Schepens Eye Research Institute, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
Ocul Surf. 2012 Apr;10(2):67-83. doi: 10.1016/j.jtos.2012.01.005. Epub 2012 Jan 25.
Corneal avascularity is necessary for the preservation of optimal vision. The cornea maintains a dynamic balance between pro- and antiangiogenic factors that allows it to remain avascular under normal homeostatic conditions; however, corneal avascularity can be compromised by pathologic conditions that negate the cornea's "angiogenic privilege." The clinical relevance of corneal neovascularization has long been recognized, but management of this condition has been hindered by a lack of safe and effective therapeutic modalities. Herein, the etiology, epidemiology, pathogenesis, and treatment of corneal neovascularization are reviewed. Additionally, the authors' recent findings regarding the clinical utility of topical ranibizumab (Lucentis®) and bevacizumab (Avastin®) in the treatment of corneal neovascularization are summarized. These findings clearly indicate that ranibizumab and bevacizumab are safe and effective treatments for corneal neovascularization when appropriate precautions are observed. Although direct comparisons are not conclusive, the results suggest that ranibizumab may be modestly superior to bevacizumab in terms of both onset of action and degree of efficacy. In order to justify the increased cost of ranibizumab, it will be necessary to demonstrate meaningful treatment superiority in a prospective, randomized, head-to-head comparison study.
角膜无血管是保持最佳视力所必需的。角膜在促血管生成和抗血管生成因子之间保持着动态平衡，使其在正常的体内平衡条件下保持无血管状态；然而，角膜的“血管生成特权”可能会被否定其的病理条件所损害。角膜新生血管的临床相关性早已得到认可，但由于缺乏安全有效的治疗方法，这种疾病的治疗一直受到阻碍。本文回顾了角膜新生血管形成的病因、流行病学、发病机制和治疗方法。此外，作者还总结了最近关于局部应用雷珠单抗（Lucentis®）和贝伐单抗（Avastin®）治疗角膜新生血管的临床应用的发现。这些发现清楚地表明，雷珠单抗和贝伐单抗是安全有效的角膜新生血管治疗方法，只要观察到适当的预防措施。尽管直接比较尚无定论，但结果表明，雷珠单抗在作用开始和疗效程度方面可能略优于贝伐单抗。为了证明雷珠单抗的成本增加是合理的，有必要在一项前瞻性、随机、头对头的比较研究中证明其具有有意义的治疗优越性。
