Blohm Klaas-Ole, Nell Barbara
Tierklinik Lüsche im SANAKENA, Appen-Etz, Germany.
Tierarztpraxis Schönhoff, Stendal, Germany.
Tierarztl Prax Ausg G Grosstiere Nutztiere. 2024 Apr;52(2):108-114. doi: 10.1055/a-2253-8103. Epub 2024 May 3.
A 17-year-old Appaloosa mare was referred for evaluation of presumed refractory keratitis of the left eye. Gross examination revealed ocular discomfort and corneal neovascularization with a nasal focal opacification affecting approximately 40% of the corneal surface. On ophthalmic examination, extensive subepithelial to mid-stromal vascular branching accompanied by a homogeneous white, dense opacification, which affected up to 80% of the total corneal thickness, were apparent. Signs of concurrent uveitis were absent. Deep-stromal lamellar keratectomy with a conjunctival pedicle graft was performed under general anesthesia. Histopathology confirmed a poorly differentiated corneal stromal invasive squamous cell carcinoma (SI-SCC) with neoplastic cell extension to the surgical margins. Postoperatively, 4 topical mitomycin C 0.04% chemotherapy cycles combined with oral firocoxib therapy were initiated. Seven months after surgery, regrowth of the SI-SCC was clinically suspected. A total volume of 1 ml bevacizumab 2.5% was administered in the standing sedated horse via 3 mid-stromal corneal injections. Four weeks later, intrastromal bevacizumab injections (ISBIs) were repeated, however, this time the solution was injected directly into the main corneal vessel branches.Seven weeks after the second ISBIs, the left eye was comfortable and significant remission of corneal vascularization and opacity was recognized. No recurrence has been noted for a follow-up period of more than 53 months.Equine SI-SCC usually has a very poor prognosis for globe maintenance. To the authors' knowledge this is the first report of well-tolerated intrastromal antivascular endothelial growth factor adjunctive therapy with bevazicumab 2.5% and SI-SCC resolution after a multimodal treatment approach.
一匹17岁的阿帕卢萨马因左眼疑似难治性角膜炎被转诊评估。肉眼检查发现眼部不适、角膜新生血管形成，伴有鼻侧局部混浊，累及约40%的角膜表面。眼科检查显示，广泛的上皮下至基质中层血管分支，伴有均匀的白色致密混浊，累及总角膜厚度的80%。未发现并发葡萄膜炎的迹象。在全身麻醉下进行了带结膜蒂移植的深层基质层角膜切除术。组织病理学证实为低分化角膜基质浸润性鳞状细胞癌（SI-SCC），肿瘤细胞延伸至手术切缘。术后，开始了4个周期的0.04%丝裂霉素C局部化疗联合口服非罗考昔治疗。术后7个月，临床怀疑SI-SCC复发。通过3次角膜基质中层注射，在站立镇静的马体内给予总量为1 ml的2.5%贝伐单抗。4周后，重复角膜基质内注射贝伐单抗（ISBIs），但这次溶液直接注射到主要角膜血管分支中。第二次ISBIs后7周，左眼舒适，角膜血管化和混浊明显缓解。在超过53个月的随访期内未发现复发。马的SI-SCC通常对眼球保留的预后非常差。据作者所知，这是第一份关于采用多模式治疗方法后，2.5%贝伐单抗角膜基质内抗血管内皮生长因子辅助治疗耐受性良好且SI-SCC消退的报告。
