title: A randomized controlled prospective study to assess the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients.
abstract: BACKGROUND
  Pterygium is an ocular surface disorder with prevalence rates ranges from 0.3% to 29% in different parts of the world. Vascular endothelial growth factor (VEGF) has been detected in increased amounts in pterygium epithelium, compared with normal conjunctiva. Bevacizumab is a recombinant, humanized anti-VEGF antibody suggested as a possible adjunctive therapy for pterygium excision that appears to have a role in prevention of recurrence. We conducted this study to evaluate the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients.
  
  
  METHODS
  In this randomized prospective clinical study, the patients were randomized into two groups of 30 patients each. Study group received 1.25 mg/0.05 ml subconjunctival bevacizumab 1 week before pterygium surgery with conjunctival autograft. Control group received 1.25 mg (0.05 ml) subconjunctival normal saline 1 week prior to pterygium surgery with conjunctival autograft. Patients were followed up at day 1, day 7, 1 month and 3 months. The main outcome measures were morphology of pterygium after injection, intra-operative ease, recurrence of pterygia, and any complications.
  
  
  RESULTS
  After giving bevacizumab, there was statistically significant improvement in grade, color intensity, size of pterygium, and symptoms of patients. Intra-operatively, less bleeding was observed by the surgeon. No statistically significant difference regarding reduction in astigmatism, improvement of visual acuity, and complications were observed in two groups. Recurrence was noted in five patients (8.33%) in total study population at the end of 3 months. It was present in two patients (6.67%) in Group A and three patients (10%) in Group B.
  
  
  CONCLUSIONS
  Single preoperative administration of subconjunctival injection bevacizumab given 1 week before the pterygium excision with conjunctival autograft decreases the vascularity of newly formed blood vessels, hence may decrease recurrence rate though not in our study.
authors.affiliation: Department of Ophthalmology, VMMC and Safdarjung Hospital, New Delhi, India.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Singh
authors.forename: Lopa
authors.initials: L
authors.lastname: Sarkar
authors.forename: H S
authors.initials: HS
authors.lastname: Sethi
authors.forename: V S
authors.initials: VS
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000637:transplantation*; D019781:Corneal Topography; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007194:India; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011625:Pterygium / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012008:Recurrence; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab