a condition caused by disruption homeostasis in which proangiogenic balanced by antiangiogenic, thereby maintaining avascularity. Bevacizumab as VEGF-A-binding proteins could prevent VEGF-A from binding cell surface receptors.&#x0D; Conclusion : Subconjunctival injection of Bevacizumab can be considered as a treatment for corneal neovascularization. It has shown promising effects in recess neovascularization in cornea regardlessthe etiology.

Efficacy of Subconjunctival Bevacizumab Injection after Pterygium Excision with Limbal Conjunctival Autograft in Recurred Pterygium

Purpose: To evaluate the efficacy and safety of subconjunctival bevacizumab injection after pterygium excision with limbal conjunctival autograft and limbal fixation suture in recurred pterygium.Methods: We retrospectively reviewed the medical records of 9 patients (11 eyes) who received subconjunctival bevacizumab injection after pterygium excision with limbal conjunctival autograft and limbal fixation suture for recurred pterygium. All patients included in this study completed follow-up for at least 12 months. Demographic variables, postoperative clinical outcomes, and recurrence rate were analyzed. Recurrence of pterygium was evaluated at 12 months after surgery.Results: The study subjects comprised 5 male patients (5 eyes) and 4 female patients (6 eyes) with a mean age of 66.0 ± 13.0 years (range 43-78 years). Among the 11 eyes, no recurrence occurred after the follow-up period of 12 months.Conclusions: Subconjunctival bevacizumab injection after pterygium excision with limbal conjunctival autograft and limbal fixation suture appears to be an effective method of preventing the recurrence in recurred pterygium.

Effects of Subconjunctival Bevacizumab Injection after Primary Pterygium Surgery

Purpose: This study evaluated the efficacy and safety of subconjunctival bevacizumab injection after primary pterygium surgery.Methods: We performed a conjunctivo-limbal autograft after pterygium resection in 136 eyes of 128 patients with primary pterygium between December 2019 and July 2021. A subconjunctival bevacizumab injection of 2.5 mg (0.1 mL) was administered in the bevacizumab group but not in the control group (54 eyes of 48 patients). We compared pterygium recurrence rates between the two groups at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery.Results: Pterygium recurrence occurred in one eye (1.21%) in the bevacizumab group and five eyes (9.25%) in the control group. Additionally, fibrovascular tissue proliferation was suppressed in the bevacizumab group and no postoperative complications were observed.Conclusions: Pterygium recurrence occurred in one eye (1.21%) in the bevacizumab group and five eyes (9.25%) in the control group. Additionally, fibrovascular tissue proliferation was suppressed in the bevacizumab group and no postoperative complications were observed.

Successful regression of newly formed corneal neovascularization by subconjunctival injection of bevacizumab in patients with chemical burns.

To investigate the effect and timing of subconjunctival bevacizumab injection on inhibiting corneal neovascularization (CorNV) in patients after chemical burns. Patients with CorNV secondary to chemical burns were involved. Two subconjunctival injections of bevacizumab (2.5 mg/0.1 mL per involved quadrant) with an interval of 4 weeks were administered, and followed up a year. The area occupied by neovascular vessels (NA), accumulative neovascular length (NL), mean neovascular diameter (ND), best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were evaluated. Complication was also recorded. Eleven patients with CorNV were involved. Eight patients had a history of surgery (four had amniotic grafts, one had keratoplasty, and three had amniotic grafts and keratoplasty). Decreasing in NA, NL, and ND were statistically significant at each time point compared to the baseline (p < 0.01). CorNV that developed within 1 month was considerably regressed, and vessels with fibrovascular membranes were found to be narrower and shorter than pretreatment. BCVA improved in five patients (from one to five lines), remained unchanged in five patients, and decreased in one patient compared to pretreatment. Subconjunctival bevacizumab injection has a particular potential for the regression of CorNV, especially newly formed within 1 month in patients after chemical burns.

BEVACIZUMAB EFFECT ON EXPRESSION OF COLLAGEN TYPE I AFTER TRABECULECTOMY

Objective to determine the effect of bevacizumab as an antifibrotic agent on collagen density, collagen thickness and collagen type I after trabeculectomy in rabbit. Materials and methods : Sixteen male New Zealand white rabbits divided by two groups, 8 rabbits in control group and 8 rabbits in treatment group. Control group underwent trabeculectomy and injection of balanced salt solution. Treatment group underwent trabeculectomy and subconjunctival injection of bevacizumab (1.25mg, 25mg/mL). They were terminated on 14 postoperative days. Masson Trichrome were performed to evaluate collagen collagen density, collagen thickness. Immunohistochemistry using a monoclonal antibody to collagen type I was performed to evaluate collagen type I expression. Results This study showed the density of collagen fibers decreased and statistically significant in the treatment group (p = 0.075, p 0.05). Expression of type I collagen obtained a decrease in the treatment group compared to BSS group (p = 0.006, p&lt;0.05). Conclusion Bevacizumab reduces bleb fibrosis by inhibition of angiogenesis and accumulation of extracellular matrix. Postoperative subconjunctival injection of bevacizumab may limiting scar tissue formation at the site of trabeculectomy by blocking collagen synthesis.

EFFECT OF BEVACIZUMAB ON α-SMOOTH MUSCLE ACTIN EXPRESSION AND FIBROBLAST COUNT IN TRABECULECTOMY AREA TOWARDS PREVENTION OF FIBROSIS

Objective to analyze the effect of bevacizumab on α-smooth muscle actin expression and fibroblast count in trabeculectomy area of rabbit models in order to find a safer modulator of wound healing to improve surgical outcome. Material and methods 16 New Zealand white rabbits aged 4-6 months and weigh between 2,5-3,5 kg were performed trabeculectomy in their right eyes with postoperative subconjunctival injection of BSS and Bevacizumab. Rabbits were put into control and bevacizumab group using simple random sampling. Examination were done postoperative day 1, 7, and 14 and subjects were terminated and performed enucleation on postoperative day 14. The samples were histologically stained with Haematoxyline-Eosin to count the fibroblast and immunohistochemistry using α-smooth muscle actin antibody to differ the myofibroblast from fibroblast and the expression of α-SMA were collected using immunoreactive score. Result Mann Whitney u test and independent t-test were used to analyze the data, and we found both less expression of α-smooth muscle actin and fibroblast count on bevacizumab group compared to control group which indicates less myofibroblast, fibroblast, and less scarring potential in trabeculectomy area. Conclusion bevacizumab inhibits fibroblast proliferation and its differentiation to myofibroblast that lead to less collagen production and fibrosis.

EFFECT OF BEVACIZUMAB ON ANGIOGENESIS INTRABECULECTOMY AREA

Objective to examine the effect of Bevacizumab injection to the angiogenesis which the amount and density of blood vessel as the indicators after trabeculectomy procedure. Method This was a true experimental study using 16 eyes of 16 New Zealand White Rabbit eye treated by trabeculectomy procedure with eight eyes as the control group using Balanced Saline Solution (BSS) and eight eyes as the treatment group using Bevacizumab. It was injected subconjuctiva after the trabeculectomy. At the end of the study all rabbits in each group was sacrified, the eye was enucleated and the bleb area was dissected, and then processed for histological studies. The amount and density of blood vessel were evaluated using haematoxyllin eosin methode at day 14 after the eyes was done for trabeculectomy procedure. Result The mean of amount of blood vessel in control group was 22,63 ± 11,02 and treatment group was 14,75 ± 4,92 (p=0.043). The mean of density of blood vessel in control group was 19,10 ± 1,69 % and treatment group was 16,53 ± 2,90 % (p=0.029)%. The result shows there were statistically significant difference between the two groups (p&lt;0.05). Conclusion In this study the subconjunctival Bevacizumab injection after trabeculectomy reduce the amount and density of blood vessel compared with subconjunctival BSS injection only, thus it is potential in preventing subconjunctival fibrosis after trabeculectomy

Corneal fine‐needle diathermy with intrastromal and subconjunctival injection of bevacizumab in a child with corneal neovascularization of herpetic origin

AbstractPurpose: Corneal neovascularization (CNV) in the paediatric population has a variety of etiologies including bacterial ulcers, herpes keratitis, exposure keratopathy, blepharokeratoconjunctivitis and corneal anaesthesia. Monotherapy with antiangiogenic agents or corneal fine‐needle diathermy (FND) alone do not completely resolve CNV; however, the combined treatment of these two seems to offer better results.Methods: We present the results of FND with adjuvant injection of intrastromal and subconjunctival Bevacizumab in a child with CNV of herpetic origin.Results: A 3‐year‐old patient who has been treated in our hospital for corneal involvement in the left eye (LE) due to herpetic keratitis of weeks of evolution comes to our consultation. Examination under general anaesthesia reveals in LE an inferior paracentral corneal leukoma with partial involvement of the visual axis and CNV that enters through the limbus from 5 to 8 h and begins to involve corneal stroma; no epithelial lesions, no corneal oedema or inflammatory activity in the anterior segment. After not improvement, it was decided to perform FND of lower CNV in conjunction with an intrastromal injection and another subconjunctival injection of Bevacizumab. Subsequently, it remains stable with topical and oral antiherpetic treatment, and topical corticosteroid therapy. At 3 months, the CNV reactivated, for which FND + intrastromal and subconjunctival bevacizumab was performed again. Finally, at 2 months, the patient is asymptomatic with VA LE of 1.0, with 2 corneal leukomas without CNV or epithelial lesions, and continues to be treated with oral acyclovir at prophylactic doses.Conclusions: FND of CNV together with adjuvant treatment with intrastromal and subconjunctival Bevacizumab is a good choice in children to treat those active corneal neovascularizations that do not respond to corticosteroid.

Preoperative Intralesional Bevacizumab Injection in Primary Pterygium in Tunisian Patients: A Randomized Controlled Prospective Study.

To assess the efficacy and safety of a single preoperative intralesional bevacizumab injection as an adjuvant treatment before primary pterygium surgery. We conducted a randomized controlled interventional study from January 2019 to December 2020. The study included a total of 60 patients (60 eyes) with primary pterygium. We defined two groups of 30 patients each. Group A received an intralesional injection of bevacizumab (Avastin), 1 month before surgery (lesion excision and conjunctival autograft). Group B (control) had only the surgical treatment. Patients were followed up 7 days (D7), 1 month (M1), 3 months (M3), and 6 months (M6) postoperatively. Pre-, per-, and postoperatively, photographs of the lesions were taken, as well as a histopathological examination. The main outcome measures were the change in functional discomfort following intralesional bevacizumab injection and pterygium recurrence. Recurrence was defined as fibrovascular tissue growth invading the cornea. Therapeutic success was defined as the absence of pterygium recurrence in M6. The mean age of the 60 patients was 54.17 ± 10.53. After bevacizumab injection, the preoperative functional discomfort score decreased significantly (P = 0.048). There was a significant improvement in grade and color intensity (P = 0.001). We noted no local nor systemic complications after intralesional injection of bevacizumab. After pterygium excision, the success rate was statistically higher in Group A (P = 0.047). There was no significant difference in either final best-corrected spectral visual acuity or astigmatism between the two groups. We noted a statistically significant association between recurrence and color intensity (P = 0.046), vascular density (P = 0.049), and the degree of elastic tissue degeneration (P = 0.040). A single preoperative subconjunctival injection of bevacizumab 1 month before surgery decreases the vascularity of newly formed blood vessels and hence may reduce the recurrence rate.

Treating refractory corneal hydrops in a male patient with vernal keratoconjunctivitis and mental retardation: a case report

BackgroundKeratoconus is the most common noninflammatory bilateral corneal ectasia. Vernal keratoconjunctivitis (VKC) and eye rubbing may be associated with keratoconus in children and young adults. Timely management of advanced keratoconus is important to improve visual quality. In addition, it is challenging to carry out VKC treatment with an intent to avoid the occurrence of punctate epithelial keratitis, ulceration, or corneal neovascularization on corneal grafts.Case presentationWe report the case of an 18-year-old male patient with a long-term history of mental retardation due to megalencephaly presenting with acute onset of corneal hydrops with prominent bulging and refractory steroid-induced glaucoma of the right eye. The topography of the right eye was unavailable due to advanced ectasia, and that of the left eye revealed central steepening with inferior-superior dioptric asymmetry. According to the clinical findings, the patient was diagnosed with keratoconus. Because of progressive corneal opacity and neovascularization, the patient underwent penetrating keratoplasty (PK) with combination of interrupted and intrastromal running suturing after receiving a preoperative subconjunctival injection of bevacizumab in his right eye, followed by lower eyelid correction. After surgery, the patient was treated with 0.1% tacrolimus dermatological ointment, 0.1% cyclosporine eye drops, artificial tears, and 0.5% loteprednol for keratoplasty and VKC. Repeated education on avoiding eye rubbing was offered to the patient. Two years after PK treatment, his best-corrected visual acuity of the right eye successfully improved from hand motion at 10 cm preoperatively to 6/20 postoperatively.ConclusionsLarge-diameter PK with intrastromal suturing technique for advanced keratoconus could achieve better visual outcomes and avoid suture-related complications. In addition, tacrolimus dermatological ointment rather than tacrolimus topical eye drops or ointment showed satisfactory efficacy when combined with topical cyclosporine and steroid that no significant VKC reactivation were noted after PK.

Bi-weekly Subconjunctival Injection of Bevacizumab for Corneal Neovascularization after Burn Injury

Purpose: We report two cases of corneal neovascularization (NV) after burn injury successfully treated by subconjunctival bevacizumab injections at 2-week intervals.Case summary: Three bi-weekly subconjunctival injections of bevacizumab were administered to two patients with corneal NV after burn injury. In our first patient, corneal NV was markedly reduced by bevacizumab injection. The patient exhibited with a clear cornea and improved visual acuity (20/30) after treatment. Eleven weeks after the last injection, the cornea remained clear, with clinical regression of smaller vessels; the improvement in visual acuity was maintained. In the second case, the diameter of the vessels, hemorrhagic lesions, and corneal edema decreased/regressed, with improvement of the visual acuity to 20/25; these improvements persisted for 12 weeks after the last subconjunctival injection.Conclusions: Our results suggest that bi-weekly subconjunctival injection of bevacizumab is well-tolerated and effective for inhibiting chronic corneal NV after burn injury.

Comparison between Limbal Autograft Transplantation and Subconjunctival Bevacizumab Injection in Lowering Recurrence of Primary Pterygium

Comparison between Limbal Autograft Transplantation and Subconjunctival Bevacizumab Injection in Lowering Recurrence of Primary Pterygium

Assessing safety and success after using bevacizumab, 5-fluorouracil or placebo in primary trabeculectomy. A prospective randomized placebo controlled 1-year follow-up study

Purpose The aim of this study was to determine whether glaucoma patients after trabeculectomy could benefit more from subconjunctival injections of bevacizumab than 5-FU or placebo. Methods and results Fifty-one eyes of 51 patients were recruited for primary MMC (0.2 mg/mL for 1 min) augmented trabeculectomy. 17 patients were randomly assigned to receive 1.25 mg (0.05 mL) of bevacizumab augmentation, 21 patients were assigned to receive 0.1 mL of 50 mg/mL 5-FU and 13 patients were assigned to a control group receiving a normal saline injection as a placebo. Initial recruitment included 58 patients, but seven patients had to be excluded from the study for various reasons. Postoperative follow up of IOP and bleb characteristics was carried out at 1 day, 1 week, 3 weeks, 6 weeks, 6 months and 1 year after surgery. All analyses where carried out by two masked clinicians. IOP reduction was statistically significant (p < 0.05) across all three groups between baseline visit and final 1-year postoperative visit. There was no significant difference of the final average IOP values between the three groups. Bleb evaluation was made using the Moorfields bleb grading system (MBGS) after 1 year follow up. Central bleb area was statistically greater in the Bevacizumab group when compared with the 5-FU group but not with the placebo group. The vascularity of the central bleb was significantly different between the groups with the Bevacizumab group showing the least vascularity. Vascularity of the peripheral bleb was also decreased in the Bevacizumab group when compared with the placebo group but not with the 5-FU group. Conclusion The 12-month IOP results showed no significant differences between the groups of patients after Bevacizumab, 5-FU or placebo to augment primary MMC enhanced trabeculectomy. However, by the analysis of bleb morphology there was a significant difference in terms of central bleb area and vascularity.

A Comparative Study Between Preoperative Subconjunctival Bevacizumab Injection And Postoperative Topical Application In Prevention Of Recurrence After Excision Of Primary Pterygium In Egyptian Patients

Abstract Purpose to compare between recurrence incidence after primary pterygium excision when using preoperative subconjunctival injection of Bevacizumab (Avastin) and using it as a postoperative eye drops. Methods thirty two eyes of thirty patients (two patients had bilateral pterygium) with primary pterygia were clinically examined, classified into 3 groups and operated by simple excision with bare sclera technique. Group 1 included 10 patients received Bevacizumab (Avastin) in the form of eye drops (10 mg/ml) 3 times daily for 6 days postoperative. Group 2 included 10 patients received preoperative Bevacizumab in the form of subconjunctival injection (1.25 mg/0.05ml) single dose 1 week preoperative. Group 3 included 10 patients (12 eyes) 2 patients with bilateral Pterygium didn’t receive any form of Bevacizumab. Postoperative follow up was done clinically and by serial photography at 1 week, 1 month, 3 months and 6 months searching for signs of recurrence and/or complications. Results The results showed different grades of recurrence in 18 eyes of 32.True recurrence was seen in 7 patients of 18 (1 patient in group 1, 2 in group 2 and 4 in group3).Recurrence grades in group 1and 2 who used the Bevacizumab (20%grade II, 50% grade III, and 30% grade IV). Recurrence could be predicted by 100% depending on fibrovascular tissue appearing in the surgical bed at 3 months postoperative (P value 0.038).Preoperative fleshy pterygium has high statistical significance in realation to recurrence(P value = 0.006).Patient’s sex, residence and occupation had no statistically significant value in the process of recurrence (P value &amp;gt; 0.05). Patients with recurrent Pterygia (in group 1&amp;2) had statistically significant changes in the corneal K- readings at 3 months and 6 months.No significant difference in the limbal or central corneal thickness in the operated eye and the other eye (Pvalue &amp;gt; 0.05). Conclusion Bevacizumab (Avastin) is a well tolerated drug with multiple drug delivery methods.The eye drops give better results than the subconjunctival injection.Appearance of fibrovascular tissue in the surgical bed at 3 months predict the recurrence by 100%. Preoperative fleshy pterygia will mostly recur again whatever Bevacizumab form was used .The corneal thickness by anterior segment OCT has no role in prediction or detection of early pterygium recurrence.

Comparison between the triamcinolone and bevacizumab subconjunctivals and changes in Interleukin-1 mRNA expression in pterygium

ObjectivesPterygium is a fibrovascular external ocular mass that grows from the conjunctiva into the cornea. The effect of subconjunctival injection of triamcinolone and bevacizumab has been inadequately investigated worldwide. This study aims to analyse the expression of IL-1 after the injection of triamcinolone and bevacizumab subconjunctiva. MethodsAll patients are randomized into three groups: the triamcinolone, bevacizumab group, and placebo groups, with 5 patients in each in group. All subjects are injected subconjunctivally one week before surgery, and then surgery is performed with the autograft technique. The main outcome measures include changes in the IL-1 mRNA expression between the triamcinolone, bevacizumab, and placebo groups. ResultsAll samples are completed after one month of follow-up. The changes in blood levels of mRNA IL-1 expression are as follows: 4.81 ± 0.52 in the bevacizumab group, 3.40 ± 2.63 in the triamcinolone group, and 1.08 ± 1.48 in the placebo group (p = 0.04). In the comparison between groups, there is a significant effect between the bevacizumab and placebo groups, 3.73 ± 1.12 (p = 0.00), with no significant effect in the triamcinolone group, 1.40 ± 1.12 (p = 0.06). ConclusionThe subconjunctival injection of bevacizumab and triamcinolone before surgery is effective in suppressing inflammation in pterygium.

Subconjunctival bevacizumab injection on primary pterygium in Thammasat Hospital:a randomized controlled trial

Subconjunctival bevacizumab injection on primary pterygium in Thammasat Hospital:a randomized controlled trial

COMPARISON OF RECURRENCE INCIDENCE AFTER PTERYGIUM EXCISION BY USING PEROPRATIVE SUBCONJUNCTIVAL BEVACIZUMAB INJECTION VERSUS CONJUNCTIVAL AUTO GRAFT

Background: A pterygium is a fleshy, wing-shaped growth from the conjunctiva, crossing over the limbus onto the cornea. The tissue is fibrovascular and can occur over the nasal or temporal cornea. It can be a bilateral process and asymmetric with one eye affected by a larger pterygium than the other. Objectives: To compare between Subconjunctival injection of bevacizumab (Avastin) and conjunctival autograft in the treatment of primary pterygium. Patients and Methods: This study was performed on 40eyes of 40 patients with primary pterygia of variable durations. The eyes were randomly classified into two equal groups: group A patients to be treated by Subconjunctival Bevacizumab (avastin) 0.2 ml (5 mg) for Primary Pterygium Excision, group B patients treated by conjunctival auto graft. Best corrected visual acuity, occurrence of recurrence, IOP and postoperative complications were compared. Patients were evaluated preoperatively then 1 day, 1 week, 1 month, 3 months after surgery. Eye photography was done before surgery and during the follow up period. This study was conducted at Department of Ophthalmology Al-Azhar University Hospital and Kobry El Kobba Military Hospital, from August 2018 to July 2020. Results: When the two groups were compared together, we found no statistically significant differences among them in multiple compared items, but the recurrence rate in group A (bevacizumab group) occurred in (10%), while in group B conjunctival auto graft no recurrence occurred and this was statistically insignificant difference among the 2 groups. There were no statistically significant differences regarding improvement in visual acuity, intraocular pressure change and postoperative complications among the two groups. Conclusion: A single preoperative subconjunctival injection of bevacizumab had decreased the recurrence rate befor primary pterygium excision, but did not give a more desirable recurrence rate. On the other hand conjunctival autograft was more effective than bevacizumab in reducing the recurrence rate of primary pterygium after surgical excision.

Inhibition of Type I Collagen Expression in Fibrosis Prevention after Trabeculectomy: Oryctolagus cuniculus

The administration of postoperative bevacizumab injection in subconjunctival trabeculectomy will reduce bleb fibrosis. This study aimed to investigate the effect of bevacizumab as an antifibrotic agent on collagen density, collagen thickness and type I collagen expression after trabeculectomy in rabbits. Sixteen males New Zealand white rabbits were divided into two groups, control and treatment group. Masson’s trichrome was performed to evaluate collagen density and thickness. Immunohistochemistry examination using a monoclonal antibody to type I collagen was performed to evaluate collagen expression. Among the sixteen samples, postoperative bleb conditions obtained diffuse bleb, and there were no differences in bleb characteristics between the control and treatment groups. Anterior chamber was deep, and cornea was clear in all animals. This study showed that the density of collagen fibers and type 1 collagen expression significantly decreased in the treatment group compared to control group (p = 0.0075; p = 0.006, respectively). However, there was no significant difference in the thickness of collagen fibers in both groups (p = 0.323). Bevacizumab reduces bleb fibrosis by inhibition of angiogenesis and accumulation of extracellular matrix. Postoperative subconjunctival injection of bevacizumab may limit scar tissue formation at the site of trabeculectomy by blocking collagen synthesis.