Long-term outcome of using Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) as a drug delivery system for bevacizumab in the treatment of corneal neovascularization

Abstract

Purpose: To report the long-term outcome of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) for delivery of bevacizumab in the treatment of corneal neovascularization (KNV). Methods: Retrospective, non-comparative, interventional case series of 13 sequential patients treated for KNV at the BostonSight between 2006 and 2017. In all cases, PROSE treatment was initiated for management of ocular surface disease and patients wore PROSE consistently on a daily wear basis prior to bevacizumab treatment. Patients applied a drop of 1% preservative free bevacizumab to the reservoir of PROSE device twice daily. Patients continued with daily wear of the device during treatment and afterwards. Results: 13 patients (8 female and mean age of 45 years) are included with a mean follow-up of 5.1 years (range 6 months to 11 years). Underlying ocular diagnoses included Stevens- Johnson syndrome (7), ocular chronic graft-versus-host disease (2), corneal transplant (2), contact lens-related corneal ulcer and limbal stem cell deficiency (1), and familial dysautonomia (1). Median duration of bevacizumab use was 6 months (range 3 months to 10 years). Twelve cases (92%) had regression of KNV and 10 cases (77%) had improved best-corrected visual acuity (BCVA) with treatment. Median BCVA improved from −1.1 (LogMAR) at baseline, to −0.66 at end of bevacizumab treatment, and remained −0.63 at last follow-up (P=0.047). KNV progressed in one eye after discontinuation of bevacizumab. There were no ophthalmic or systemic complications. Conclusions: Topical bevacizumab used in PROSE is effective in treating KNV and improving vision. Long-term follow-up reveals durable response and no complications.

A Systematic Review of Potential Therapeutic Use of Lycium Barbarum Polysaccharides in Disease

“…The use of latanoprost-eluting contact lenses has already shown promising results in combating poor long-term drug compliance in glaucomatous optic neuropathy [41]. Furthermore, scleral contact lens systems have been used as a method to effectively deliver bevacizumab to the ocular surface as a method to treat sight-threatening corneal neovascularization [42].…”

The Limbal Niche and Regenerative Strategies

“…Other methods, including improving the tear film through autologous serum tears and protecting the corneal epithelium with scleral contact lenses, have shown promising results in reducing pain and enhancing vision [ 16 ]. Contact lenses have also been used as novel drug delivery devices [ 17 ]. These strategies are aimed at restoring the function of existing epithelial and stem cells to accelerate corneal healing [ 18 ].…”

Goals and Challenges of Stem Cell-Based Therapy for Corneal Blindness Due to Limbal Deficiency

“…The currently used protocols for treating neovessels are rarely successful [ 114 ] and could affect stem cell viability; thus, there is uncertainty about the most adequate timing of treatments. However, the encouraging protocol developed by Yin and Jacobs using the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) as a delivery system for topical bevacizumab has shown spectacular long-term results [ 115 ], and it may be applied to LSCD cases before cell transplantation or even after.…”