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. 2017 Mar 10:11:493-501.
doi: 10.2147/OPTH.S127700. eCollection 2017.

Preoperative subconjunctival combined injection of bevacizumab and mitomycin C before the surgical excision of primary pterygium: clinical and histological results

Alahmady Hamad Alsmman  1 , Gamal Radwan  1 , Mortada Ahmed Abozaid  1 , Usama Ali Mohammed  1 , Nesreen Gamal Abd Elhaleim  2
Affiliations

Preoperative subconjunctival combined injection of bevacizumab and mitomycin C before the surgical excision of primary pterygium: clinical and histological results

Alahmady Hamad Alsmman et al. Clin Ophthalmol. .

Abstract

Purpose: The aim of this study was to detect the clinical and histological effects of preoperative subconjunctival injection of both bevacizumab and mitomycin C (MMC) 1 month before the surgical excision of primary pterygium using a bare sclera technique.

Patients and methods: A total of 20 patients with primary pterygium underwent subconjunctival combined injection of 0.1 mL of MMC (0.1 mg/mL) and 0.1 mL of bevacizumab (1.25 mg/0.1 mL) 1 month before bare sclera excision of the pterygium. The excised pterygium tissues were examined histologically and immunohistologically by CD31 staining, and the patients were followed up clinically for at least 2 years. The excised pterygia of two patients without preoperative injection were used for histological comparison.

Results: Clinically, there were no intraoperative or postoperative complications. No recurrence was noted during the follow-up period. Histologically, the previously injected pterygia showed a decreased number of epithelial cells and stromal fibroblasts. The latter were rounded or oval and swollen rather than spindle shaped, and some were degenerating or apoptotic. Collagen and elastic fibers were degenerated, distorted, and decreased in density, while blood capillaries were obliterated. There was a significant decrease in CD31-positive cells in previously injected pterygia.

Conclusion: Preoperative subpterygium combined injection of bevacizumab and MMC is safe and effective in reducing the postoperative recurrence of primary pterygium. Histological and immunohistological changes in the form of decreased fibrovascular activity and degeneration of the extracellular matrix and nerve axons were noted.

Keywords: CD31; histological changes; primary pterygium; subconjunctival bevacizumab; subconjunctival mitomycin C.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Subpterygium injection of MMC and bevacizumab by insulin syringe under topical anesthesia. Abbreviation: MMC, mitomycin C.
Figure 2
Figure 2
Grades of recurrence.
Figure 3
Figure 3
A photomicrograph of untreated pterygium section showing alternative thin and thick areas that appear in the surface epithelium. Notes: Some goblet cells are arranged as intraepithelial gland (I). Some areas of hyaloid degeneration of collagen fibers (C) and numerous nuclei of fibroblast cells (arrow) are seen. H&E: ×400. Abbreviation: H&E, haematoxilin and eosin stain.
Figure 4
Figure 4
A photomicrograph of untreated pterygium section showing connective tissue stroma that is covered by conjunctival epithelium. Notes: The stroma is rich in vascular network of dilated congested blood vessels (arrow). Marked inflammatory mononuclear cellular infiltration with an area of hemorrhage (H) is also noticed. H&E: ×200. Abbreviation: H&E, haematoxilin and eosin stain.
Figure 5
Figure 5
A photomicrograph of untreated pterygium section showing subepithelial connective tissue that is rich in collagen fibers. Notes: Some areas exhibit hyaloid degeneration (C). Light green: ×400.
Figure 6
Figure 6
A photomicrograph of noninjected pterygium section immunostained with CD31 antibody showing numerous CD31-positive vessels in subepithelial and connective tissue stroma. Note: Anti-CD31: ×400.
Figure 7
Figure 7
A photomicrograph of treated pterygium section showing the absence of goblet cells in the covering conjunctival epithelium. Notes: The connective tissue stroma is devoid of the inflammatory infiltration and congested blood vessels. An apparent decrease in the number of fibroblast nuclei (arrow) is noticed. H&E: ×200. Abbreviation: H&E, haematoxilin and eosin stain.
Figure 8
Figure 8
A photomicrograph of treated pterygium section showing the collagen fibers that are regularly arranged close to each other with no signs of degeneration. Note: Light green: ×400.
Figure 9
Figure 9
A photomicrograph of injected pterygium-immunostained section showing a small number of subepithelial CD31-positive vessels. Note: Anti-CD31: ×400.
Figure 10
Figure 10
The mean of area percentage of collagen fibers and microvessel density of CD31 of the two groups.
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