1. PTERYGIUM AND TOPICAL BEVACIZUMAB: A 2 YEAR FOLLOW UP DR. ADITYA SUDHALKAR,M.S. DR. ANAND SUDHALKAR,M.S. The authors have no financial interest in this presentation

3. Can be a cosmetic blemish and/or interfere with vision

4. Excision is the primary treatment modality; recurrence is often a problem

5. Numerous adjuvants suggested for preventing recurrence, including:

6. Mitomycin C, 5 FU, triamcinolone

7. Irradiation**

8. Conjunctivalautografts

9. Their efficacy however, is variable

10. Bevacizumab has been suggested as an off label use**Effect of subconjunctivalbevacizumab on primary pterygiumTeng CC, Patel NN, Jacobson L. Cornea. 2009 May;28(4):468-70 *Topical bevacizumab for corneal limbalneovascularisation to prevent impending recurrence of pterygiumWu PC, Kuo HK, Tai MH, Shin SJ.Cornea. 2009 Jan;28(1):103-4 **Strahlenther Onkol. 2009 Dec;185(12):808-14 Vastradis et al. *Med Hypotheses. 2007;69(4):925-7. Bevacizumab as a potential novel adjunct in the management of pterygia

11. PURPOSE: To determine the efficacy and safety of topical bevacizumab in flurbiprofen as an adjunct to conjunctivalautograftin prevention of recurrence of primary pterygium

13. PATIENTS: 17 consecutive patients of primary pterygium, with :

14. No associated systemic or ocular disorder

15. No known predisposition to hypersensitivity reactions

16. TREATMENT: Primary pterygium excision with conjunctivalautograft; single surgeon, standardised technique.

17. POST OPERATIVE REGIMEN(FOR 4 WEEKS-q.i.d.):

18. Antibiotic steroid *eye drops

19. Bevacizumab(0.3mg/drop), topically with punctal occlusion-5 minutes

20. Flurbiprofen eye drops

21. Preservative free artificial tears

24. GENDER DISTRIBUTION: Males: 10; Females 7

25. TOPICAL REGIMEN WELL TOLERATED

26. NO RECURRENCE TILL THE END OF THE FOLLOW -UP PERIOD

27. Seven patients complained of foreign body sensation; treated with lubricants

28. 2 had dellen formation, resolved with artificial tears

30. DISCUSSION: Recurrence of pterygium entails further procedures on a patient; excision can leave a scar Antimetabolites, irradiation not without side effects Bevacizumab in an off label use has been shown to be effective in prevention of recurrence* Subconjunctivalbevacizumab in immediate post operative period might not prevent neovascularisation which usually occurs later Multiple subconjunctival* injections potentially hazardous and painful; *Ann Ophthalmol (Skokie). 2010;42 Spec No:28-30. Multiple subconjunctival injections for advanced primary pterygium *Cornea. 2011 Feb;30(2):127-9 Fallah et al. Intralesionalbevacizumab in decreasing pterygium size.

31. DISCUSSION: Administration of topical therapy(bevacizumab+flurbiprofen) with punctal occlusion did not produce ocular/systemic side effects Topical therapy gives a prolonged dose of bevacizumab to the autograft None of the patients showed a recurrence till the end of follow up period Steroids not a confounding factor as they have not shown to significantly alter recurrence rates*~ *Cornea. 2010 Feb;29(2):141-5, Comparison of recurrence rates….Kandavel et al ~Ann Ophthalmol. 1985 Jan;17(1):92-5. Pterygium: clinical classification and management in Virgin Islands. Anduze et al. ~East Afr Med J. 1992 Sep;69(9):490-3. Post-operative management of pterygium in Jos, Nigeria--comparison of antibiotics, steroids and opticrom

32. REFERENCES: Pterygium. Etiology, clinical aspects and novel adjuvant therapies].HeindlLM, CursiefenC.Ophthalmologe. 2010 Jun;107(6):517-20, 522-4 Safety and efficacy of intraoperative 5-fluorouracil infiltration in pterygium treatment]. VleziVG, et al. ArqBras Oftalmol. 2009 Mar-Apr;72(2):169-73. Comparative Study of Different β-Radiation Doses for Preventing Pterygium Recurrence. Yamada Tet al. IntJ RadiatOncolBiol Phys. 2010 Oct Results of treatment with topical mitomycin C 0.02% following excision of primary pterygium.Rachmiel R et al.BrJ Ophthalmol. 1995 Mar;79(3):233-6 Postoperative subconjunctival corticosteroid injection to prevent pterygium recurrence. Paris Fdoset al.Cornea. 2008 May;27(4):406-10 DevOphthalmol. 2010;46:133-9. Scholl et al. Anti vascular growth factors in anterior segment disease Cornea. 2009 May;28(4):468-70. Teng et al. Effect of subconjunctivalbevacizumab on primary pterygium

34. No control group