Efficiency and safety of subconjunctival injection of anti-VEGF agent – bevacizumab – in treating dry eye

Abstract

PurposeDry eye is a chronic inflammatory ocular surface disease with high prevalence. The current therapies for dry eye remain to be unspecific and notcomprehensive. This study aims to explore safety and efficacy of a novel treatment – subconjunctival injection of bevacizumab – in dry eye patients.MethodsSixty-four eyes of 32 dry eye patients received subconjunctival injection of 100 μL 25 mg/mL bevacizumab. Dry eye symptoms, signs (corrected visual acuity, intraocular pressure, conjunctival vascularity, corneal staining, tear break-up time, Marx line score, and blood pressure), and conjunctival impression cytology were evaluated 3 days before and 1 week, 1 month, and 3 months after injection.ResultsSignificant improvements were observed in dry eye symptoms, tear break-up time, and conjunctival vascularization area at all the visits after injection compared to the baseline (P<0.05). The density of the goblet cell increased significantly at 1 month and 3 months after injection (P<0.05). There was no visual and systemic threat observed in any patient.ConclusionSubconjunctival injection of 100 μL 25 mg/mL bevacizumab is a safe and efficient treatment for ocular surface inflammation of dry eye disease.

Efficacy of topical bevacizumab 0.05% eye drops in dry eye disease: A double-masked, randomized trial

“…The improvements we observed in TBUT and OSDI results are in accordance with Jiang et al's study of subconjunctival bevacizumab injection in DED [2]. Improvement in corneal staining in the bevacizumab group in this study was not, however, in agreement with the Jiang et al study, but was consistent with Goyal et al's study showing improvement in corneal staining after intraperitoneal injections of anti-VEGF antibody in mice [7].…”

“…As a result, autoreactive Helper T cell (T H )17 and T H 1 cells, which are involved in DED immunopathogenesis, are generated in these lymphoid tissues [7]. Recently, VEGF has been studied, and anti-VEGF has been developed into various ophthalmic medications [2,8]. Bevacizumab, a monoclonal antibody to VEGF-A, prevents attachment of VEGF-A to its receptors [13].…”

“…Evidence of inflammation in DED has been shown as increased secretion of inflammatory cytokines, such as interleukin (IL)-1α, IL-1β, tumor necrosis factor α (TNFα) and vascular endothelial growth factor (VEGF), which leads to tear hyperosmolarity. Inflammation also causes neovascularization, which, in turn, produces more pro-inflammatory cytokines, making a vicious cycle [1][2][3][4]. Therefore, the definitive treatment for DED would be to remove one of the factors in this cycle.…”

“…Jiang et al found that patients with DED who underwent subconjunctival bevacizumab (anti-VEGF-A) injection had a better tear break-up time (TBUT) and fewer symptoms than did patients in a control group [2]. VEGF, acting as a pro-inflammatory cytokine, plays an important role in neovascularization and could promote other pro-inflammatory cytokines, such as TNFα and IL-6, in the process of inflammation [5].…”

Gene Delivery by Subconjunctival Injection of Adenovirus in Rats: A Study of Local Distribution, Transgene Duration and Safety

“…Similarly, subconjunctival injection provides additional benefits over traditional intravitreal or intravenous gene delivery routes; it is much less invasive and has been shown in previous animal studies to be a safe and efficient mode of gene therapy for different ocular diseases [ 19 – 21 ]. Despite this, the use of subconjunctival injection has been thought to be largely restricted to treatment of anterior segment eye diseases [ 22 – 24 ]. Our study is, to our knowledge, the first that accurately characterizes the local distribution and safety profile of adenovirus administered via subconjunctival injection in rat eyes.…”