Efficacy of intra-meibomian gland injection of the anti-VEGF agent bevacizumab for the treatment of meibomian gland dysfunction with lid-margin vascularity

Abstract

PurposeTo investigate the efficacy of a novel treatment – intra-meibomian gland (MG) injection of the anti-VEGF agent bevacizumab – for MG dysfunction (MGD) with eyelid-margin vascularity.MethodsA total of 26 eyes from 13 patients diagnosed with MGD and eyelid-margin vascularity were included in our study. Patients received intra-meibomian gland injections of bevacizumab (150 μL, 2.5 mg/0.1 mL) at multiple sites with a 29 G needle where telangiectasia was severe. The Ocular Surface Disease Index (OSDI), tear film, tear-breakup time (TBUT), eyelid-margin features, MG features, conjunctiva, and corneal staining were assessed at 1 day before injection and 1 week, 1 month, and 3 months after injection. Blood pressure, best-corrected visual acuity, intraocular pressure, and slit lamp examinations were performed to assure the safety of patients at 1 day before and 1 day, 1 week, 1 month, and 3 months after injection.ResultsLid-margin vascularity, conjunctival injection, expressed secretion quality, expressivity of the MG, TBUT, corneal staining, and OSDI were significantly improved 1 week, 1 month, and 3 months after injection compared to baseline values. Lid-margin vascularity, conjunctival injection, meibomian gland expressivity, TBUT, and OSDI continued to improve; the greatest improvements were observed at 1 month and sustained for 3 months. Spearman’s correlation analysis indicated that age and sex significantly influenced TBUT improvement. Females and older patients tended to have shorter baseline TBUT that followed a different trend from that of males and younger patients during postinjection visits, revealed by subgroup analysis. No local or systemic side effects were observed at follow-up visits.ConclusionThis study is the first to explore a novel therapy for MGD – intra-MG injection of the anti-VEGF agent bevacizumab – and it demonstrates that the treatment is effective and safe in eliminating eyelid-margin vascularity, improving MG function and relieving clinical signs and symptoms of MGD.

Bevacizumab Eye Drops Vs. Intra-meibomian Gland Injection of Bevacizumab for Meibomian Gland Dysfunction-Associated Posterior Blepharitis

“…However, both groups exhibited significant improvements in dry eye symptoms and clinical signs, including corneal staining, meibum quality, meiboscore, and conjunctival redness. Our results are consistent with those of previous studies (11,18,19).…”

“…The OSDI scores decreased significantly from week 1 to month 3, although there were no between-group differences. Previous studies of bevacizumab therapy in DED and MGD (11,18,19) showed significantly improve dry eye symptoms. Improvements in OSDI scores may be explained by decreases in corneal staining and lid margin inflammation and by improvements in tear film stability.…”

“…To determine the adequate sample size, power calculations were made according to neovascularized area reduction as the designated outcome. The percentage reduction of corneal neovascularization as a result of bevacizumab eye drop was 29% (10) and the percentage reduction of eyelid neovascularization as a result of an intra-MG bevacizumab injection was 42% (11). With a p-value of <0.05 and a study power of 90%, we determined a sample size of 13 patients per group.…”

“…Bevacizumab [an anti-vascular endothelial growth factor (VEGF)-A recombinant humanized monoclonal antibody] has been widely used in the treatment of systemic and ocular diseases (9,10). Moreover, previous studies have reported that an intra-MG bevacizumab injection (11) can decrease lid margin telangiectasia by up to 42%, in addition to improving dry eye symptoms. However, to our best knowledge, no randomized controlled trials have investigated the use of bevacizumab eye drops in patients with MGD-associated posterior blepharitis compared with the use of intra-MG injections.…”

Investigation of Prognostic Factors for Intense Pulsed Light Treatment with a Vascular Filter in Patients with Moderate or Severe Meibomian Gland Dysfunction

“…Significant improvements in the positivity rates and MMP-9 expression levels were observed, which could explain improvements in the clinical signs and symptoms. In one study that evaluated the effect of an intra-MG bevacizumab injection on the lid margin telangiectasia in MGD patients, the lid margin telangiectasia was improved significantly, subsequently resulting in improvements in TBUT, corneal staining scores, and symptoms [ 33 ]. In accordance with previous studies on IPL, Schirmer’s test was not improved in the present study [ 23 , 30 , 34 ].…”