J Korean Ophthalmol Soc.  2015 Jun;56(6):847-855. 10.3341/jkos.2015.56.6.847.

The Effect of Subconjunctival Bevacizumab Injection before Conjunctival Autograft for Pterygium

• Kim YI
• Lee GY
• Kim EJ
• Kim YH
• Lee KW
• Park YJ

• KMID: 2339148
• DOI: http://doi.org/10.3341/jkos.2015.56.6.847

Abstract

PURPOSE
To evaluate the effect of subconjunctival bevacizumab injection before conjunctival autograft for pterygium.
METHODS
Twenty-five eyes (25 patients) with pterygium received a subconjunctival injection of 2.5 mg (0.1 mL) bevacizumab 1-2 weeks prior to conjunctival autograft surgery. The control group (25 eyes of 25 patients) received the same operation. Two weeks, 1 month and every month after the surgery, the vascularization of surgical site, the recurrence rate and the effect of wound healing were analyzed.
RESULTS
The bevacizumab group showed a decreased conjunctival vascularity grade compared with the control group based on light microscopy. The bevacizumab group also showed lower vascular epithelial growth factor (VEGF) compared with the control group using immunohistochemical analysis and western blot. There was no recurrence in both groups, but, persistent autograft edema was observed at 8 weeks postoperatively in the bevacizumab group.
CONCLUSIONS
Although preoperative injection of bevacizumab effectively reduced vascularity and VEGF concentration of pterygium tissue, prolonged autograft edema was observed. Based on these results, bevacizumab inhibits lymphangiogenesis as well as angiogenesis. Therefore, delayed wound healing should be considered when subconjunctival bevacizumab injection is administered before pterygium surgery.

Keyword

Bevacizumab; Conjunctival autograft; Lymphangiogenesis; Pterygium; VEGF

MeSH Terms

Autografts*
Blotting, Western
Edema
Lymphangiogenesis
Microscopy
Pterygium*
Recurrence
Vascular Endothelial Growth Factor A
Wound Healing
Bevacizumab
Vascular Endothelial Growth Factor A

Figure

• 

  Figure 1. Comparison vascularization of pterygium tissue obtained from pterygium surgery in cases treated with bevacizumab, and the control group. (A-1, B-1) Anterior segment photography of primary pterygium cases before injection of bevacizumab. (C-1) Anterior segment photography of recurrent pterygium cases before injection of bevacizumab. (A-2, B-2, C-2) Anterior segment photography shows decreased conjuntival injection after injection of bevacizumab, but before the surgery. (A-3, B-3, C-3) LM (H&E stain, ×100) of biopsy obtained from pterygium surgery. (A-4, B-4, C-4) Control group of similar degree of pterygium without bevacizumab injection. (A-4, B-4) primary pterygium (C-4) recurrent pterygium. (A-5, B-5, C-5) LM of biopsy form the above-mentioned (A-4, B-4, C-4) control group. These results show marked decrease in vascularization grade in group with bevacizumab treatment compared to the control group. LM ＝ light microscopy (Axio Vision 4; Carl Zeiss, Jena, Germany).

• 

  Figure 2. LM immunohistochemistry for VEGF (peroxidase stain, ×100) of pterygium tissue form pterygium surgery in control group (A, C) and bevacizumab group (B, D). (A) and (C) show stronger stain at the apical epithelium, indicating denser concentration of VEGF than (B) and (D). VEFG=vascular endothelial growth factor; LM = light microscopy (Axio Vision 4; Carl Zeiss, Jena, Germany).

• 

  Figure 3. Western blot for vascular endothelial growth factor (VEGF) of pterygium tissue form pterygium surgery in bevacizumab group and control group. Bevacizumab group were lower VEGF expression than control group. * Student t-test (p ＜0.05).

• 

  Figure 4. Comparison of the graft edema presented at conjuntivolimbal autograft between the bevacizumab group and the control group at each follow-up. The bevacizumab group exhibits more persistent, and significant graft edema on second month follow-up after surgery. The scoring system of graft edema (0 means no edema, equal in thickness to normal conjunctiva; 1 means mild edema, graft edema within x1 of the corneal thickness under slit-lamp exam; 2 means moderate edema, between 1-3; 3 means severe edema, graft edema above x2 of the corneal thickness under slit-lamp exam). * Fisher’s exact test, p＜0.05.

• 

  Figure 5. Persistent post-surgical graft edema due to application of subconjuntival bevacizumab injection 2 weeks before the surgery. (A-1, B-1) Shows severe graft edema 2 months after surgery. (A-2, B-2) Shows normal connection between graft vessels and recipient vessels.

Reference

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