Effects of ranibizumab on microvasculature, oxidative stress and recurrence in primary pterygium surgery.

Purpose: To evaluate the effects of pre-operative ranibizumab injection on microvascular density (MVD), 8-hydroxyguanosine (8-OHdG) and recurrence after surgical excision of primary pterygium.

Method: This was a prospective cohort interventional study involving 52 patients with primary pterygium divided equally into control and intervention groups. The intervention group received 0.5 mg ranibizumab two weeks prior to pterygium excision surgery. All participants had pterygium excision with autologous conjunctival graft under local anaesthesia. Excised pterygium tissues were evaluated for MVD and 8-OHdG. Each participant was monitored for recurrence up to 2 years after intervention. Pearson chi-square and Fisher exact tests were used to examine the differences between both groups.

Results: The intervention group demonstrated significantly lower MVD (p < 0.001) and recurrence rates (p < 0.001). In the intervention group, 53.8% (n = 14) of patients had MVD 1 + , and 46.2% (n = 12) had MVD 2 + , which was notably lower than the control group, where 53.8% (n = 14) of patients had MVD 3 + and 4 + . No significant difference in 8-OHdG scores was observed between the groups (p = 0.482). In the intervention group, 84.6% (n = 22) of patients had an 8-OHdG score of 3 + , while 76.9% (n = 20) of patients in the control group also had 8-OHdG scores of 3 + . 46.2% (n = 12) of patients from the control group experienced recurrent pterygium, while no cases of pterygium recurrence were observed in the intervention group. Reduction in MVD was significantly associated with lower frequency of pterygium recurrence (p = 0.004).

Conclusion: Pre-operative intralesional ranibizumab decreases pterygium recurrence rate after surgical excision via modulation of vascularity. Ranibizumab may be considered as an adjunctive treatment in pterygium surgery with high risk of recurrence.