Seminars in Ophthalmology, 24, 149–155, 2009 Copyright C  Informa Healthcare USA, Inc. ISSN: 0882-0538 print / 1744-5205 online DOI: 10.1080/08820530902802013 The Boston Ocular Surface Prosthesis as a Novel Drug Delivery System for Bevacizumab Mira Lim Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Deborah S. Jacobs, Perry Rosenthal, and Karen G. Carrasquillo Boston Foundation for Sight, Boston, Massachusetts, USA ABSTRACT Corneal neovascularization causes deterioration of visual acuity and increases surface irregularities. Various techniques have been employed to help control the progression of corneal neovasculariza- tion; 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 demon- strated improvement in their visual acuity and clinical exam. No adverse reactions were noted. Keywords: corneal neovascularization, bevacizumab, scleral lens INTRODUCTION The cornea is an avascular organ. This avascularity con- tributes to its optical clarity and is maintained through a constant equilibrium among angiogenic and antian- giogenic factors. 1 If the cornea undergoes inflamma- tion or infection the balance may be tipped in favor of angiogenesis, leading to lipid deposition, scarring, de- creased vision, and an increased risk of graft failure. 2,3 Various approaches towards controlling corneal neo- vascularization have been reported including: topical corticosteroids, cryotherapy, nonsteroidal antiinflam- matory agents, and photodynamic therapy. 4,5,6 Suc- cess with these treatments varies depending on the location and degree of corneal neovascularization. Fur- thermore, these treatments may have deleterious side effects. Until recently, there have been no agents that specifically target the pathway of angiogenesis itself. Address correspondence to: Mira Lim, MD, 243 Charles Street, Ophthalmic Education, Boston, MA 02114, USA. E-mail: mira lim@meei.harvard.edu Many factors contribute to the process of corneal neovascularization; among the leading angiogenic factors are a group of vascular endothelial growth factors (VEGF), which have been shown to be upregulated in instances of corneal inflammation and neovascularization. 7,8,9,10 Bevacizumab is a re- combinant, humanized, monocolonal antibody that binds to and deactivates VEGF; it was FDA ap- proved in 2004 as a treatment for patients with metastatic colorectal cancer. It has revolutionized treatment for wet age-related macular degeneration, when administered off-label by intra-vitreal injec- tion, and it is now being explored for other ar- eas of ocular angiogenesis. 11,12,13,14,15 In particular, bevacizumab has been demonstrated to have in- hibitory effects on corneal neovascularization in the laboratory setting when applied both topically and subconjunctivally. 16,17,18,19 Miltiades and colleagues noted regression mostly of smaller branches of neo- vascularization in the rabbit cornea, suggesting be- vacizumab is effective mostly on newly developing corneal neovascularization. 20 149 Semin Ophthalmol Downloaded from informahealthcare.com by University of Colorado on 12/09/11 For personal use only.