The authors compare the outcome of pterygium treatment using 5-fluorouracil as an adjunct to free conjunctival autograft versus bevacizumab (Avastin) as an adjunct to free conjunctival autograft, via a randomised controlled prospective study. Seventy eyes of 70 patients were included into the study with a mean age of 51.49 (±14.36) years. Patients with pterygium encroaching 2mm or more into cornea (from the limbus) were selected. In both groups >80% were nasal in location and >90% were large and fleshy in morphology. The mean size in length of the pterygia for the 5-FU treatment group was 3.94mm and for the Avastin treatment group was 3.36mm. There was no statistically significant difference between the two groups (p=0.11). Exclusion criterion included pterygia of size <2mm into cornea as well as recurrent pterygium from previous surgery.
Thirty-five patients each were randomised into the 5-fluorouracil treatment group and into the Avastin treatment group respectively. The mean follow-up was 18.35 months. Postoperative pterygium recurrence was observed in 1/27 (3.7%) eyes treated with 5-fluorouracil and 1/26 (3.9%) eyes of the Avastin group. Twenty-seven of the 5-FU and 26 of the Avastin patients were followed up to two years. Postoperatively pterygium recurrence was observed in 1/27 (3.7%) eyes treated with 5-FU and 1/26 (3.9%) eye of the Avastin group (p=0.32). Both recurrences were observed at one year of follow-up and they were both female patients aged 46 and 52 years, respectively. The pterygia in both cases were of the fleshy morphologic type.
This study observed the same success rate of treatment (>96%) for the two groups. The study concluded that a single subconjunctival injection of 0.5mg/ml bevacizumab intraoperatively with conjunctival autograft and 5-FU intraoperative use with conjunctival autograft have a very high success rate in prevention of pterygium recurrence. Cost, convenience and availability of 5-FU appeared to have an advantage over bevacizumab. Limitation: Seventeen (24.6%) of the patients comprising eight from 5-FU group and nine from the Avastin group were lost to follow-up before the end of the study at two years and were excluded from the final analysis. Their inclusion may have altered the success rate. However, the authors have suggested that since these were evenly distributed between the two groups, these were therefore not likely to bias the group comparison.