Nguyen Chu Luan, Chen Tony S, Tran Khoi, Smith James E H, Lewis Noni
Department of Ophthalmology, Royal North Shore Hospital, Sydney, NSW, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Case Rep Ophthalmol Med. 2018 Jun 5;2018:2602487. doi: 10.1155/2018/2602487. eCollection 2018.
To report the efficacy of subconjunctival triamcinolone (Kenalog A-40, Alcon) and bevacizumab (Avastin, Genentech) injections in fraternal twins with blepharokeratoconjunctivitis (BKC) causing progressive, bilateral corneal neovascularization and scarring.
In this retrospective observational case series, two three-year-old male twins with BKC had presented with bilateral red eyes, photophobia, and frequent blinking. Examination of each child showed bilateral deep stromal and superficial corneal neovascularization, corneal infiltrates, multiple follicles on the palpebral conjunctiva bilaterally with blepharitis, and thick turbid sebum expressed from the Meibomian glands. Their disease progressed despite conventional treatment. Both twins were managed with subconjunctival triamcinolone injection and subconjunctival bevacizumab injection of each eye.
The treatment resulted in improvement of symptoms, and examination over an 8-10-month period postinjections showed fading stromal corneal infiltrates, partially regressed corneal neovascularization, and reduced conjunctival injection without complications.
This case series highlights the potential vision threatening complications of BKC. In addition to conventional management options, this report is the first published use of subconjunctival triamcinolone and bevacizumab injections for BKC in children in an attempt to minimize and improve corneal neovascularization and scarring and subsequently to retain useful vision.
报告结膜下注射曲安奈德（康宁克通A - 40，爱尔康公司）和贝伐单抗（阿瓦斯汀，基因泰克公司）对患有睑角膜结膜炎（BKC）并导致进行性双侧角膜新生血管形成和瘢痕的异卵双胞胎的疗效。
在这个回顾性观察病例系列中，两名患有BKC的三岁男性双胞胎出现双侧眼红、畏光和频繁眨眼症状。对每个孩子的检查显示双侧角膜深层基质和浅层新生血管形成、角膜浸润、双侧睑结膜多个滤泡伴睑缘炎，以及睑板腺排出的浓稠混浊皮脂。尽管进行了传统治疗，他们的病情仍在进展。两名双胞胎均接受了每只眼睛的结膜下曲安奈德注射和结膜下贝伐单抗注射治疗。
治疗使症状得到改善，注射后8 - 10个月的检查显示角膜基质浸润消退、角膜新生血管部分消退、结膜充血减轻，且无并发症。
该病例系列突出了BKC潜在的视力威胁性并发症。除了传统的治疗方法外，本报告首次发表了在儿童BKC中使用结膜下曲安奈德和贝伐单抗注射，试图减少并改善角膜新生血管形成和瘢痕，从而保留有用视力。
