The Effects of the Subconjunctival Injection of Bevacizumab (Avastin®) in
Recurrrent Pterygium
Cheil Eye Hospital
Young Jeung Park, MD
Jong Wook Lee, MD
Kyoo Won Lee, MD
Background
• Vascular Endothelial Growth Factor (VEGF)
- Mediator cytokine
of pathological angiogenesis
- Key transcriptional regulator
of hypoxic responses
Angiogenesis in pterygiumAngiogenesis in pterygium Angiogenic stimulators↑, inhibitors↓ : the formation and progression of pterygium
Abundant expression of VEGF in pterygium tissue
Application of anti-VEGF therapy
Inducing regression of blood vessels in pterygium
Bevacizumab (Avastin®)• Humanized recombinant Ab : binds all isoforms of VEGF
Purpose• To evaluate the effects of
the subconjunctival injection
of Bevacizumab (Avastin®)
in recurrent pterygium.
• From December 2006 to May 2007• 20 eyes with recurrent pterygium• Bevacizumab subconjunctival injection (0.2cc)• Folllowed up at 1st week, 2nd week, 4th week, and every
month thereafter.• Evaluation
- Clinical results (degree of conjunctival injection)
- ICG angiography
: at pre-injection and at 2 weeks post-injection)
- Ocular and systemic complications
Materials and Methods
Method of subconjunctival Method of subconjunctival BevacizumabBevacizumab injectioninjection
• Bevacizumab (Avastin®) - Refrigerated before use
- No more than 14 days
1. Topical anesthesia
2. 5% povidone/iodine and topical antibiotics
3. 0.2cc (5.0mg) of Avastin® injected subconjuntivally with tuberculin syringe(30G)
4. Topical antibiotics & steroid
The level of conjunctival injection
Level 1 - Reached the rock-bottom after injection.
Level 2 - Level between 1~3.
Level 3 - Similar level before injection.
Level 4 - Increase of conjunctival injection
compared to the degree before
Bevacizumab injection.
• Wilcoxon signed ranks test
Vessel thickness• ICG ant. segment angiography
with HRA II®
- 10 eyes
- Before and 2 weeks after the subconjunctival injection
- Measured 5 vessels thickness per eye
- Larger than 0.01mm
(possible to measure the thickness)
• Paired t-test
Demography
Patients No. 20
Sex (M / F) 6/14
Age (years) 53.45 ± 18.32(38~72)
Follow-up period (weeks) 17.10±8.22
(Mean ± SD)
Clinical Results
Before treatment 1 week after treatment
Progressive change in the level of conjunctival injection
* Wilcoxon signed ranks test
Pre-injection level
B. 2 weeks after
D. 5 months afterC. 2 months after
A. Pre-injection
Changes in degree of conjunctival injection
B. 2 weeks after
D. 5 months afterC. 2 months after
A. Pre-injection
B. 2 weeks after
D. 5 months afterC. 2 months after
A. Pre-injection
B. 2 weeks after
D. 5 months afterC. 2 months after
A. Pre-injection
Pre-injection 2 weeks after
0.04mm
0.04mm
Pre-injection
0.03mm
0.02mm
2 weeks after
Ant. segment photographs and ICG angiopgaphy
The change of conjunctival vessel thickness of recurrent pterygium
* Paired T-test
Complications
• Subconjunctival hemorrhage - 4 cases
resolved within 1 week
• Rebound conjunctival injection - 2 cases
improved after reinjection
• Other ocular & systemic complication - none
A. before injection
C. 2 months after
B. 2 weeks after
D. after reinjection
Rebound conjunctival injection Case-1
A. before injection
C. 2 months after
B. 2 weeks after
D. after reinjection
Rebound conjunctival injection Case-2
Conclusions1. After injection, Conjunctival injection was
decreased than before injection.
2. The maximum effect of subconjunctival injection of pterygium lasted less than 1 month.
3. In ICG, the thickness of conjunctival blood vessels decreased(30.14%).
The subconjunctival injection of Bevacizumab
0.2cc was effective for recurrent pterygium
4. Additional research
- timing of additional injection
- the long term effect on the progress of
recurrent pterygium.
Rebound phenomenon
Matsumoto Y et al. Rebound macular edema following bevacizumab therapy
for retinal venous occlusive disease.Retina 2007;27:426-31
Inhibition of the VEGF pathway by Bevacizumab → Upregulate VEGF receptors → An increase in VEGF receptors → the endothelial cells more sensitive to the VEGF
The EndThank you for your attention