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

Abstract

Volkan Hurmeric,1 Pravin Vaddavalli,1 Anat Galor,1,2 Victor L Perez,1 Janika San Roman,1 Sonia H Yoo11Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA; 2Miami Veterans Affairs Medical Center, Miami, FL, USAPurpose: 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: pterygium, recurrence, ranibizumab, conjunctival hyperemia, corneal neovascularization