Observation Of Subconjunctival Injection Of Ranibizumab Treatment Of Corneal Neovascularization Clinical Curative Effect

BackgroundThe normal corneal refractive device is colorless and transparent. Physical and chemical injury, inflammation, ischemia, hypoxia and other pathogenic factors destroyed the dynamic balance between angiogenic factors and anti angiogenic factors, resulting in corneal neovascularization (corneal neovascularization, CNV), affected the corneal transparence, resulting in decreased visual acuity. At the same time, CNV has changed the corneal "immune privilege" function, is a common risk factors rejection after corneal transplantation. Corneal neovascularization is one of the main causes of blindness, therefore, how to restrain and the treatment of corneal neovascularization is the hot spot in the current research of Department of ophthalmology.Studies indicate that, the over-expression of angiogenesis factor and the lack of expression of anti-angiogenesis factor is the main reason for the formation of CNV. In the process of CNV, Vascular endothelial growth factor (vascular endothelial growth factor, VEGF) play an important role. Suppress the VEGF expression is the key to the treatment of CNV. Anti-VEGF drugs to bring a new dawn for corneal neovascularization. VEGF inhibitor:Pegaptanib (Macugen), Bevacizumab (Avastin) and Ranibizumab (Lucentis), VEGF Trap-Eye/Aflibercept. A lot of basic research and clinical trials confirm Lucentis on fundus-neovascular disease clinical efficacy and good biological safety. In order to investigate the ranibizumab inhibiting corneal neovascularization, we carried out this study. ObjectiveTo explore the efficacy and safety of ranibizumab treatment of corneal neovascularization.MethodsProspective observation cases of patient with corneal neovascularization with subconjunctival injection of ranibizumab treated, a total of6eyes of7patients, followed up for1to6months. Topical anesthesia, along close to corneal limbal of the corneal neovascularization, conjunctival injection of ranibizumab (0.1ml0.5mg). Compared with before and after injection (1w,2w and4w) with visual acuity, intraocular pressure, the morphology of corneal neovascularization, corneal neovascularization area, corneal neovascularization caliber changes.Result1. The morphology of corneal neovascularization:subconjunctival injection of ranibizumab after1w,5eyes ciliary hyperemia alleviated,6eyes shorter length of corneal neovascularization, lumen thinning, reduced blood flow, part of the small vessels disappeared, corneal edema and opacity varying degrees of ease, of which1eyes vascular atrophy, vascular phantoms;2w, partial atrophy of blood vessels to regeneration, vessel length, diameter is slightly longer, thickening then1w;4w,5eyes with less vascular before injection,4eyes with thinning diameter,1eyes,progress then pre-injection.2. Vision:subconjunctival injection of ranibizumab can improve most of the visual acuities.After injection of1W,then pre-injection, increased1line in1eyes,3eyes improved3lines;2w, improved1line in2eyes, improve2lines in3eyes,1eyes improved4lines;4w, increased1lines in1eyes,1eyes improved2lines, improve the3lines in2eyes,1eyes improved4lines.3. CNV area and diameter:Lucentis can inhibit the progression of CNV.CNV area:after injection of1W, reduction of10%-15%in3eyes, reduction of30%-35%in1eye,1eye reduced by58.7%,and1eye reduced by78.6%;2w, reduction of6%-10%in2eyes, reduction of10%-15%in2eyes, reduction of25%-30%in2eyes;4w, reduction of1%-5%in1eye,2eyes reduced6%-10%, reduction of10%-15%in1eye, reduction of20%-25%in1eye,1eye were increased by61.8%.VC:after injection of1W, reduced10%-15%in1eye,2eyes narrowed down the20%-25%,30%-35%in1eye,1eye narrowed40%, reduced to70%in1eye;2w to4w,20%-25%diameter reduced in2eyes,30%-35%in3eyes,1eye diameter compared with preoperative thickening21.2%.4. Superficial vascular group and deep stromal vascular group:superficial vascular group,CNV area decreased significantly then deep stromal vascular group, especially obvious in1w after operation, but the superficial vascular regenerative fast, poor stability.Acute/immature vessel group and chronic/mature vascular group:chronic/mature vessel group,1eyes had no obvious change,3eyes were compared with pre-injection, neovascular area reduced in different degrees, namely chronic/mature vessels on Lucentis is effective; the same concentration, dose of ranibizumab, acute/immature vessel group and chronic/mature vessel group were no significant differences change in CNV area.5. Complications:After injection of1w, IOP of1eye is25.50mmHg; stop steroid eye drops, retest IOP16.2mmHg. Ocular and systemic adverse reactions were not found in more than during treatment and follow-up.Conclusion1. Subconjunctival injection of ranibizumab can reduce corneal CNV area, lessen vascular diameter, increased most patients of the visual acuity, and the most obvious on1w.2. Subconjunctival injection of ranibizumab short-term security is good, no ocular and systemic adverse reactions.3. The same concentration, dose of ranibizumab, the curative effect of superficial vascular is better, CNV area decreased more obviously, but at the same time, poor stability and regenerative fast, deep stromal vascular dependent on higher concentrations and dose; ranibizumab for some mature vessels also effectively, and the same concentration, dose of ranibizumab, mature and immature blood vessels curative effect not obvious difference.4. More large sample, multi center, randomized, controlled clinical research are needed.