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Treatment of corneal neovascularization in ocular chemical injury with an off-label use of subconjunctival bevacizumab: a case report.

Iannetti L, Abbouda A, Fabiani C, Zito R, Campanella M - J Med Case Rep (2013)

Bottom Line: Her visual acuity improved to 0.3 logarithm of the minimum angle of resolution.After 2 weeks, her vision had improved to 0.1 logarithm of the minimum angle of resolution, vessel regression was observed, and corneal opacity was significantly reduced.During the next months, the patient's condition was well-controlled, and, at the end of follow-up 24 months later, her visual acuity and clinical condition were unaltered.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, University of Rome "La Sapienza," , Rome, Italy. l.iannetti@policlinicoumberto1.it.

ABSTRACT

Introduction: In this report, we describe the case of a patient with ocular chemical injury, symblepharon, and corneal neovascularization in whom subconjunctival injection of bevacizumab caused regression of corneal opacification and neovascularization, which led to visual improvement.

Case presentation: A 54-year-old Caucasian woman presented at our eye emergency department following a splash injury of the left eye with sodium hydroxide. At presentation, her visual acuity was light perception. Slit-lamp examination showed diffuse corneal epithelial defects, stromal edema, and localized Descemet's folds. Despite administration of topical and systemic steroids, she developed symblepharon after 3 months as well as superficial and deep corneal neovascularization with visual acuity 0.5 logarithm of the minimum angle of resolution. A subconjunctival bevacizumab injection (dose 1.25mg/0.05ml) was administered. After 1 week, the vessels appeared thinner and corneal opacity was clearer. Her visual acuity improved to 0.3 logarithm of the minimum angle of resolution. Three weeks later her visual acuity had not changed, and the vessels had started to perfuse again. A second subconjunctival bevacizumab injection was given. After 2 weeks, her vision had improved to 0.1 logarithm of the minimum angle of resolution, vessel regression was observed, and corneal opacity was significantly reduced. Three months after the second injection her vision was unchanged, and the neovascularization remained stable. During the next months, the patient's condition was well-controlled, and, at the end of follow-up 24 months later, her visual acuity and clinical condition were unaltered.

Conclusion: Subconjunctival bevacizumab injection may be considered as a second-line treatment of corneal neovascularization caused by chemical injury that is unresponsive to conventional steroid therapy.

No MeSH data available.


Related in: MedlinePlus

Pre-injection examination revealed symblepharon and corneal opacity in the inferior sector with superficial and deep corneal neovascularization (arrows).
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Figure 1: Pre-injection examination revealed symblepharon and corneal opacity in the inferior sector with superficial and deep corneal neovascularization (arrows).

Mentions: At the first examination, her visual acuity (VA) was light perception in the left eye. Her eyelids and conjunctiva were congested. A slit-lamp examination showed a diffuse corneal epithelial defect, stromal edema, and localized Descemet’s folds. She was treated with 1% dexamethasone sodium phosphate drops six times daily, 1% atropine drops three times daily, and tobramycin six times daily. The corticosteroid prednisone 50mg was administered daily for the first 10 days, then the daily dose was gradually tapered by 5mg every 15 days. Three months later, despite the frequent use of topical steroids a symblepharon with superficial and deep corneal neovascularization was observed (Figure 1). The patient’s VA was 0.5 logarithm of the minimum angle of resolution (LogMAR). We suggested administering a subconjunctival bevacizumab injection in the left eye with the aim of reducing corneal neovascularization. Written, informed consent was obtained from the patient after explaining the off-label use of bevacizumab on the basis of two case reports [3,4]. A subconjunctival injection of 0.05ml (1.25mg) of sterile, undiluted, commercially available bevacizumab (Avastin®; Genentech, South San Francisco, CA, USA) was administered with topical anesthesia in the subconjunctival space close to the corneal limbus and adjacent to the pathological blood vessels. After the procedure, the patient was advised to use 0.3% ofloxacin and 1% dexamethasone sodium phosphate drops three times daily for one week. One week after the subconjunctival bevacizumab injection, the vessels appeared thinner and the corneal opacity was clearer. The patient’s VA improved to 0.3LogMAR after one week. Three weeks later her VA had not changed, and the vessels started to perfuse again. A second subconjunctival bevacizumab injection was then given. Two weeks after the second injection her VA improved to 0.1LogMAR and corneal neovascularization was significantly reduced. Notably, three months later her vision was unchanged and the neovascularization remained stable (Figure 2). During the next months, the patient’s condition was well-controlled, and, at the end of follow-up 24 months later, her VA and clinical condition were unaltered.


Treatment of corneal neovascularization in ocular chemical injury with an off-label use of subconjunctival bevacizumab: a case report.

Iannetti L, Abbouda A, Fabiani C, Zito R, Campanella M - J Med Case Rep (2013)

Pre-injection examination revealed symblepharon and corneal opacity in the inferior sector with superficial and deep corneal neovascularization (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750591&req=5

Figure 1: Pre-injection examination revealed symblepharon and corneal opacity in the inferior sector with superficial and deep corneal neovascularization (arrows).
Mentions: At the first examination, her visual acuity (VA) was light perception in the left eye. Her eyelids and conjunctiva were congested. A slit-lamp examination showed a diffuse corneal epithelial defect, stromal edema, and localized Descemet’s folds. She was treated with 1% dexamethasone sodium phosphate drops six times daily, 1% atropine drops three times daily, and tobramycin six times daily. The corticosteroid prednisone 50mg was administered daily for the first 10 days, then the daily dose was gradually tapered by 5mg every 15 days. Three months later, despite the frequent use of topical steroids a symblepharon with superficial and deep corneal neovascularization was observed (Figure 1). The patient’s VA was 0.5 logarithm of the minimum angle of resolution (LogMAR). We suggested administering a subconjunctival bevacizumab injection in the left eye with the aim of reducing corneal neovascularization. Written, informed consent was obtained from the patient after explaining the off-label use of bevacizumab on the basis of two case reports [3,4]. A subconjunctival injection of 0.05ml (1.25mg) of sterile, undiluted, commercially available bevacizumab (Avastin®; Genentech, South San Francisco, CA, USA) was administered with topical anesthesia in the subconjunctival space close to the corneal limbus and adjacent to the pathological blood vessels. After the procedure, the patient was advised to use 0.3% ofloxacin and 1% dexamethasone sodium phosphate drops three times daily for one week. One week after the subconjunctival bevacizumab injection, the vessels appeared thinner and the corneal opacity was clearer. The patient’s VA improved to 0.3LogMAR after one week. Three weeks later her VA had not changed, and the vessels started to perfuse again. A second subconjunctival bevacizumab injection was then given. Two weeks after the second injection her VA improved to 0.1LogMAR and corneal neovascularization was significantly reduced. Notably, three months later her vision was unchanged and the neovascularization remained stable (Figure 2). During the next months, the patient’s condition was well-controlled, and, at the end of follow-up 24 months later, her VA and clinical condition were unaltered.

Bottom Line: Her visual acuity improved to 0.3 logarithm of the minimum angle of resolution.After 2 weeks, her vision had improved to 0.1 logarithm of the minimum angle of resolution, vessel regression was observed, and corneal opacity was significantly reduced.During the next months, the patient's condition was well-controlled, and, at the end of follow-up 24 months later, her visual acuity and clinical condition were unaltered.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, University of Rome "La Sapienza," , Rome, Italy. l.iannetti@policlinicoumberto1.it.

ABSTRACT

Introduction: In this report, we describe the case of a patient with ocular chemical injury, symblepharon, and corneal neovascularization in whom subconjunctival injection of bevacizumab caused regression of corneal opacification and neovascularization, which led to visual improvement.

Case presentation: A 54-year-old Caucasian woman presented at our eye emergency department following a splash injury of the left eye with sodium hydroxide. At presentation, her visual acuity was light perception. Slit-lamp examination showed diffuse corneal epithelial defects, stromal edema, and localized Descemet's folds. Despite administration of topical and systemic steroids, she developed symblepharon after 3 months as well as superficial and deep corneal neovascularization with visual acuity 0.5 logarithm of the minimum angle of resolution. A subconjunctival bevacizumab injection (dose 1.25mg/0.05ml) was administered. After 1 week, the vessels appeared thinner and corneal opacity was clearer. Her visual acuity improved to 0.3 logarithm of the minimum angle of resolution. Three weeks later her visual acuity had not changed, and the vessels had started to perfuse again. A second subconjunctival bevacizumab injection was given. After 2 weeks, her vision had improved to 0.1 logarithm of the minimum angle of resolution, vessel regression was observed, and corneal opacity was significantly reduced. Three months after the second injection her vision was unchanged, and the neovascularization remained stable. During the next months, the patient's condition was well-controlled, and, at the end of follow-up 24 months later, her visual acuity and clinical condition were unaltered.

Conclusion: Subconjunctival bevacizumab injection may be considered as a second-line treatment of corneal neovascularization caused by chemical injury that is unresponsive to conventional steroid therapy.

No MeSH data available.


Related in: MedlinePlus