Subconjunctival Bevacizumab Injection for Ocular Surface Squamous Neoplasia

Purpose: To determine the efficacy and safety of perilesional/subconjunctival bevacizumab injections in the management of ocular surface squamous neoplasia (OSSN). Methods: Ten eyes of 10 patients with an OSSN diagnosis confirmed by impression cytology received 2 perilesional/subconjunctival injections of bevacizumab at a 2-week interval. Patients were evaluated for 3 months, during which time, changes in the lesions were documented using digital photography. After this period, excisional biopsy of the remaining tumor and cryotherapy of the conjunctival borders were performed if deemed necessary. Results: The mean age of the patients was 65 +/- 12 years (+/-SD). All of the tumors were nasal in origin and had varying degrees of vascularization. The mean lesion area before treatment was 16 +/- 6.9 mm(2). Two weeks after the first injection, the mean reduction observed in the tumor area was 25% +/- 5.65% and ranged from 17% to 33% (P = 0.001). Two weeks after the second injection, the mean tumor area was further decreased (42% +/- 33%, ranging from 15% to 100%, P = 0.049). Corneal extension of the tumor was not affected significantly in 8 of the eyes with concomitant conjunctival and corneal involvement. Complete disappearance of the tumor was demonstrated by impression cytology and occurred in 2 cases involving lesions clinically confined to the conjunctiva. No systemic or ocular side effects occurred during the study period. Conclusions: Perilesional/subconjunctival injections of bevacizumab decrease the size and vascularity of OSSN and may be curative in lesions limited to the conjunctiva. However, this treatment has no significant effect on the corneal extension of OSSN.