The Effects of a Subtenoncapsular Injection of Bevacizumab for Ocular Surface Disease With Corneal Neovascularization

Jae Hoon Jeong; Yeoun Sook Chun; Jae Chan Kim

doi:10.3341/jkos.2009.50.10.1475

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Jeong, Chun, and Kim: The Effects of a Subtenoncapsular Injection of Bevacizumab for Ocular Surface Disease With Corneal Neovascularization

Original Article

J Korean Ophthalmol Soc 2009;50(10):1475-1482.

Published online: 3 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.10.1475

The Effects of a Subtenoncapsular Injection of Bevacizumab for Ocular Surface Disease With Corneal Neovascularization

Jae Hoon Jeong, MD, Yeoun Sook Chun, MD, PhD, Jae Chan Kim, MD, PhD

Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea

Address reprint requests to Jae Chan Kim, MD, PhD Department of Ophthalmology, Chung-Ang University Yongsan Hospital #65-207 Hangangro 3-ga, Yongsan-gu, Seoul 140-757, Korea Tel: 82-2-748-9838, Fax: 82-2-792-6295, E-mail: jck50ey@kornet.net

Received 15 April 2009 Accepted 30 June 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the effect of an injection of bevacizumab into the sub-Tenon’s capsule on ocular surface neovascularization disease including pterygium and corneal neovascularization.

Methods

Twenty-five eyes of 21 patients with pterygium and 19 eyes of 15 patients with corneal neovascularization were given an injection of 5 mg bevacizumab into the sub-Tenon’s capsule. The clinical effects and complications were evaluated by analyzing the changes in anterior segment photo, visual acuity, and intraocular pressure at week one, week two, week four, and every month thereafter.

Results

After injections of bevacizumab, partial remission of corneal neovascularized lesion was observed in five eyes (20%) of the pterygium group, and there were no significant changes in the visual acuity and no complications. In the corneal neovascularization group, corneal neovascularized lesions of 18 eyes (95%: 2 eyes, complete remission 16 eyes, partial remission) improved after injections of the bevacizumab and the scores of extent and severity of corneal neovascularized lesion improved significantly, unlike the pterygium group. The visual acuity of two eyes (11%) improved more than two lines of Yong-Han Jin’s distance visual acuity test and there were no systemic side effects. Localized side effects included four eyes (21%) with punctate epithelial erosions and two eyes (11%) with temporary, elevated intraocular pressure in the corneal neovascularization group. The side effects improved without any additional treatment.

Conclusions

An injection of bevacizumab into the sub-Tenon’s capsule is more effective in fresh lesions of corneal neovascularization disease than in old and stable lesions of pterygium. Therefore, it could be used as a prominent treatment of various corneal neovascularization diseases.

Keywords: Bevacizumab, Clinical effects, Corneal neovascularization, Subtenon injection

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Figure 1.

Comparison of the changes in the average scores of corneal neovascularizaion before and after sub-Tenon’s capsule injections of bevacizumab. (A) There was a significant decrease of the score of corneal neovascularization extent in the corneal neovascularization group. (B) There was a significant decrease of the score of corneal neovascularization severity in the corneal neovascularization group.^*

p<0.05, Wilcoxon signed ranks test.

Figure 2.

Thirty-eight-year-old man with a history of pterygium over 10 years. Color photographs of his right eye before bevacizumab injection (A), 2 weeks after the first injection (B), 1 month after the second injection (C), 2 months after the third injection (D). Conjunctival injection was subsided slightly but magnified photographs of pterygium head showed unchanged lesion of corneal neovascularizaion (extent 1, severity 1.5) at before bevacizumab injection (E), 1 month after the second injection (F), 2 months after the third injection (G).

Figure 3.

Fifty-one-year-old woman with a month history of herpes zoster keratoconjunctivitis. Before bevacizumab injection, (A) Left eye showed some of small, round stromal opacities(arrow heads) (extent 1). (B) Slight limbal elevation with injection of conjunctiva (arrow) was noted. (C) Magnified photograph of superior cornea showed severity 1. Two weeks after the first injection, (D) stromal opacities, (E) limbal elevated lesion, and conjunctival injection disappeared. (F) Corneal neovascularized lesion disappeared completely (extent 0 and severity 0) until 6 months.

Figure 4.

Sixty-three-year-old man with one-month history of herpes stromal keratitis. Before bevacizumab injection (A) Left eye showed corneal neovascularization at the inferior portion (extent 2). (B, C) Magnified photograph of inferior cornea showed severity 2. (D, E, F) Two weeks after the first injection, inferior corneal neovascularized lesion disappeared completely (extent 0 and severity 0) until 6 months.

Figure 5.

Twenty-five-year-old woman with one-year history of ocular surface disease caused by Stevens-Johnson syndrome. (A) Right eye showed epithelial and stromal opacification at the central cornea with total peripheral corneal neovascularization (extent 12) before bevacizumab injection. (B) One month after the fifth injection, it showed marked reduction of corneal opacification, with significant disappearance of blood vessels (extent 6.5). (C) Magnified photograph of superior cornea before bevacizumab injection showed severity 4 and (D) 1 month after the fifth injection showed severity 3. Her best corrected visual acuity (BCVA) was 20/500 before bevacizumab injection, and eventually it improved to 20/100.

Figure 6.

Forty-five-year-old woman with 3-month history of ocular surface disease caused by rejected corneal graft. (A) Photograph of right eye showed central stromal opacity with nearly total peripheral corneal neovascularization (extent 11) before bevacizumab injection.(B) One month after the fifth injection, it showed marked reduction of central corneal opacity with significant disappearance of blood vessels (extent 6). (C) Magnified photograph of nasal cornea before bevacizumab injection showed severity 3.5 and (D) 1 month after the fifth injection showed severity 3. Her best corrected visual acuity (BCVA) was 20/100 before bevacizumab injection, and eventually it improved to 20/50.

Table 1.

Distribution of corneal neovascularization group

Cause of corneal neovascularization	Number of patients (Number of eyes)
Rejection of corneal graft	5 (6)
Stevens-Johnson syndrome	3 (5)
Chemical burn	2 (3)
Herpes stromal keratitis	2 (2)
Neurotrophic ulcer	1 (1)
Herpes zoster keratoconjunctivitis	1 (1)
Superior limbic keratoconjunctivitis	1 (1)
Total	15 (19)

Table 2.

Baseline characteristics and outcomes of bevacizumab injections to subtenoncapsule for pterygium and corneal neovascularization (Mean± Standard Deviation)

	Pterygium	Corneal neovascularization
Number of patients (eyes)	21 (25)	15 (19)
Male : Female (eyes)	9 (10) : 12 (15)	10 (12) : 5 (7)
Age (years)	53±12.1	46.6±17.5
Mean number of injections (Mean days of interval)	1.6 (15.7)	3.8 (14.2)
Mean duration of follow-up (months)	3.6±1.3	4.2±1.5
Regression of lesions (eyes)	CR^*: 0 (0%)	CR^*: 2 (11%)
	PR^†: 5 (20%)	PR^†: 16 (84%)
Change of visual acuity (eyes)	none	2 (11%)^‡
Side effects (eyes)	none	6 (32%)^§

^* CR=complete remission of neovascularized lesion;

^† PR=partial remission of neovascularized lesion;

^‡ Improvement more than 2 lines of Yong-Han Jin’s distance visual acuity test;

^§ No systemic but localized side effects like punctate epithelial erosion (4 eyes), high intraocular pressure greater than 24 mmHg (2 eyes).

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