The Boston Ocular Surface Prosthesis as a Novel Drug Delivery System for Bevacizumab

Abstract

Corneal neovascularization causes deterioration of visual acuity and increases surface irregularities. Various techniques have been employed to help control the progression of corneal neovascularization; bevacizumab is a medication that targets the specific pathway of corneal neovascularization. The Boston Ocular Surface Prosthesis (BOSP) is a large diameter contact lens that aids in maintaining corneal surface integrity and may serve as a delivery system for topical bevacizumab. This paper reviews five patients who were treated with topical bevacizumab in their BOSP. All patients demonstrated improvement in their visual acuity and clinical exam. No adverse reactions were noted.

Recent Advances in Ophthalmic Drug Delivery

“…The drug may be added to the scleral lens, which acts as a reservoir for sustained release of the drug, or administered externally as an eye drop, which is retained in the expanded precorneal tear film. The topical delivery of Avastin for the treatment of corneal neovascularization using scleral lens delivery system showed promising results in a clinical study with five patients [56]. One drop of 1% bevacizumab solution free from preservatives and penetration enhancers was applied twice daily over 3 months to the eyes of patients fitted with Boston ocular surface prosthesis (BOSP) lens in the fluid reservoir of BOSP (a reservoir for expanded tear film formed between the inner surface of the scleral lens and the cornea filled with artificial tears).…”

Scleral Lenses

“…Utilization of a scleral lens with an occlusive piggyback hydrogel lens for management of amblyopia in an infant with familial dysautonomia has been described. 76,82 Reduction of corneal scarring due to vascularized limbal keratitis with long-term wear of a scleral lens has been reported, 81 as has maintenance of corneal surface integrity after discontinuation of scleral lens treatment for limbal stem-cell deficiency. 125 Scleral lenses have been used to protect the ocular surface during treatment for head and neck malignancy 75 and staged eyelid reconstructive surgery 90 and to deliver medication to the ocular surface.…”

Scleral lens for ocular surface disease

“…Three of these are large cohort studies that include analyses on OSD patient subgroups (Severinsky and Millodot, 2010;Stason et al, 2010;Gumus et al, 2011), while three more reports examined the effect of scleral RGP lenses in populations with one specific surface disease (Schornack et al, 2008;Tougeron-Brousseau et al, 2009;Rathi et al, 2011). Also included in the twelve publications are four case reports or series of single disease entities reporting outcome measures demonstrating the effectiveness of scleral RGP lenses (Schornack and Baratz, 2009;Grover et al, 2010;Gumus et al, 2010;Schornack, 2011), and two case series describing innovative uses of scleral lenses in patients with other ocular complications secondary to OSD (Lim et al, 2009;Tanhehco and Jacobs, 2010). Scleral rigid gas-permeable lenses for general corneal and ocular surface disease In a report from 2010 (Stason et al, 2010), 80 consecutive patients seen at the Boston Foundation for Sight (Needham, MA) from January to June 2006 are reviewed.…”

“…Two recently published reports by Lim et al (2009) and Tanhehco and Jacobs (2010) highlight the novel use of scleral RGP lenses in the management of ocular surface diseases complicated by secondary ocular issues. In the Lim et al report (2009), the authors describe five cases of ocular surface disease accompanied by corneal neovascularization.…”