Korean J Ophthalmol.  2013 Aug;27(4):235-242. 10.3341/kjo.2013.27.4.235.

The Effect of Bevacizumab versus Ranibizumab in the Treatment of Corneal Neovascularization: A Preliminary Study

• Kim JH
• Seo HW
• Han HC
• Lee JH
• Choi SK
• Lee D

• KMID: 1705418
• DOI: http://doi.org/10.3341/kjo.2013.27.4.235

Abstract

PURPOSE
To compare the short term effects of bevacizumab and ranibizumab injections on the regression of corneal neovascularization (NV).
METHODS
Sixteen eyes of 16 patients with corneal NV were randomly assigned for an injection with 2.5 mg of bevacizumab (group 1, n = 8) or 1 mg of ranibizumab (group 2, n = 8) through subconjunctival and intrastromal routes. The patients were prospectively followed-up for one month after the injections. Corneal NV areas, as shown on corneal slit-lamp photographs stored in JPEG format, were calculated using Image J software before the injection, one week after the injection, and one month after the injection. The corneal NV areas were compared before and after the injections.
RESULTS
Seven women and nine men, with an average age of 51 years, presented with corneal NV secondary to herpetic keratitis (7 cases), graft rejection (6), chemical burn (1), pemphigoid (1), and recurrent ulcer (1). In group I, the preoperative corneal NV area (8.75 +/- 4.33%) was significantly decreased to 5.62 +/- 3.86% one week after the injection and to 6.35 +/- 3.02% one month after the injection (p = 0.012, 0.012, respectively). The corneal NV area in group 2 also exhibited a significant change, from 7.37 +/- 4.33% to 6.72 +/- 4.16% one week after the injection (p = 0.012). However, no significant change was observed one month after the injection. The mean decrease in corneal NV area one month after injection in group 1 (28.4 +/- 9.01%) was significantly higher than in group 2 (4.51 +/- 11.64%, p = 0.001).
CONCLUSIONS
Bevacizumab injection resulted in a more effective and stable regression of corneal NV compared to the ranibizumab injection. The potency and dose of these two drugs for the regression of corneal NV require further investigation.

Keyword

Bevacizumab; Corneal neovascularization; Ranibizumab

MeSH Terms

Adult
Aged
Aged, 80 and over
Angiogenesis Inhibitors/*therapeutic use
Antibodies, Monoclonal, Humanized/*therapeutic use
Corneal Neovascularization/*drug therapy
Female
Humans
Male
Middle Aged
Pilot Projects
Prospective Studies
Treatment Outcome
Young Adult
Angiogenesis Inhibitors
Antibodies, Monoclonal, Humanized

Figure

• 

  Fig. 1 The measurement of corneal neovascularization (NV) area using the Image J program. We measured the area of the entire cornea (A) and the area of the new corneal vessels with its branches (B). The ratio of NV area was then calculated as a percentage of the entire corneal area.

• 

  Fig. 2 Areas of corneal neovascularization (NV; mean ± standard error, % value) in group 1 patients who received bevacizumab injections (A) and group 2 patients who received ranibizumab injections (B) before and after treatment. Pre, before injection; postoperative day (POD) 1 week, one week after injection; POD 1 month, one month after injection. (A) Group 1, *p = 0.012, **p = 0.012 by the Wilcoxon signed-rank test. (B) Group 2, *p = 0.012 by the Wilcoxon signed-rank test. A p-value <0.05 was considered statistically significant.

• 

  Fig. 3 A histogram showing a significant difference in the decrease in corneal neovascularization between group 1 (bevacizumab) and group 2 (ranibizumab) patients after treatment. postoperative day (POD) 1 week, one week after injection; POD 1 month, one month after injection. *p = 0.003 in POD 1 week, *p = 0.001 in POD 1 month; Mann-Whitney test. *A p-value <0.05 was considered statistically significant.

• 

  Fig. 4 Slit-lamp photographs of the cornea of patient 12, who failed to show regression of corneal neovascularization (NV) after ranibizumab injection but demonstrated measurable regression after bevacizumab injection. The associated graph and photographs show changes in the area of corneal neovascularization (% values) after each treatment. Pre-ranibizumab injection (A): before ranibizumab injection ([A] shows the slit-lamp image obtained at that time). Postoperative day (POD) 1 week: one week after ranibizumab injection. POD 1 month (B): one month after ranibizumab injection ([B] shows the slit-lamp image obtained at that time). Pre-bevacizumab injection (C): before bevacizumab injection, thus three months after the prior ranibizumab injection ([C] shows the aggravation of corneal NV in the slit-lamp image obtained at that time). POD 1 week: one week after bevacizumab injection. POD 1 month (D): one month after bevacizumab injection ([D] shows the remarkable regression of corneal NV in the slit-lamp image obtained at that time). (E) The graph shows changes in the area of corneal neovascularization (% values) after each treatment.

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