Single and multiple injections of subconjunctival ranibizumab for early, recurrent pterygium

Abstract

Purpose: To assess the effect of single versus multiple subconjunctival ranibizumab injections in patients with an early pterygium recurrence.

Setting: Single-center, academic practice.

Study population: Nine patients with early pterygium recurrence.

Observational procedure: Subconjunctival ranibizumab (0.5 mg/0.05 mL) was administered adjacent to pterygium recurrence. Group 1 (n = 5) received one injection; group 2 (n = 4) received three injections (time points 0, 2, and 4 weeks) with the ability to retreat as needed.

Main outcome measures: Effect of ranibizumab on conjunctival hyperemia and corneal neovascular area over a 6-month follow-up period.

Results: In the single injection group, a decrease in conjunctival hyperemia was noted in all patients on postinjection day 1. At follow up, hyperemia grade fluctuated, although all patients had less hyperemia than at baseline. In the recurrent injection group, the median number of injections was 8.5 (range 7 to 9) over the 6 months. In spite of the repeated injections, the pattern of conjunctival hyperemia was similar to that of the single injection group. In group 1, corneal neovascularization remained relatively unchanged over the 6-month period in four patients and decreased in one patient by 24%. In group 2, corneal neovascularization increased in one patient by 39%, remained stable in one patient, and decreased in two patients by 34% and 44%.

Conclusion: This is the first study to evaluate the role of ranibizumab in the treatment of an early pterygium recurrence and the first to compare multiple versus single injections. Recurrent injections did not appear to be superior to a single injection with regards to conjunctival hyperemia.

Keywords: conjunctival hyperemia; corneal neovascularization; pterygium; ranibizumab; recurrence.

Figure 1

(A) Slit lamp photograph of a patient before subconjunctival injection. (B) Area of neovascularization (asterisk) was outlined with the software. Note: The location of the limbus and subconjunctival vessels (grey lines) was marked at the baseline visit.

Figure 2

Conjunctival hyperemia scores in patients who received a single subconjunctival ranibizumab injection (group 1) and multiple injections (group 2) for a pterygium recurrence (scale 0 to 4).

Figure 3

Representative photographs of a patient with significant improvement in conjunctival hyperemia after repeated subconjunctival ranibizumab injections, and photographs of a patient with only mild improvement in conjunctival hyperemia. Representative photographs of a patient with significant improvement in conjunctival hyperemia after repeated subconjunctival ranibizumab injections. (A) Preinjection photograph; (B) postinjection photograph. Representative photographs of a patient with only mild improvement in conjunctival hyperemia after repeated subconjunctival ranibizumab injections. (C) Preinjection photograph; (D) postinjections photograph.

Figure 4

Corneal vessel area at each time point in group 1. Notes: Arrows demonstrate the subconjunctival ranibizumab injection in each patient. Percentages represent changes in the vessel area between 6 months and baseline. Positive values indicate increasing area, while negative numbers indicate decreasing area. Abbreviation: Preinjec, preinjection.

Figure 5

Corneal vessel area at each time point in group 2. Notes: Arrows demonstrate the subconjunctival ranibizumab injections in each patient. Percentages represent changes in the vessel area between 6 months and baseline. Positive values indicate increasing area, while negative numbers indicate decreasing area. Abbreviation: Preinjec, preinjection.