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Dohlman TH, Singh RB, Amparo F, Carreno-Galeano T, Dastjerdi M, Coco G, Di Zazzo A, Shikari H, Saboo U, Sippel K, Ciralsky J, Yoo SH, Sticca M, Wakamatsu TH, Murthy S, Hamrah P, Jurkunas U, Ciolino JB, Saeed H, Gomes JA, Perez VL, Yin J, Dana R. Suppression of Neovascularization by Topical and Subconjunctival Bevacizumab After High-Risk Corneal Transplantation. OPHTHALMOLOGY SCIENCE 2024; 4:100492. [PMID: 38682029 PMCID: PMC11046200 DOI: 10.1016/j.xops.2024.100492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 05/01/2024]
Abstract
Purpose To assess the effectiveness of topical and subconjunctival bevacizumab in suppressing vascularization in graft and host bed after high-risk corneal transplantation. Design Secondary analysis of prospective, randomized, double-blind, placebo-controlled multicentric clinical trial. Participants The study includes patients aged > 18 years who underwent high-risk penetrating keratoplasty, which was defined as corneal vascularization in ≥ 1 quadrants of the corneal graft and host bed, excluding the limbus. Methods Patients were randomized to treatment and control groups. The patients in the treatment group received subconjunctival injection of bevacizumab (2.5 mg/0.1 ml) on the day of the procedure, followed by topical bevacizumab (10 mg/ml) 4 times per day for 4 weeks. The patients in control group received injection of vehicle (0.9% sodium chloride) on the day of procedure, followed by topical vehicle (carboxymethylcellulose sodium 1%) 4 times a day for 4 weeks. Main Outcome Measures Vessel and invasion area of vessels in the corneal graft and host beds. Results This study included 56 eyes of 56 patients who underwent high-risk corneal transplantation, with equal numbers in the bevacizumab and vehicle (control) treatment groups. The mean age of patients who received bevacizumab was 61.2 ± 15.9 years, and the mean age of those treated with vehicle was 60.0 ± 16.1 years. The vessel area at baseline was comparable in the bevacizumab (16.72% ± 3.19%) and control groups (15.48% ± 3.12%; P = 0.72). Similarly, the invasion areas were also similar in the treatment (35.60% ± 2.47%) and control (34.23% ± 2.64%; P = 0.9) groups at baseline. The reduction in vessel area was significantly higher in the bevacizumab-treated group (83.7%) over a period of 52 weeks compared with the control group (61.5%; P < 0.0001). In the bevacizumab-treated group, invasion area was reduced by 75.8% as compared with 46.5% in the control group. The vessel area was similar at 52 weeks postprocedure in cases of first (3.54% ± 1.21%) and repeat (3.80% ± 0.40%) corneal transplantation in patients who received bevacizumab treatment. In the vehicle-treated patients, the vessel area was significantly higher in repeat (9.76% ± 0.32%) compared with first (8.06% ± 1.02%; P < 0.0001) penetrating keratoplasty. In the bevacizumab treatment group, invasion areas at week 52 were comparable in first (11.70% ± 3.38%) and repeat (11.64% ± 1.74%) procedures, whereas invasion area was significantly higher in repeat (27.87% ± 2.57%) as compared with first (24.11% ± 2.17%) penetrating keratoplasty in vehicle-treated patients. Conclusions In patients undergoing vascularized high-risk corneal transplantation, bevacizumab is efficacious in reducing vascularization of corneal graft and host bed, thereby reducing the risk of corneal graft rejection in vascularized host beds. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Thomas H. Dohlman
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Rohan Bir Singh
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Francisco Amparo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tatiana Carreno-Galeano
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Mohammad Dastjerdi
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Giulia Coco
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Antonio Di Zazzo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Hasanain Shikari
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ujwala Saboo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Kimberly Sippel
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Jessica Ciralsky
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Matheus Sticca
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tais H. Wakamatsu
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Somasheila Murthy
- Cornea Service, The Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Pedram Hamrah
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Ula Jurkunas
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Joseph B. Ciolino
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Hajirah Saeed
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jose A.P. Gomes
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Victor L. Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Foster Center for Ocular Immunology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Jia Yin
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Reza Dana
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Wu D, Chan KE, Lim BXH, Lim DKA, Wong WM, Chai C, Manotosh R, Lim CHL. Management of corneal neovascularization: Current and emerging therapeutic approaches. Indian J Ophthalmol 2024; 72:S354-S371. [PMID: 38648452 DOI: 10.4103/ijo.ijo_3043_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/25/2023] [Indexed: 04/25/2024] Open
Abstract
Corneal neovascularization (CoNV) is a sight-threatening condition affecting an estimated 1.4 million people per year, and the incidence is expected to rise. It is a complication of corneal pathological diseases such as infective keratitis, chemical burn, corneal limbal stem cell deficiency, mechanical trauma, and immunological rejection after keratoplasties. CoNV occurs due to a disequilibrium in proangiogenic and antiangiogenic mediators, involving a complex system of molecular interactions. Treatment of CoNV is challenging, and no therapy thus far has been curative. Anti-inflammatory agents such as corticosteroids are the mainstay of treatment due to their accessibility and well-studied safety profile. However, they have limited effectiveness and are unable to regress more mature neovascularization. With the advent of advanced imaging modalities and an expanding understanding of its pathogenesis, contemporary treatments targeting a wide array of molecular mechanisms and surgical options are gaining traction. This review aims to summarize evidence regarding conventional and emerging therapeutic options for CoNV.
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Affiliation(s)
- Duoduo Wu
- Department of Ophthalmology, National University Hospital, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Blanche Xiao Hong Lim
- Department of Ophthalmology, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dawn Ka-Ann Lim
- Department of Ophthalmology, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wendy Meihua Wong
- Department of Ophthalmology, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Charmaine Chai
- Department of Ophthalmology, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ray Manotosh
- Department of Ophthalmology, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chris Hong Long Lim
- Department of Ophthalmology, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Singapore Eye Research Institute, Singapore
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Jiang C, Yin X, Chang J, Liu G, Lu P. Topical Administration of Bevacizumab to Facilitate the Functional Filtering Bleb After Trabeculectomy in the Rabbit. J Ocul Pharmacol Ther 2023; 39:716-724. [PMID: 37669059 DOI: 10.1089/jop.2023.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Purpose: To evaluate the effects of bevacizumab in 3 different application methods, subconjunctival injection (SCI), hyaluronic acid retardant (HAR), and eye drop (ED), on attenuating scar formation in the filtering bleb. Methods: Trabeculectomy (TRAB) was performed on New Zealand rabbits. TRAB rabbits were intervened with bevacizumab SCI, HAR, ED, or mitomycin C, respectively. Intraocular pressure (IOP) of 1, 7, 14, and 28 days after TRAB was recorded, and the bleb survival rate was analyzed. Bleb height, area, and vascularization were evaluated using anterior segment optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) at 7, 14 and 28 days after surgery. A histopathology examination of the bleb tissue was performed. The expression levels of vascular endothelial growth factor (VEGF)-A, interleukin (IL)-1α, tumor necrosis factor-alpha (TNF-α), transforming growth factor-β1 (TGF-β1), and α-smooth muscle actin (α-SMA) were measured by Western blot. Results: Bevacizumab significantly reduced postoperative IOP and increased the survival of the filtering bleb, especially in the ED group. Less vascularization was shown in the SCI, HAR, and ED groups. Histopathological results showed the fewest levels of scarring and fibrosis in the ED group. The local VEGF-A, IL-1α, and TNF-α expression levels after bevacizumab ED were decreased, combined with suppression of TGF-β1 and α-SMA. Conclusions: Postoperative use of bevacizumab EDs was an effective application method for improving surgical outcomes after TRAB in rabbits. It might be effective in preventing scarring of the filtering bleb by antivascularization and anti-inflammation.
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Affiliation(s)
- Chun Jiang
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xue Yin
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiayu Chang
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gaoqin Liu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peirong Lu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, China
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Gore A, Kadar T, Cohen M, Gutman H, Gez R, Dachir S, Horwitz V. The use of aflibercept (VEGF trap) in mitigating sulfur mustard-induced corneal neovascularization in a rabbit model. Toxicol Rep 2023; 10:206-215. [PMID: 36825253 PMCID: PMC9941054 DOI: 10.1016/j.toxrep.2023.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/29/2023] Open
Abstract
Sulfur mustard (SM)-induced ocular injury is characterized by an acute inflammatory response that may become chronic or enter a latent phase with delayed pathology. This study aimed to evaluate the efficacy of ziv-aflibercept and aflibercept in preventing and ameliorating corneal neovascularization (NV), respectively, following chemical eye exposure to SM vapor in a rabbit model. Chemical SM ocular insult was induced in the right eye of rabbits. A single application of ziv-aflibercept was administered 2 h or 9 days post-exposure. A single subconjunctival aflibercept treatment in an ocular formulation was administered 4 weeks after SM vapor exposure and subsequent to an initial 1-week treatment with 0.1 % dexamethasone. Clinical monitoring was performed 5-12 weeks post-exposure, and digital corneal pictures were taken to assess the extent of NV. The rabbits were euthanized and the corneas were processed for histological assessment. Treatment with ziv-aflibercept 2 h and 9 days post-exposure moderately reduced insult severity and partially delayed or prevented corneal NV. Aflibercept application 4 weeks post-exposure significantly reduced the extent of NV for 8 weeks. The substantial decrease in existing corneal NV in this group was confirmed by histology. These results reveal the powerful anti-angiogenic efficacy of the VEGF-trap for ameliorating existing NV as opposed to preventing NV development, revealing the ability of this treatment to mitigate corneal NV.
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Addeen SZ, Oyoun Z, Alfhaily H, Anbari A. Outcomes of mitomycin C intravascular chemoembolization (MICE) in refractory corneal neovascularization after failed keratoplasty. Digit J Ophthalmol 2023; 29:9-13. [PMID: 37101562 PMCID: PMC10125729 DOI: 10.5693/djo.02.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Corneal neovascularization is a determinant of corneal graft survival and preservation of immune privilege after keratoplasty. We report the outcomes in 2 patients with failed corneal grafts who underwent mitomycin C (MMC) intravascular chemoembolization (MICE) in the affected eye. A 30-year-old woman with failed penetrating keratoplasty (PK) in the right eye was started on prednisolone acetate eyedrops. Graft sutures were removed, and bevacizumab was injected subconjunctivally. The eye remained intermittently painful, and MICE was performed on the main feeding vessel, with regression of the vessels apparent within the first day following the procedure. The second case was a 40-year-old man who had a history of repaired penetrating injury in the left eye followed by failed PK. Prednisolone acetate eyedrops were initiated, and corneal sutures were removed. The patient failed to improve with three subconjunctival injections of bevacizumab. MICE was performed, but in this case neovascularization did not regress until 20 weeks post-procedure. MMC is thought to inhibit vascular endothelial cell proliferation, but its use in corneal injection is debated. In these cases, MICE was not associated with any concerning adverse events.
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Affiliation(s)
- Sarah Zaher Addeen
- Department of Ophthalmology, Al Mouassat University Hospital, Damascus University, Damascus, Syria
- Correspondence: Sarah Zaher Addeen MD, FICO ()
| | - Ziad Oyoun
- Department of Ophthalmology, Al Mouassat University Hospital, Damascus University, Damascus, Syria
| | | | - Anas Anbari
- Department of Ophthalmology, Al Mouassat University Hospital, Damascus University, Damascus, Syria
- Department of Ophthalmology, Eastbourne District General Hospital, Eastbourne, United Kingdom
- Ophthalmology Unit, Kuwait Oil Company Hospital, Kuwait, Kuwait
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Zhang W, Schönberg A, Bock F, Cursiefen C. Posttransplant VEGFR1R2 Trap Eye Drops Inhibit Corneal (Lymph)angiogenesis and Improve Corneal Allograft Survival in Eyes at High Risk of Rejection. Transl Vis Sci Technol 2022; 11:6. [PMID: 35533080 PMCID: PMC9100603 DOI: 10.1167/tvst.11.5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess whether topical application of VEGFR1R2 Trap after corneal transplantation can impair corneal (lymph)angiogenesis and promote murine corneal allograft survival in eyes at high risk of rejection. Methods We used the murine model of suture-induced neovascularization and subsequent keratoplasty in eyes at high risk of rejection, which is an established model for local drug application. After transplantation, the mice were treated with either VEGFR1R2 Trap (aflibercept) or human IgG Fc as eye drops for 2 weeks (three times/d). Deposition of VEGFR1R2 Trap in corneal tissue was detected by immunohistochemistry. Two and 8 weeks after transplantation, corneal (lymph)angiogenesis was assessed morphometrically. Dendritic cells (DCs) and regulatory T cells (Tregs) in the draining lymph nodes (dLNs) were examined by flow cytometry. Allograft survival was determined by corneal graft opacity scores. Results Topically applied VEGFR1R2 Trap penetrated into corneal host and graft stroma after keratoplasty in eyes at high risk of rejection. Additional postsurgical corneal hemangiogenesis (P < 0.0001) and lymphangiogenesis (P < 0.01) as well as infiltrating CD45+ leukocytes (P < 0.001) and macrophages (P < 0.01) were significantly reduced in the VEGFR1R2 Trap group compared to controls. VEGFR1R2 Trap eye drops significantly decreased the frequency of total CD11c+ DCs (P < 0.01), as well as activated CD11c+MHC II+ DCs (P < 0.01) and CD11c+CD40+ DCs (P < 0.05). In contrast, the frequency of CD200R+ regulatory DCs (P < 0.05) and Tregs in dLNs (P < 0.01) was enhanced. Moreover, long-term allograft survival was also improved (P < 0.05). Conclusions Temporary, topical application of VEGFR1R2 Trap after corneal transplantation can achieve sufficient anti-VEGF activity, inhibit additional (lymph)angiogenesis, and significantly improve corneal allograft survival in eyes at high risk of rejection. Translational Relevance VEGFR1R2 Trap eye drops after transplantation present a new therapeutic option for patients undergoing corneal transplantation and are at high risk of graft rejection.
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Affiliation(s)
- Wei Zhang
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alfrun Schönberg
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Felix Bock
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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Initial outcomes of mitomycin intravascular chemoembolization (MICE) for corneal neovascularization. Int Ophthalmol 2022; 42:2407-2416. [PMID: 35099664 PMCID: PMC8801928 DOI: 10.1007/s10792-022-02240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
Purpose To report on the preliminary outcomes of mitomycin C (MMC) intravascular chemoembolization (MICE) for corneal neovascularization (NV). Methods This is a retrospective case series of three consecutive eyes that underwent MICE for progressive corneal NV with sight threatening lipid keratopathy. A 1.0 cc syringe was partially filled with MMC (0.4 mg/mL) and attached to a 33-gauge needle used to cannulate the vessels. The MMC (0.01–0.05 ml) was injected with enough retrograde hydrostatic force to fill efferent and afferent vessels. Follow-up ranged from 4 months to 1 year. Results Three eyes of three patients aged 59, 73 and 33 years were included. There were no intraoperative or postoperative complications associated with the MICE procedure. Patient 1 presented with progressive corneal NV and lipid keratopathy secondary to herpes zoster ophthalmicus (HZO) and a best-corrected spectacle visual acuity (BSCVA) of 20/100 Snellen. At one-year post-MICE, there was no recurrence (BSCVA was 20/20 Snellen). Patient 2 presented with idiopathic lipid keratopathy (BSCVA 20/50 Snellen). At four months post-MICE, there were no signs of recurrence (BSCVA 20/20 Snellen). Patient 3 presented with corneal NV and lipid keratopathy secondary to HZO (BSCVA 20/30 Snellen). At four months following two MICE treatments, resolution of the lipid keratopathy was noted (BSCVA 20/20 Snellen). Conclusions Preliminary findings suggest that MICE may be an additional modality for treating progressive corneal NV with lipid keratopathy. Larger comparative studies with longer follow-up are warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s10792-022-02240-6.
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Eski MT, Teberik K, Oltulu P, Ankaralı H, Kaya M, Alpay M. The effects of subconjunctival bevacizumab, ranibizumab, and aflibercept on corneal neovascularization. Hum Exp Toxicol 2022; 41:9603271221084674. [PMID: 35465742 DOI: 10.1177/09603271221084674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate the effects of subconjunctival bevacizumab, ranibizumab, and aflibercept in an experimental corneal neovascularization model. MATERIALS AND METHODS The eyes of 24 rats were chemically cauterized and randomly divided into four groups: bevacizumab group (0.05 mL/1.25 mg bevacizumab), ranibizumab group (0.05 mL/0.5 mg ranibizumab), aflibercept group (0.05 mL/1.25 mg aflibercept), and control group (0.05 mL saline solution). Plasma vascular endothelial growth factor (VEGF) levels were among the major measurement outcomes to assess corneal neovascularization. The collected plasmas were analyzed using the SIGMA RAB0511 Rat VEGF Elisa kit. The PCR technique and VEGF amplification procedures were used for molecular analysis. Each cornea was removed and histologically examined on day 21. Corneal images were evaluated by image analyzer software. RESULTS In the post-injection period, the number of major corneal arteries decreased significantly in the injection groups when compared to the control group (p = 0.037), but no statistically significant differences were noted among the injection groups (p > 0.05). The aflibercept group had the lowest area of neovascularization. Immunohistochemical staining revealed substantially lower VEGF percentages in neovascularized arteries of the injection groups than the control group (p = 0.015). In TUNEL staining, the mean TUNEL value (number/1hpf) was substantially greater in the control group than in the injection groups, but the mean TUNEL values were similar between the injection groups (p = 0.019, p > 0.05, respectively). No statistically significant differences were observed between the groups in terms of corneal surface area with increased cellularity, edema, and inflammation (p = 0.263). The mean plasma VEGF concentration in the control group was statistically greater than those in the injection groups (p = 0.001). CONCLUSION Subconjunctival bevacizumab, ranibizumab, and aflibercept crossed the blood and seemed to be effective in inhibiting corneal neovascularization without causing epitheliopathy in an experimental rat model compared to the controls. However, no significant results were noted between these three anti-VEGF molecules.
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Affiliation(s)
- M T Eski
- 498080Private Neon Hospital, Erzincan, Turkey
| | - Kuddusi Teberik
- Department of Ophthalmology, Medical School, 121595Duzce University, Duzce, Turkey
| | - Pembe Oltulu
- Department of Pathology, Faculty of Medicine, 226846Necmettin Erbakan University, Konya, Turkey
| | - Handan Ankaralı
- Department of Biostatistics and Medical Informatics, Medical School, 226842İstanbul Medeniyet University, Istanbul, Turkey
| | - Murat Kaya
- Department of Ophthalmology, Medical School, 121595Duzce University, Duzce, Turkey
| | - Merve Alpay
- Department of Medical Biochemistry, Faculty of Medicine, 121595Duzce University, Duzce, Turkey
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Muellerleile LM, Bernkopf M, Wambacher M, Nell B. Topical bevacizumab for the treatment of corneal vascularization in dogs: A case series. Vet Ophthalmol 2021; 24:554-568. [PMID: 34487608 PMCID: PMC9292418 DOI: 10.1111/vop.12931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/11/2021] [Accepted: 08/23/2021] [Indexed: 12/27/2022]
Abstract
Objective To evaluate the effect and safety of topical anti‐human vascular endothelial growth factor bevacizumab in dogs with persistent corneal vascularization. Animals studied Prospective case series of 15 adult dogs (20 eyes). Procedures Dogs received 0.25% bevacizumab eye drops BID for 28 days. Follow‐ups were scheduled 28 days and 6–7 months after treatment start. Macroscopic findings were scored for conjunctival hyperemia, chemosis, ocular discharge, corneal edema, vascularization, and pigmentation. Vascularized area was assessed by analyzing photographs using an imaging software. Results The treatment response was variable. Some cases showed a marked reduction in vascularized area and edema, while other eyes had subtle signs of improvement. Vascularization score decreased from 1.5 to 1.1 and vascularized area was reduced by 48.8% after 28 days. A thinning of vessels, consolidation of areal bleedings into fine vascular networks, decrease in distal vessel branching, and a change from blurry vascularized beds into demarcated thin vessels were observed. One dog developed a SCCED 6 months after the last bevacizumab administration. Two dogs died 4 and 4.5 months after the last bevacizumab administration, aged 16 and 12 years, respectively. In all events, a causal relationship is unlikely but cannot be ruled out with certainty. Conclusions Our findings suggest that topical 0.25% bevacizumab may be an effective treatment option for corneal vascularization in dogs. Further long‐term placebo‐controlled studies with larger patient cohorts are recommended to provide scientific evidence of efficacy and to investigate dosage, safety, possible use as a single treatment, and routes of administration.
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Affiliation(s)
- Lisa-Marie Muellerleile
- Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Michael Bernkopf
- E-Learning and New Media, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Michael Wambacher
- Hospital Pharmacy, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Barbara Nell
- Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
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Subconjunctival Aflibercept for the Treatment of Formed Corneal Neovascularization. Eye Contact Lens 2021; 47:180-184. [PMID: 32443011 DOI: 10.1097/icl.0000000000000709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of a single subconjunctival aflibercept injection on formed corneal neovascularization. METHODS A prospective clinical trial, conducted at a single tertiary medical center. Included were consecutive patients with corneal pathologies complicated by corneal neovascularization, who were candidates for anti-vascular endothelial growth factor treatment at the discretion of a cornea specialist. A single subconjunctival injection of 0.08 mL of Aflibercept (Eylea 25 mg/mL) was administered near the limbus in proximity to the areas of maximal pathological neovascularization. Follow-up visits were scheduled on days 7, 30, 60, and 90 following injection. Best-corrected visual acuity (BCVA), intraocular pressure, slitlamp examination, digital cornea photography, specular microscopy, and anterior-segment optical coherence tomography were documented at each visit. The images were graded by a masked observer for density, extent, and centricity of corneal vascularization. RESULTS Six eyes of six patients were analyzed. No clinically significant ocular or systemic adverse events were documented. No change was noted in extent, density, or centricity of corneal blood vessels at seven, 30, and 90 days after injection (P>0.1 for all time point comparisons, Friedman test). Best-corrected visual acuity fluctuated insignificantly in 5/6 patients during follow-up time, and objective but not subjective improvement of BCVA was noted in one patient with no concurrent change of neovascularization. The recruitment has therefore halted prematurely. CONCLUSIONS A single subconjunctival aflibercept injection seems to be well tolerated. However, it is ineffective for regressing formed corneal neovascularization.
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Intrastromal versus subconjunctival anti-VEGF agents for treatment of corneal neovascularization: a rabbit study. Eye (Lond) 2021; 35:3123-3130. [PMID: 33469129 DOI: 10.1038/s41433-020-01347-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/14/2020] [Accepted: 11/26/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine whether subconjunctival or intrastromal administration of anti-VEGF agents is more effective on suture-induced corneal neovascularization (CoNV) in rabbits. METHODS CoNV was induced in 48 eyes of 24 New Zealand white rabbits by using an 8/0 silk suture. On the 7th day after suturing, the rabbits were divided into four treatment groups as follows: six rabbits received subconjunctival bevacizumab (group 1), six rabbits received subconjunctival aflibercept (group 2), six rabbits received intrastromal bevacizumab (group 3) and six rabbits received intrastromal aflibercept (group 4). On the 7th and 14th days after suturing, the CoNV area was calculated by standardised analysis of photographs using the Image-J program. On the 14th day after suturing, all rabbits were sacrificed and then corneal tissue was harvested for the analysis of vascular endothelial growth factor (VEGF)-A, VEGF-B and placental growth factor (PIGF) levels. RESULTS On the 7th day after suturing, CoNV areas were 17.10 ± 2.98, 18.88 ± 3.78, 17.36 ± 4.52, 18.57 ± 4.16 and 17.31 ± 2.81 mm2 in the groups 1-4 and control group, respectively. On the 7th day after intervention and removal of suture, CoNV areas were 4.85 ± 1.99, 6.66 ± 1.73, 2.83 ± 1.08, 2.63 ± 1.16 and 11.93 ± 2.64 mm2 in the group 1-4 and control group, respectively. CoNV area was reduced by 88.1% and 82.5% in eyes receiving intrastromal aflibercept and bevacizumab, respectively (both p < 0.001), and by 64.5% and 69.9% in eyes receiving subconjunctival aflibercept and bevacizumab, respectively (both p = 0.001). CONCLUSION Intrastromal anti-VEGF therapy regressed CoNV more effectively than subconjunctival therapy regardless of the type of anti-VEGF agent.
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12
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Nicholas MP, Mysore N. Corneal neovascularization. Exp Eye Res 2020; 202:108363. [PMID: 33221371 DOI: 10.1016/j.exer.2020.108363] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022]
Abstract
The optical clarity of the cornea is essential for maintaining good visual acuity. Corneal neovascularization, which is a major cause of vision loss worldwide, leads to corneal opacification and often contributes to a cycle of chronic inflammation. While numerous factors prevent angiogenesis within the cornea, infection, inflammation, hypoxia, trauma, corneal degeneration, and corneal transplantation can all disrupt these homeostatic safeguards to promote neovascularization. Here, we summarize its etiopathogenesis and discuss the molecular biology of angiogenesis within the cornea. We then review the clinical assessment and diagnostic evaluation of corneal neovascularization. Finally, we describe current and emerging therapies.
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Affiliation(s)
- Matthew P Nicholas
- Flaum Eye Institute, University of Rochester Medical Center, 210 Crittenden Blvd., Rochester, NY, USA
| | - Naveen Mysore
- Flaum Eye Institute, University of Rochester Medical Center, 210 Crittenden Blvd., Rochester, NY, USA.
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13
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Muellerleile L, Tichy A, Nell B. Serum vascular endothelial growth factor changes and safety after topical anti-human VEGF antibody bevacizumab in healthy dogs. Vet Ophthalmol 2019; 22:600-606. [PMID: 30716185 PMCID: PMC6850477 DOI: 10.1111/vop.12628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/03/2018] [Accepted: 10/23/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate ocular and general safety of topical anti-human VEGF bevacizumab and the effect on serum vascular endothelial growth factor (VEGF) values in healthy dogs. PROCEDURES Nine university-owned beagles received 0.05 mL of 0.25% bevacizumab eyedrops (Avastin® , Roche) in one eye and 0.05 mL of 0.9% saline solution in the other eye as a control, administered at 12 hours intervals over a period of 28 days. Continuous monitoring for vital parameters and ocular examinations were conducted. Complete blood counts including hematology and coagulation parameters were performed before trial start as well as 24 hours, 7 days, and 28 days after trial start. Measurements of serum VEGF values were obtained using an ELISA-based approach at days 0, 7, and 28. The experiment was designed as a masked placebo-controlled study. RESULTS No clinical signs of ocular toxicity or systemic incompatibility were noted in any dog at any time point of the study. No signs of pain were present in any dog at any time point. All blood count values remained in normal clinical ranges without relevant variation. There was no significant change in mean serum VEGF values between day 0 and day 7 and between day 0 and day 28. CONCLUSIONS The results indicate that topical bevacizumab treatment is safe in healthy dogs. However, further studies are needed to assess safety and efficacy in diseased dogs with naturally occurring corneal neovascularization.
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Affiliation(s)
- Lisa‐Marie Muellerleile
- Department of Companion Animals and HorsesUniversity of Veterinary Medicine ViennaViennaAustria
| | - Alexander Tichy
- Department of Biomedical SciencesUniversity of Veterinary Medicine ViennaViennaAustria
| | - Barbara Nell
- Department of Companion Animals and HorsesUniversity of Veterinary Medicine ViennaViennaAustria
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14
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Luis de Redín I, Boiero C, Recalde S, Agüeros M, Allemandi D, Llabot JM, García-Layana A, Irache JM. In vivo effect of bevacizumab-loaded albumin nanoparticles in the treatment of corneal neovascularization. Exp Eye Res 2019; 185:107697. [PMID: 31228461 DOI: 10.1016/j.exer.2019.107697] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/28/2019] [Accepted: 06/11/2019] [Indexed: 02/07/2023]
Abstract
Corneal neovascularization (CNV) is associated with different ocular pathologies, including infectious keratitis, trachoma or corneal trauma. Pharmacological treatments based on the topical application of anti-VEGF therapies have been shown to be effective in the treatment and prevention of CNV. The aim of this work was to evaluate the effect of bevacizumab-loaded albumin nanoparticles in a rat model of CNV. Bevacizumab-loaded nanoparticles, either "naked" (B-NP) or coated with PEG 35,000 (B-NP-PEG), were administered once a day in the eyes of animals (10 μL, 4 mg/mL every 24 h) during 7 days. Bevacizumab and dexamethasone were employed as controls and administered at the same dose every 12 h. At the end of the study, the area of the eye affected by neovascularization was about 2-times lower for animals treated with B-NP than with free bevacizumab. In the study, dexamethasone did not demonstrate an inhibitory effect on CNV at the employed dose. All of these results were confirmed by histopathological analysis, which clearly showed that eyes treated with nanoparticles displayed lower levels of fibrosis, inflammation and edema. In summary, the encapsulation of bevacizumab in human serum albumin nanoparticles improved its efficacy in an animal model of CNV.
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Affiliation(s)
- Inés Luis de Redín
- Department of Chemistry and Pharmaceutical Technology, NANO-VAC Research Group, University of Navarra, Spain
| | - Carolina Boiero
- UNITEFA-CONICET, Department of Pharmacy, Faculty of Chemical Sciences (FCQ-UNC), National University of Córdoba, Argentina
| | - Sergio Recalde
- Experimental Ophthalmology Laboratory, University of Navarra, Navarra Institute for Health Research, IdiSNA, Spain
| | - Maite Agüeros
- Department of Chemistry and Pharmaceutical Technology, NANO-VAC Research Group, University of Navarra, Spain
| | - Daniel Allemandi
- UNITEFA-CONICET, Department of Pharmacy, Faculty of Chemical Sciences (FCQ-UNC), National University of Córdoba, Argentina
| | - Juan M Llabot
- UNITEFA-CONICET, Department of Pharmacy, Faculty of Chemical Sciences (FCQ-UNC), National University of Córdoba, Argentina
| | - Alfredo García-Layana
- Experimental Ophthalmology Laboratory, University of Navarra, Navarra Institute for Health Research, IdiSNA, Spain
| | - Juan M Irache
- Department of Chemistry and Pharmaceutical Technology, NANO-VAC Research Group, University of Navarra, Spain.
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15
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Eiger-Moscovich M, Livny E, Sella R, Gal-Or O, Nisgav Y, Livnat T, Bahar I. Comparison of Subconjunctival Aflibercept and Betamethasone for the Treatment of Formed Corneal Neovascularization in a Rabbit Model. Ophthalmic Res 2019; 62:116-122. [PMID: 31112967 DOI: 10.1159/000499165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
Abstract
AIM To compare the efficacy of aflibercept (Eylea®), a potent antivascular endothelial growth factor (VEGF) agent, with betamethasone (Celestone®) and placebo for the treatment of formed corneal neovascularization in a rabbit model. METHODS A central corneal chemical burn was created in the right eye of 24 New Zealand albino rabbits. Four weeks later, the rabbits were randomly divided into 4 equal groups for subconjunctival injection of aflibercept, betamethasone, aflibercept+ betamethasone, or saline (control). Digital photographs taken at weekly intervals were rated by 2 masked observers for extent, centricity, and density of corneal neovascularization according to a predefined scale. The percentage of corneal surface involved by neovascularization was quantified by image analysis software (Fiji-J). The change in corneal neovascularization from treatment administration (4 weeks after injury) to 4 weeks later (8 weeks after injury) was assessed. The rabbits were then euthanized, and their eyes were enucleated and processed for histopathological and immunofluorescence studies. RESULTS There was no significant difference in the change in corneal neovascularization after treatment among the 4 groups according to the digital images (p > 0.15) or histological evaluation with hematoxylin and eosin (p > 0.08). On immunofluorescence assay, a lower VEGF concentration was observed in all treatment groups compared to the control group. CONCLUSIONS In this rabbit model, corneal neovascularization induced by chemical burn failed to regress with treatment with aflibercept, betamethasone, or their combination.
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Affiliation(s)
- Maya Eiger-Moscovich
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel, .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Eitan Livny
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruti Sella
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Gal-Or
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Yael Nisgav
- Laboratory of Eye Research, Felsenstein Medical Research Center, Beilinson Hospital, Petach Tikva, Israel
| | - Tami Livnat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Laboratory of Eye Research, Felsenstein Medical Research Center, Beilinson Hospital, Petach Tikva, Israel
| | - Irit Bahar
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Muellerleile LM, Buxbaum B, Nell B, Fux DA. In-vitro binding analysis of anti-human vascular endothelial growth factor antibodies bevacizumab and aflibercept with canine, feline, and equine vascular endothelial growth factor. Res Vet Sci 2019; 124:233-238. [PMID: 30933891 DOI: 10.1016/j.rvsc.2019.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/20/2019] [Accepted: 03/21/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Promising results have been described for antibodies binding vascular endothelial growth factor (VEGF) in patients with corneal neovascularization. Whether veterinary patients would also benefit from this therapeutic approach has not been investigated yet. We examined binding properties of anti-human VEGF antibodies bevacizumab (Avastin®) and aflibercept (Zaltrap®) for canine, feline, and equine VEGF. METHODS Human, equine, feline, and canine VEGF were analyzed for sequence similarity using the "Basic Local Alignment Search Tool" (BLAST). Western-blot analysis and ELISA were used to assess binding properties. RESULTS BLAST analysis revealed a sequence homology of canine, feline, and equine VEGF to human VEGF-A of 93%, 92%, and 89%, respectively. Western-blot analysis showed immunoreactivity of bevacizumab with human, canine, and feline VEGF, but not with equine VEGF. Aflibercept recognized VEGF of all tested species. ELISA data indicated that bevacizumab and aflibercept bind canine VEGF in a dose-dependent manner. Feline VEGF was bound by bevacizumab and aflibercept in a dose-independent manner. ELISA study further confirmed the lack of bevacizumab binding to equine VEGF, and yielded also a dose-independent binding by aflibercept. CONCLUSIONS Bevacizumab and aflibercept turned out to bind VEGF with species-specific differences. Further studies are required to investigate their efficacy and safety under clinical conditions.
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Affiliation(s)
- Lisa-Marie Muellerleile
- Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Austria.
| | - Bernhard Buxbaum
- Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Austria
| | - Barbara Nell
- Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Austria.
| | - Daniela A Fux
- Department for Biomedical Sciences, Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, Austria.
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17
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Aksoy S. Treatment of corneal neovascularization with topical aflibercept in a case of exposure keratopathy following cerebellar astrocytoma surgery. Indian J Ophthalmol 2018; 67:145-147. [PMID: 30574927 PMCID: PMC6324144 DOI: 10.4103/ijo.ijo_418_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this report, we report the case of a 7-year-old boy with corneal neovascularization due to exposure keratopathy following cerebellar astrocytoma surgery. Corneal surface healing was achieved with topical treatment and therapeutic contact lens, after which topical steroid was administered for stromal haze and corneal neovascularization. After 2 months of steroid therapy failed, corneal neovascularization responded well to topical aflibercept administration, showing complete regression.
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Affiliation(s)
- Sibel Aksoy
- Department of Ophthalmology, Saglik Bilimleri University, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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18
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Wang JK, Huang TL, Chang PY, Chen YT, Chang CW, Chen FT, Hsu YR, Chen YJ. Intravitreal aflibercept versus bevacizumab for treatment of myopic choroidal neovascularization. Sci Rep 2018; 8:14389. [PMID: 30258077 PMCID: PMC6158246 DOI: 10.1038/s41598-018-32761-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/13/2018] [Indexed: 12/13/2022] Open
Abstract
The authors performed a retrospective and comparative study to compare the efficacy of intravitreal aflibercept and bevacizumab for patients with myopic choroidal neovascularization (mCNV). The patients with treatment-naïve mCNV received 1 + PRN intravitreal bevacizumab from March 2008 to February 2013, while from March 2013 to July 2016 patients were treated by 1 + PRN intravitreal aflibercept, all with monthly follow-up for 12 months. Primary outcome measures included change in central foveal thickness (CFT) in 1 mm by spectral-domain optic coherence tomography, and best corrected visual acuity (BCVA) at month 12. Complications after injections were recorded. The intra-group changes in CFT and BCVA were compared with Wilcoxon signed rank test, the between-group difference compared with Wilcoxon rank sum test. Fisher's exact test was used for categorical comparison between groups. Seventy-eight eyes of 78 patients were collected. There were 42 eyes in bevacizumab group, with mean age of 53.2 ± 5.4 years and 27 female patients of them. The mean BCVA significantly improved from baseline 0.56 ± 0.35 logMAR to 0.35 ± 0.35 logMAR at Month 12 after bevacizumab treatment (p < 0.001). The mean CFT significantly decreased from baseline 315.3 ± 25.6 μm to 253.7 ± 24.4 μm at Month 12 following intravitreal bevacizumab (p < 0.001). There were 36 eyes in aflibercept group, with mean age of 52.8 ± 6.8 years and 24 female patients of them. The mean BCVA significantly improved from baseline 0.61 ± 0.47 logMAR to 0.38 ± 0.41 logMAR at Month 12 after aflibercept treatment (p < 0.001). The mean CFT significantly decreased from baseline 328.2 ± 19.8 μm to 241.8 ± 27.2 μm at Month 12 following intravitreal aflibercept (p < 0.001). The baseline demographics, lens status, axial length, refractive errors, duration of symptoms, BCVA, and CFT did not differ significantly between groups (p > 0.05). There was no significant difference between bevacizumab and aflibercept groups in BCVA and CFT from Month 1 to Month 12 (p > 0.05). Injection number of aflibercept was 2.11 ± 0.41, less than that of bevacizumab (3.23 ± 0.38) during 12-month period (p = 0.01). There were no systemic thromboembolic event, elevated intraocular pressure, retinal detachment, or infectious endophthalmitis following injections in both groups. We concluded that both aflibercept and bevacizumab can effectively treat choroidal neovascularization in high myopes. Intravitreal aflibercept had similar efficacy but less treatment number than bevacizumab for mCNV during 12-month period.
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Affiliation(s)
- Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan. .,Department of electrical engineering, Yuan Ze University, Taoyuan City, Taiwan. .,Department of Medicine, National Yang Ming University, Taipei City, Taiwan. .,Department of Healthcare Administration and Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan. .,Department of Medicine, National Taiwan University, Taipei City, Taiwan.
| | - Tzu-Lun Huang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of electrical engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Pei-Yao Chang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Yen-Ting Chen
- Department of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Chin-Wei Chang
- Department of Medicine, National Yang Ming University, Taipei City, Taiwan
| | - Fang-Ting Chen
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Yung-Ray Hsu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Yun-Ju Chen
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, National Taiwan University, Taipei City, Taiwan
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19
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Gore A, Horwitz V, Cohen M, Gutman H, Cohen L, Gez R, Kadar T, Dachir S. Successful single treatment with ziv-aflibercept for existing corneal neovascularization following ocular chemical insult in the rabbit model. Exp Eye Res 2018; 171:183-191. [PMID: 29548928 DOI: 10.1016/j.exer.2018.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/11/2018] [Accepted: 03/11/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the efficacy of ziv-aflibercept as a treatment for established corneal neovascularization (NV) and to compare its efficacy to that of bevacizumab following ocular chemical insult of sulfur mustard (SM) in the rabbit model. METHODS Chemical SM burn was induced in the right eye of NZW rabbits by vapor exposure. Ziv-aflibercept (2 mg) was applied once to neovascularized eyes by subconjunctival injection while subconjunctival bevacizumab (5 mg) was administered twice a week, for 3 weeks. Non-treated exposed eyes served as a control. A clinical follow-up employed by slit-lamp microscope, was performed up to 12 weeks following exposure and digital photographs of the cornea were taken for measurement of blood vessels length using the image analysis software. Eyes were taken for histological evaluation 2, 4 and 8 weeks following treatment for general morphology and for visualization of NV, using H&E and Masson Trichrome stainings, while conjunctival goblet cell density was determined by PAS staining. RESULTS Corneal NV developed, starting as early as two weeks after exposure. A single subconjunctival treatment of ziv-aflibercept at 4 weeks post exposure, significantly reduced the extent of existing NV already one week following injection, an effect which lasted for at least 8 weeks following treatment, while NV in the non-treated exposed eyes continued to advance. The extensive reduction in corneal NV in the ziv-aflibercept treated group was confirmed by histological evaluation. Bevacizumab multiple treatment showed a benefit in NV reduction, but to a lesser extent compared to the ziv-aflibercept treatment. Finally, ziv-aflibercept increased the density of conjunctival goblet cells as compared to the exposed non-treated group. CONCLUSIONS Subconjunctival ziv-aflibercept single treatment presented a highly efficient long-term therapeutic benefit in reducing existing corneal NV, following ocular sulfur mustard exposure. These findings show the robust anti-angiogenic efficacy of ziv-aflibercept and demonstrate the advantage of this treatment over the other anti-angiogenic therapies in ameliorating corneal NV and protecting the ocular surface.
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Affiliation(s)
- Ariel Gore
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel.
| | - Vered Horwitz
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Maayan Cohen
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Hila Gutman
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Liat Cohen
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Rellie Gez
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Tamar Kadar
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Shlomit Dachir
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
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Claros-Chacaltana FDY, Kobashigawa KK, Padua IRM, Valdetaro GP, Aldrovani M, Laus JL. Corneal angiogenesis based on different protocols of alkaline cauterization in murine models. Acta Cir Bras 2017; 32:607-616. [PMID: 28902936 DOI: 10.1590/s0102-865020170080000002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/18/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose: To establish and compare protocols of alkaline cauterization for inducing corneal angiogenesis in murine models. Methods: Twenty-four adult Wistar rats were distributed into four groups (G1, G2, G3, and G4). The right eye cornea from each rat was cauterized using filter paper (3 mm), soaked in a solution of silver and potassium nitrates (3:1). Cauterization times were 10 (G1 and G4), or 20 seconds (G2 and G3). Cauterized corneas were washed with Ringer's lactate solution. The filter paper was either removed before washing (G1 and G2), or kept on the corneas (G3 and G4). Corneas were photographed at multiple time points (2, 4, 6, 8, 11, 13, and 15 days after the procedure), and neovascularization parameters were assayed. Results: Neovascularization was observed in 66% of G1 corneas, and 100% of G2, G3, and G4 corneas. On day 15, G1 corneas showed smaller vascularized areas (12.63 ± 12.59%) compared to those in the G3 (41.95 ± 17.32%) and G4 (33 ± 11.74%) (P < 0.05) groups. Conclusions: The silver and potassium nitrate solution effectively induced corneal angiogenesis. The G2, G3, and G4 protocols showed excellent reproducibility, and induced vascularization in 100% of corneas.
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Affiliation(s)
- Flor Diana Yokoay Claros-Chacaltana
- MSc, Fellow PhD degree, Ophthalmology Unit, Department of Veterinary Clinical Medicine and Surgery, Faculty of Agrarian and Veterinary Sciences, Universidade Esatdual de São Paulo, FCAV-UNESP, Jaboticabal-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; manuscript writing
| | - Karina Kamachi Kobashigawa
- MS, Fellow PhD degree, Ophthalmology Unit, Department of Veterinary Clinical Medicine and Surgery, Faculty of Agrarian and Veterinary Sciences, FCAV-UNESP, Jaboticabal-SP, Brazil. Acquisition, analysis and interpretation of data; critical revision
| | - Ivan Ricardo Martinez Padua
- PhD, Ophthalmology Unit, Department of Veterinary Clinical Medicine and Surgery, Faculty of Agrarian and Veterinary Sciences, FCAV-UNESP, Jaboticabal-SP, Brazil. Acquisition of data, critical revision
| | - Gisele Pereira Valdetaro
- MS, Ophthalmology Unit, Department of Veterinary Clinical Medicine and Surgery, Faculty of Agrarian and Veterinary Sciences, FCAV-UNESP, Jaboticabal-SP, Brazil. Acquisition of data, critical revision
| | - Marcela Aldrovani
- PhD, Ophthalmology Unit, Department of Veterinary Clinical Medicine and Surgery, Faculty of Agrarian and Veterinary Sciences, FCAV-UNESP, Jaboticabal-SP, Brazil. Analysis and interpretation of data, critical revision, final approval
| | - José Luiz Laus
- PhD, Associate Professor, Ophthalmology Unit, Department of Veterinary Clinical Medicine and Surgery, Faculty of Agrarian and Veterinary Sciences, FCAV-UNESP, Jaboticabal-SP, Brazil. Critical revision, final approval
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21
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Kang S, Choi H, Rho CR. Differential Effects of Bevacizumab, Ranibizumab, and Aflibercept on the Viability and Wound Healing of Corneal Epithelial Cells. J Ocul Pharmacol Ther 2016; 32:671-676. [PMID: 27827554 DOI: 10.1089/jop.2016.0094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE This study compared the effects of 3 antivascular endothelial growth factor (VEGF) agents (bevacizumab, ranibizumab, and aflibercept) on corneal epithelial cell viability and wound healing using human corneal epithelial cells (HCECs). METHODS To determine the cytotoxic effects of anti-VEGF agents on HCECs, HCEC viability was determined at various concentrations of these agents. An in vitro migration assay was used to investigate the migration of HCECs treated with 3 anti-VEGF agents. The protein level of extracellular signal-regulated kinase was used to evaluate the effect of anti-VEGF treatment on cell proliferation. The protein levels of p38 mitogen-activated protein kinase (MAPK) were analyzed by Western blotting to investigate cell migration. RESULTS After 24 or 48 h of exposure, aflibercept treatment showed no apparent effect on cell viability; however, bevacizumab and ranibizumab treatment decreased cell viability at high concentrations (1 and 2 mg/mL). A migration assay showed that HCEC migration was different among the 3 anti-VEGF treatment groups. Bevacizumab significantly delayed HCEC migration. Western blotting showed that bevacizumab treatment decreased the expression levels of phosphorylated p38 MAPK. CONCLUSIONS Bevacizumab, the most widely used and investigated anti-VEGF agent, decreased epithelial cell migration and viability. Anti-VEGF agents other than bevacizumab might therefore be better for treating corneal neovascularization complicated with epithelial defects.
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Affiliation(s)
- Seungbum Kang
- 1 Department of Ophthalmology and Visual Science, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,2 Clinical Research Institute, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Daejeon, Republic of Korea
| | - Hyunsu Choi
- 2 Clinical Research Institute, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Daejeon, Republic of Korea
| | - Chang Rae Rho
- 1 Department of Ophthalmology and Visual Science, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,2 Clinical Research Institute, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Daejeon, Republic of Korea
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