Ação do bevacizumabe subconjuntival na neovascularização e re-epitelização corneana 25 dias após queimadura química

Abstract

Nota Editorial: Depois de concluída a análise do artigo sob sigilo editorial e com a anuência do Dr. Vinícius Coral Ghanem e Procópio Miguel dos Santos sobre a divulgação de seu nome como revisor, agradecemos sua participação neste processo.Ação do bevacizumabe subconjuntival na neovascularização e re-epitelização corneana 25 dias após queimadura química ABSTRACT Purposes:To evaluate the effect of subconjunctival bevacizumab in an experimental model of neovascularization in rabbit cornea. Determine its effect on vessels extension, inflammation, epithelialization of the cornea and whether the evaluation method used is appropriate to compare neovascular models. Methods: Experimental, prospective, randomized, blinded study in twenty rabbits subjected to chemical trauma with sodium hydroxide at 1N divided into two groups. The study group received subconjunctival injection of 0.15 ml (3.75 mg) of bevacizumab and was compared with the control group that received subconjunctival injection of 0.15 ml saline solution. After 25 days, digital photographic analysis was performed to assess the vessel's extension and inflammation/diameter according to pre-established criteria. Histopathology of the cornea, which evaluated the state of the epithelium and the number of polymorphonuclear cells was also studied. Results:The length of the neovessels was greater in the control group compared to the study group (P=<0.001). There was no difference in inflammation/vessel diameter between groups. Histopathology analysis showed that there was no difference between groups for the variables state of the epithelium and number of polymorphonuclear cells. The concordance analysis for the variable extension of the vessels and the variable inflammation/vessel diameter was estimated with Kappa coefficients of 0.705 and 0.500 respectively, indicating a good level of agreement in different evaluations and validating the method. Conclusions:The experimental model is adequate and can be reproduced to evaluate other drugs in the cornea. Bevacizumab inhibit the neovessels' growth but was not effective in preventing the inflammatory response. The drug did not delay the reepithelialization of the cornea.

Treating corneal neovascularization using a combination of anti-VEGF injection and argon laser photocoagulation application - case report

“…The pathogenesis of NVK begins with a precursor lesion, which precipitates dilation of the prelimbic vessels, followed by recruitment of leukocytes and release of growth factors that stimulate the increase in vascular permeability of the endothelium and degradation of the extracellular matrix, enabling the migration of these cells to the cornea, where the new vessels will form [ 4 ].…”

“…There is a strong expression of vascular endothelial growth factor (VEGF) in neovascularized corneas, which also occurs in other ocular pathologies such as age-related macular degeneration and diabetic retinopathy. AVEGF has been used as a treatment for these diseases since 2005 and is safe for ocular use, including for most recent corneal neovascular pathologies [ 4 ].…”

“…Photocoagulation (FCG) with argon laser is an angio-occlusive component, usually applied in association with bevacizumab; studies show that the drug’s effect is greater when simultaneously applied to chemical cauterization [ 4 ]. PAL is a safe method, but it can cause complications related to inflammatory overload, in addition to causing iris atrophy, pupil ectasia, and hemorrhages [ 8 ].…”

“…This culminates in edema and infiltrates, which reduce the transparency of the cornea and, consequently, visual acuity. In addition, neovessels favor the rejection of corneal transplantation due to the easy access of antigen-presenting cells to donor tissue [ 4 ]. NVK is the leading cause of corneal blindness in the world (trachoma) and in industrialized countries (herpetic keratitis) [ 5 ].…”