Department of Ophthalmology, Poostchi Ophthalmic Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 7134997446.
Cornea. 2012 Mar;31(3):322-34. doi: 10.1097/ICO.0b013e31822480f9.
To review the current literature concerning the use of bevacizumab in treating neovascular disorders affecting the anterior segment ocular structures.
The authors reviewed the literature on anti-vascular endothelial growth factor (VEGF) therapy with bevacizumab for various anterior segment neovascular disorders that was indexed in MEDLINE (up to January 2011).
Response to bevacizumab anti-VEGF therapy is variable, based on the amount of scarring, the chronicity and extent of corneal neovascularization, the disease process, and the medication formulation and its route of administration. Anti-VEGF agents are especially effective when administered early, before anatomical changes, such as corneal neovascularization and/or angle closure, are established. Neovascularization can recur if the ischemic or inflammatory process is not reversed, so eyes with long-standing diseases, such as autoimmune disorders that involve ongoing inflammation and VEGF production, seem to be less responsive to bevacizumab anti-VEGF therapy. For established neovascularization, combining anti-VEGF agents with the removal of established vessels may be more effective than anti-VEGF therapy alone. Subconjunctival bevacizumab may be more appropriate for focal, deep, and peripheral neovascularization, whereas diffuse superficial neovascularization with central corneal involvement may be best treated via topical application.
Besides the widely accepted use of bevacizumab in cancer therapy and chorioretinal neovascularization, the initial, striking, short-term response and patients' high tolerance of local bevacizumab therapy offer encouraging results for the potential role of anti-VEGF agents in treating anterior segment neovascular disorders. Controlled prospective trials are needed to establish the long-term safety, efficacy, and dosing guidelines for the use of anti-VEGF agents in anterior segment neovascularization.
回顾目前关于贝伐单抗治疗前部眼结构新生血管疾病的文献。
作者回顾了贝伐单抗治疗各种前部新生血管疾病的抗血管内皮生长因子（VEGF）治疗文献，这些文献均在 MEDLINE 中索引（截至 2011 年 1 月）。
根据瘢痕量、角膜新生血管化的慢性和程度、疾病过程以及药物制剂及其给药途径，贝伐单抗抗 VEGF 治疗的反应是不同的。在解剖学改变（如角膜新生血管化和/或房角关闭）确立之前，尽早给予抗 VEGF 药物治疗时，效果特别好。如果缺血或炎症过程没有逆转，新生血管化可能会复发，因此，对于慢性疾病，如涉及持续炎症和 VEGF 产生的自身免疫性疾病，眼部对贝伐单抗抗 VEGF 治疗的反应似乎较差。对于已确立的新生血管化，将抗 VEGF 药物与已建立的血管去除相结合可能比单独使用抗 VEGF 治疗更有效。结膜下贝伐单抗可能更适合于局灶性、深部和周边性新生血管化，而弥漫性浅层新生血管化伴中央角膜受累可能通过局部应用效果更好。
除了贝伐单抗在癌症治疗和脉络膜新生血管化中广泛应用外，局部应用贝伐单抗治疗的初始、显著、短期反应和患者高耐受性为抗 VEGF 药物治疗前部新生血管疾病提供了令人鼓舞的结果。需要进行对照前瞻性试验，以确定抗 VEGF 药物在前部新生血管化中的长期安全性、疗效和剂量指南。
