Eyeworld

114 | EYEWORLD | JULY 2021 C ORNEA Contact Dohlman: Thomas_Dohlman @meei.harvard.edu Nattis: asn516lu@gmail.com Singh: psingh59@nyit.edu Slomovic: allan.slomovic@utoronto.ca Yin: Jia_Yin@meei.harvard.edu Relevant disclosures Dohlman: None Nattis: None Singh: None Slomovic: Abbott, Alcon, Allergan, Johnson & Johnson Vision, Labtician Thea, Novartis, Santen, Sun Pharmaceutical Yin: None She said it is used in the management of a distorted cornea, as well as complex ocular surface diseases. In addition to protecting the ocular surface, PROSE can serve as a novel drug delivery system, Dr. Yin said, which is where the idea of using PROSE to deliver an anti-VEGF agent originated. "I worked with the former director of BostonSight Deborah Jacobs, MD, to examine the long-term outcome of using PROSE to deliver bevacizumab to [treat] corneal neo- vascularization," she said. Dr. Yin noted that patients were already fitted and using the PROSE device routinely before starting this treatment. They applied a drop of 1% preservative-free bevacizumab to the reservoir of the PROSE device twice daily, and patients continued daily wear of the device for an average of 3 months, she said. In a cohort of 13 patients, 4 there was an observed reduction in corneal neovasculariza- tion and improvement in vision with no signifi- cant adverse effects, Dr. Yin said. However, she did note that the treatment is off label and best suited for select patients. Comparing use of PROSE to other delivery methods for bevacizumab, Dr. Yin said that it provides higher bioavailability of the anti-VEGF agent, specifically compared to topical applica- tion. Compared to a subconjunctival injection, PROSE is less invasive and used daily. "We observed no adverse events, even in patients who used this method intermittently for many years," she said. PROSE with bevacizumab may be an effec- tive treatment for corneal neovascularization. Dr. Yin noted that PROSE has also been used to deliver ophthalmic antibiotics. "PROSE alone has been used in many ocular surface diseases, such as severe corneal ectasia, dry eye disease, Stevens-Johnson syndrome, and persistent corneal epithelial defect," she said, noting that a limitation could be the needed customization of the device. Thus, it may not be a first-line choice for the sole purpose of treating corneal neovascularization. than when given subconjunctivally," he said. "Both methods of administration are effective at reducing corneal neovascularization, but in an animal model of corneal transplantation where subconjunctival treatment was directly compared to topical treatment, the subconjunc- tival route showed a greater effect in reducing corneal neovascularization and improved graft survival." In this study, a hybrid approach was used with subconjunctival injection at the time of surgery followed by topical treatment for 4 weeks postoperatively. While Dr. Dohlman's recent research specifically looked at bevacizumab in corneal transplantation, he said it could be an effective treatment in a variety of corneal conditions characterized by pathologic neovascularization, including after chemical injuries and infectious keratitis. He said that there may also be a role for pretreating corneal neovascularization prior to corneal transplantation. Dr. Dohlman said results from his study showed that bevacizumab decreased the 52- week rate of endothelial rejection and graft failure, and although the results did not reach statistical significance, they showed that treat- ment with bevacizumab had a modest effect on improving the rate of endothelial rejection and overall graft failure in high-risk corneal trans- plantation, making bevacizumab a potential adjunctive therapy for improving outcomes in high-risk corneal transplantation. "Bevacizumab was safe, as there was no difference in treatment-related adverse effects between groups," Dr. Dohlman said. "A potential concern with bevacizumab is delayed epitheli- al healing, but there was no difference in the incidence of delayed epithelial healing at 7 days postop (p=0.16), and the control group actually had a higher number of patients with delayed epithelial healing (16% in the control group versus 5% in the bevacizumab group)." PROSE with bevacizumab Jia Yin, MD, PhD, has researched the use of bev- acizumab in Prosthetic Replacement of the Oc- ular Surface Ecosystem (PROSE), a custom-de- signed, fabricated prosthetic device developed by BostonSight. The device is a gas permeable lens with a diameter of 17.5–23.0 mm that rests on the bulbar conjunctiva and vaults over the entire cornea and bathes the cornea in artificial tears. continued from page 113

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