Hamdan J, Boulze M, Aziz A, Alessi G, Hoffart L
Service d'ophtalmologie, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
Service d'ophtalmologie, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
J Fr Ophtalmol. 2015 Dec;38(10):924-33. doi: 10.1016/j.jfo.2015.06.006. Epub 2015 Oct 29.
To evaluate and compare the efficacy of subconjunctival bevacizumab injections alone, photodynamic therapy alone and combined treatments for reduction of corneal neovascularization.
This study was conducted as a prospective case series. A total of seven eyes of 7 patients with corneal neovascularization caused by ocular surface disorders including fungal infectious keratitis and penetrating keratoplasty were included in the study. Patients were randomized into the three following groups: patients in group A received a single subconjunctival injection of 10mg (0.4mL) of bevacizumab, patients in group B were treated with photodynamic therapy with verteporfin (6mg/m(2)) to the neovascularized area and those in group C received a subconjunctival injection of bevacizumab and photodynamic therapy 7 days later. Morphological changes in neovascularization were evaluated over 6 months using slit-lamp biomicroscopy and digital corneal photography. A computer-assisted semi-automatic analysis of the area of corneal neovascularization was performed with Image J software.
Recession of corneal vessels was observed in all eyes at 1 month post-treatment. The neovascularized surface area in all groups combined showed a decrease in the first month after treatment and this decrease continued up to the 6th month. The surface area of corneal neovascularization decreased by 34.05±8.28% in group A (subconjunctival injection of bevacizumab), by 42.06±28.36% in group B (photodynamic therapy with verteporfin) and by 51.67±18.93% in group C (combined subconjunctival injection of bevacizumab and photodynamic therapy). A combined treatment consisting of a subconjunctival injection followed by a PDT session 7 days later might be more effective for the treatment of corneal neovascularisation. No serious local or systemic adverse events were observed.
Our medium-term results suggest that combined subconjunctival injection of bevacizumab and photodynamic therapy with verteporfin might be used safely and effectively to reduce corneal neovascularization surface. This combined therapy may show a tendency toward greater efficacy than the individual monotherapies. Controlled prospective randomized multicentric trials with a larger sample size are necessary to assess long-term efficacy and to confirm these results.
评估并比较单纯结膜下注射贝伐单抗、单纯光动力疗法以及联合治疗减少角膜新生血管的疗效。
本研究为前瞻性病例系列研究。纳入7例因眼表疾病（包括真菌性感染性角膜炎和穿透性角膜移植术）导致角膜新生血管的患者的7只眼。患者被随机分为以下三组：A组患者接受一次结膜下注射10mg（0.4mL）贝伐单抗；B组患者对新生血管区域采用维替泊芬（6mg/m²）进行光动力治疗；C组患者先结膜下注射贝伐单抗，7天后进行光动力治疗。使用裂隙灯生物显微镜和角膜数码摄影在6个月内评估新生血管的形态学变化。使用Image J软件对角膜新生血管面积进行计算机辅助半自动分析。
治疗后1个月时，所有眼均观察到角膜血管退缩。所有组联合的新生血管表面积在治疗后的第一个月有所减少，且这种减少持续至第6个月。A组（结膜下注射贝伐单抗）角膜新生血管表面积减少了34.05±8.28%，B组（维替泊芬光动力治疗）减少了42.06±28.36%，C组（结膜下注射贝伐单抗联合光动力治疗）减少了51.67±18.93%。结膜下注射后7天进行光动力治疗的联合治疗可能对角膜新生血管的治疗更有效。未观察到严重的局部或全身不良事件。
我们的中期结果表明，结膜下注射贝伐单抗与维替泊芬光动力疗法联合使用可能安全有效地减少角膜新生血管表面积。这种联合疗法可能比单独的单一疗法显示出更高的疗效趋势。需要进行样本量更大的对照前瞻性随机多中心试验来评估长期疗效并证实这些结果。
