Intrastromal Injection Of Bevacizumab In A Patient With Ocular Stevens-Johnson Syndrome: A Case Report

The purpose of this case report is to determine the effectiveness of intrastromal injection of an anti-VEGF agent in a 43 year old Filipina with Ocular Stevens-Johnson syndrome, complaining of progressive blurring of vision on her remaining good eye.

The procedure was done at the Eye Center of The Medical City Eye and Vision Institute located at The Medical City Complex, Pasig, Philippines

Two intrastromal injections were performed on the patient 60 days apart. 0.01ml of 25mg/ml Bevacizumab was injected under local anesthesia in the affected eye, targeting the quadrants with intense neovascularization. The drug was injected near the said vessels using a gauge 30 needle and an ophthalmic microscope. Hydration of the particular site of the cornea is used as a guide in the amount of drug deposited. The patient was then monitored on day 1, 7 and 30 post-injection. 

The results show that there seems to be a dramatic improvement in both the appearance of the cornea, the diminishing of the deep corneal neovascularization, and the visual acuity of the patient. Intrastromal injection of the anti-VEGF agent provides a more stable and lasting concentration of the drug to remain in the cornea, thus proving to be more effective compared to other methods such as the topical or subconjuntival route. This can be an option for extending the usability of the cornea prior to keratoplasty or keratoprosthesis. 

Although use of intrastromal Bevacizumab has been an option in corneal grafts following corneal transplant, it can also be an option to mitigate corneal neovascualrization in Ocular Stevens-Johnson syndrome, where such corneal lesions may lead to a poor visual prognosis of patients.