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Management of primary pterygium with intra-lesional injection of 5 flurouracil and bevacizumab (Avastin)

Ghoz, Noha; Britton, John; Ross, Andrew R.; Mohammed, Imran; Hogan, Emily; Said, Dalia G.; Dua, Harminder S.

Authors

Noha Ghoz

John Britton

Andrew R. Ross

Imran Mohammed

Emily Hogan

Dalia G. Said

HARMINDER DUA HARMINDER.DUA@NOTTINGHAM.AC.UK
Professor of Ophthalmology and Visual Sciences



Abstract

Background

To assess the efficacy of combined 5FU and Avastin injections in the treatment of primary pterygium

Methods

Sixteen eyes with primary pterygium received intralesional 5 fluorouracil and Avastin (2.5–5 mg) injections every 2 weeks for a maximum of five injections. Fourteen eyes of 14 patients received five injections, one eye received three injections and one eye received two injections. All eyes were followed at monthly intervals for 3 months after last injection. Tissue was obtained by surgical excision of primary pterygium from four eyes who received injections and three eyes with primary pterygium who did not receive injections (control) and subjected to immunohistological examination for beta fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), von-Willebrand factor (vWF), lymphatic vessel endothelial hyaluronan receptor (LYVE-1) and collagen-I.

Results

Pterygium progression was arrested in all patients. Sixty-two percent of patients had improvement of redness while 89% had reduced thickness of the lesion. VEGF, bFGF, EGF, vWF, LYVE-1 and collagen-I were all reduced in the injected samples.

Conclusions

The injection of 5 fluorouracil and Avastin act synergistically to arrest progression and induce atrophy in primary pterygium. This is related to the effect of agents on fibroblasts, collagen, and vascular tissues. Such medical intervention is a safe and viable option in the management of primary pterygium though excision of residual tissue is still required in some cases. Longer follow up is needed to ascertain whether this will reduce the recurrence rate following excision.

Citation

Ghoz, N., Britton, J., Ross, A. R., Mohammed, I., Hogan, E., Said, D. G., & Dua, H. S. (2019). Management of primary pterygium with intra-lesional injection of 5 flurouracil and bevacizumab (Avastin). Eye, 33(11), 1776-1783. https://doi.org/10.1038/s41433-019-0493-0

Journal Article Type Article
Acceptance Date May 10, 2019
Online Publication Date Jun 19, 2019
Publication Date 2019-11
Deposit Date Jul 21, 2020
Publicly Available Date Mar 28, 2024
Journal Eye
Print ISSN 0950-222X
Electronic ISSN 1476-5454
Publisher Nature Publishing Group
Peer Reviewed Peer Reviewed
Volume 33
Issue 11
Pages 1776-1783
DOI https://doi.org/10.1038/s41433-019-0493-0
Keywords Ophthalmology; General Arts and Humanities
Public URL https://nottingham-repository.worktribe.com/output/4781027
Publisher URL https://www.nature.com/articles/s41433-019-0493-0
Additional Information Received: 8 December 2018; Revised: 29 April 2019; Accepted: 10 May 2019; First Online: 19 June 2019; : ; : The authors declare that they have no conflict of interest.