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

Abstract

Purpose: To 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.

Methods: A 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.

Results: Lid-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.

Conclusion: This 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.

Keywords: anti-VEGF; lid-margin vascularity; meibomian gland dysfunction.

Figure 1

Clinical features of meibomian gland dysfunction. Notes: Eyelid-margin features, meibomian gland expression, tear film, and conjunctiva were graded at 1 day before and 1 week, 1 month, and 3 months after intra-meibomian gland injection of bevacizumab. (A) Eyelid-margin features; (B) tear-meniscus height; (C) conjunctiva injection and conjunctivochalasis; (D) expressed secretion quality and expressivity of the meibomian gland; (E) orifices within central 1 cm. *P<0.05.

Figure 2

Eyelid-margin features. Notes: Obtained using an IM 900 slit lamp before and after intra-meibomian gland injection of bevacizumab: (A) 1 day before injection; (B) 1 week after injection; (C) 1 month after injection; (D) 3 months after injection. Lid-margin vascularity decreased significantly 1 week postinjection (B) and continued to decrease for 1 month after the injection (C) compared with the baseline (A) and 1-week postinjection time points. At 3 months (D), lid-margin vascularity sustained a relatively reduced rate compared with baseline. Similarly, the conjunctival injection was remarkably reduced after intra-meibomian gland injection compared to baseline, and the greatest reduction was observed at 1 month (C).

Figure 3

Corneal staining, TBUT, and OSDI score. Notes: Results of corneal staining, TBUT, and OSDI score before injection and 1 week, 1 month, and 3 months after intra-meibomian gland injection of bevacizumab: (A) corneal staining; (B) TBUT; (C) OSDI score. Significance levels were set at *P<0.05. Abbreviations: TBUT, tear-breakup time; OSDI, Ocular Surface Disease Index.

Figure 4

Corneal staining images. Notes: Obtained using an IM 900 slit lamp and taken before and 1 week, 1 month, and 3 months after intra-meibomian gland injection of bevacizumab: (A) 1 day before injection; (B) 1 week after injection; (C) 1 month after injection; (D) 3 months after injection. Significant improvements were observed in images at 1 week (B), 1 month (C) and 3 months postinjection (D) compared to baseline (A).

Figure 5

Subgroup analysis of TBUT and OSDI by sex and age. Notes: Before and 1 week, 1 month, and 3 months after intra-meibomian gland injection of bevacizumab: (A) TBUT by sex; (B) TBUT by age; (C) OSDI by sex; (D) OSDI by age. *P<0.05 vs baseline for males or age <60 years; ^#P<0.05 vs baseline for females or age ≥60 years; ^ψP<0.05 between different sexes or ages. Abbreviations: TBUT, tear-breakup time; OSDI, Ocular Surface Disease Index.