Phase I study of subconjunctival ranibizumab in patients with primary pterygium undergoing pterygium surgery.

PURPOSE: To evaluate the safety and tolerability of ranibizumab given via subconjunctival injection in patients with primary pterygium undergoing pterygium surgery with autograft placement. DESIGN: Prospective, open-label pilot study. SETTING: Single-center, academic practice. STUDY POPULATION: Ten patients with primary pterygia. OBSERVATIONAL PROCEDURE: Subconjunctival ranibizumab (0.5 mg/0.05 mL) administered at the limbus, adjacent to pterygium either 3 days prior to surgery (Group 1, n = 5) or at the time of surgery (Group 2, n = 5). Patients prospectively followed for 6 months after injection. MAIN OUTCOME MEASURES: Safety and tolerability of subconjunctival ranibizumab as determined by patient reporting, clinical examination, and masked observer interpretation of slit-lamp photographs. RESULTS: The median age at presentation was 59 years (range 33 to 71 years); 60% of patients were male. Five patients were randomly assigned to be injected with 0.05 mg ranibizumab via subconjunctival injection 3 days prior to surgery; an additional 5 patients were injected with ranibizumab at the time of surgery. All 10 patients tolerated the injection well. The conjunctival autograft remained intact in the 9 patients whose grafts were secured with sutures. There was dehiscence of the autograft in the 1 patient whose graft was secured with fibrin glue. No other safety concerns arose after 6 months of follow-up. Three pterygium recurrences were noted at 6 months (all patients in Group 1). All remaining patients had a normal surgical bed appearance. CONCLUSIONS: The data from this small pilot study suggest that 1 subconjunctival injection of ranibizumab in conjunction with pterygium surgery is well tolerated.

Corneal ectasia detected 32 months after LASIK for correction of myopia and asymmetric astigmatism.

We report a case of corneal ectasia detected 32 months after laser in situ keratomileusis (LASIK) for correction of -4.25 diopters (D) of myopia associated with -2.00 D of regular but slight asymmetric astigmatism. The patient retained stable visual acuity for 15 months postoperatively. The preoperative corneal thickness was 540 microm, and the postablation untouched stroma was assumed to be 290 microm. Although a rare complication of LASIK, corneal ectasia can occur, and there is no consensus regarding how much stroma should be left intact to avoid it. Until we have a better understanding of corneal strength, we think surface photorefractive keratectomy or laser-assisted subepithelial keratectomy ablations should be considered instead of LASIK in borderline cases.