Observation Of Subconjunctival And Corneal Stroma Injection Of Conbercept Treatment Of Corneal Neovascularization Clinical Curative Effect

BackgroundCapillaris that form from limbus cornea is apt to invade the cornea under circumstances of infection,inflammation,trauma,wearing contact lenses and havin g degeneration disease.The procession is call corneal neovasculation(CNV).CNV can block the entrance of light,cause scar formation in cornea,damage the sensi tivity of vision,initiate inflammation or edema of cornea and cause postoperativ e rejection of cornea transplantation.The basic reason of CNV is the break of balance between vasculation-forming factors and vasculation-forming inhibitors.T he vascular endothelial growth factor(VEGF) is the most important factor.Recen tly, the treatment by inhibiting the activity of VEGF has sucessfully cured num erous disease like Neovascular age-related macula degeneration,Diabeticretinitis, Macular edema,Neovascular glaucoma.Treatment of neovasculation by using anti-VEGF drugs has gradully becom e the hot spot of research.The anti-VEGF drugs mainly contains Ranibizumab, Bevacizumab, pegaptanib sodium, Aflibercept at present.Their effectiveness and security are documented. Conbercept is the first independent research and dev elopment anti-VEGF drug in China.It is a recombination fusion protein produce d in Chinese Hamster Ovary’s(CHO) cell-producing system.The protein is gener ated by fusing the Domain 2 in immunoglobulin-like protein of VEGF receptor l,the Domain 3 and 4 in human immunoglobulin-like protein of VEGF recept or 2 and Fc segment of human immunoglobulin.And it combine with VEGF to competitively inhibit the binding of VEGF and its receptor.Thus,the activation of VEGF receptor family is prevented.The proliferation of vascular endothelial cell and neovasculation are prohibited.There are only clinical trial on treatment of age-related macular degeneration(AMD) by injecting the drug into corneal st roma.Our study aims on the exploration of the effectiveness and security in in hibiting the vasculation by subconjunctivally and intrastromally injecting the Co nbercept.ObjectiveTo explore the the effectiveness and security in inhibiting the vasculation by subconjunctivally and intrastromally injecting the Conbercept.MethodsProspective study of 3 patients and 4 eyes underwent subconjunctivally an d intrastromally injecting the Conbercept.The follow-up time are 3-5 months.Sur face anethesize the affected eye.Inject Conbercept into coneal stroma at 3 o’clo ck,6 o’clock,9 o’clock and 12 o’clock.0.1ml in total doze.Extra injection at cor responding site was peformed when there are relatively more neovasculation. Int rastromally injection was performed then at the limbus cornea near the neovasc ulation.Compare the vision,pressure,CNV formation,neovasculation area(NA) and vessel caliber(VC) of preinjected and postinjected eye.Result1.The morphology of corneal neovascularization:1w after subconjunctival and corneal stroma injection of Conbercept of pat ient 2 and patient 3,the ciliary hyperemia alleviated and the vessels become sh orter.The lumen become thinner and part of the small vessels disappeared.It is effective for both the superficial and deep stromal vessels.The corneal edema and opacity alleviated.The vessels become longer and wider with the time deve loped.1w after each injections of patient 1, the ciliary hyperemia alleviated and the vessels become shorter. The lumen become thinner and part of the small v essels disappeared. It is effective for both the superficial and deep stromal vess els. The corneal edema and opacity alleviated. The vessels become longer and wider with the time developed and recycled after the next injection.2.Vision:1w after injection,the left vision of patient 1 improved from 10 cm of co unting finger to 50 cm of counting finger and maintained until the follow-up was over.lw after injection,the right vision of patient 1 improved by 1 line in visual chart and improved again in the same result after the second injection a nd maintained until the follow-up was over.lw after injection,the vision of pati ent 2 improved from 30 cm of counting finger to 50 cm of counting finger an d maintained until the follow-up was over.lw after injection,the vision of patie nt 3 improved by 1 line of visual chart and reach the level before treatment a t the 15th week.3.NA and VCNAPatientl:1w after the first injection,NA in the left eye diminished by 30% and NA in right eye diminished by 19%.NA in bilateral eyes increased fluctuat 1y for 1st to 6th week after injection(The fluctuation may caused by error,so a s the condition following).At the 6th week after injection,NA in left eye recove red to the level before treatment and NA in right eye diminished by 12% com pared to that before treatment.lw after the 2nd injection,NA in left eye diminis hed by 24% compare to the level before the 2nd injection,which is the level o f 6th week after the first treatment.And NA in right eye diminished by 12%.N A increased gradually from the first to the 6th week after the 2nd injection.N A diminished by 1% and increase by 8% respectively in left and right eye co mpare to pretreatment level of the 2nd time.NA decreased by 16% and 3% res pectively in left and right eye after 1w of the 3rd injection compared to the le vel before the third injection(14w after the second injection).Patient 2:1w after injection,the NA decreased by 13%,lw to 12w after inje ction,NA were increasing but not very steady. lm(4w) after injection,NA decreas ed by 9% compared with preinjection.3m(12w) after injection,NA decreased by 5% compared with preinjection.Patient 3:1w after injection,the NA decreased by 3%.There was no follow-up between 1w to15w and the NA of 15w was same as preinjection.VCPatientl:1w after the first injection,VC in the left eye diminished by 0.25 and VC in right eye diminished by 0.205.NA in bilateral eyes increased fluctua tly for 1st to 6th week after injection(The fluctuation may caused by error,so a s the condition following).At the 6th week after injection,VC in left eye decrea se by 0.05 and VC in right eye diminished by 0.06 compared to that before tr eatment.1w after the 2nd injection,VC in left eye diminished by 0.225 compare to the level before the 2nd injection,which is the level of 6th week after the first treatment.And VC in right eye diminished by 0.17.VC increased gradually from the first to the 14th week after the 2nd injection.VC increased by 0.225 and 0.1 respectively in left and right eye compare to pretreatment level of the 2nd time.VC decreased by 0.3 and 0.17 respectively in left and right eye after 1w of the 3rd injection compared to the level before the third injection(14w af ter the second injection).Patient 2:1w after injection,the VC decreased by 0.44,lw to 12w after inje ction,VC were increasing. lm(4w) after injection,VC was same as preinjection.3 m(12w) after injection,VC increased by 0.1 compared with preinjection.Patient 3:1w after injection,the VC decreased by 0.4 There was no follow-up between 1w to15w and the VC of 15w was decreased by 0.1 compared wi th preinjection.4.ComplicationPatientl:The left intraocular pressure at the 3w after the 1st injection was 29.3mmHg.lw after ceasing hormone eye drops,the pressure was 15.3mmHg.Rig ht intraocular pressure at the 4th week after the 2nd injection was 20.9mmHg. And the pressure at the 1w after ceasing hormone eye drops was 14.5mmHg.N o systematic complications found throughout the research.Conclusionl.Subconjunctival and corneal stroma injection of Conbercept can reduce N A and lessen VC effectively.It can increased the visual acuity of patients and t he most obvious effect is on the fist week after injection.2.The security of subconjunctival and corneal stroma injection-of Conberce pt is good.There is no ocular and systemic adverse reactions.3.Subconjunctival and corneal stroma injection of Conbercept can reduce s uperficial and deep stromal vascular effectively.4. Subconjunctival and corneal stroma injection of Conbercept can reduce immature and mature vessels effectively.