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CC BY-NC-ND 4.0 · Tierarztl Prax Ausg G Grosstiere Nutztiere 2024; 52(02): 108-114
DOI: 10.1055/a-2253-8103
Case Report

Adjunctive bevacizumab therapy in an equine corneal stromal invasive squamous cell carcinoma with a 53-months follow-up

Adjuvante Bevacizumab-Therapie eines equinen kornealen stromal-invasiven Plattenepithelkarzinoms mit einer Nachbeobachtungszeit von 53 Monaten
Klaas-Ole Blohm
1   Tierklinik Lüsche im SANAKENA, Appen-Etz, Germany
2   Tierarztpraxis Schönhoff, Stendal, Germany
3   Department for Companion Animals and Horses, Ophthalmology Unit, University of Veterinary Medicine, Vienna, Austria
,
Barbara Nell
3   Department for Companion Animals and Horses, Ophthalmology Unit, University of Veterinary Medicine, Vienna, Austria
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Abstract

A 17-year-old Appaloosa mare was referred for evaluation of presumed refractory keratitis of the left eye. Gross examination revealed ocular discomfort and corneal neovascularization with a nasal focal opacification affecting approximately 40% of the corneal surface. On ophthalmic examination, extensive subepithelial to mid-stromal vascular branching accompanied by a homogeneous white, dense opacification, which affected up to 80% of the total corneal thickness, were apparent. Signs of concurrent uveitis were absent. Deep-stromal lamellar keratectomy with a conjunctival pedicle graft was performed under general anesthesia. Histopathology confirmed a poorly differentiated corneal stromal invasive squamous cell carcinoma (SI-SCC) with neoplastic cell extension to the surgical margins. Postoperatively, 4 topical mitomycin C 0.04% chemotherapy cycles combined with oral firocoxib therapy were initiated. Seven months after surgery, regrowth of the SI-SCC was clinically suspected. A total volume of 1 ml bevacizumab 2.5% was administered in the standing sedated horse via 3 mid-stromal corneal injections. Four weeks later, intrastromal bevacizumab injections (ISBIs) were repeated, however, this time the solution was injected directly into the main corneal vessel branches.

Seven weeks after the second ISBIs, the left eye was comfortable and significant remission of corneal vascularization and opacity was recognized. No recurrence has been noted for a follow-up period of more than 53 months.

Equine SI-SCC usually has a very poor prognosis for globe maintenance. To the authors’ knowledge this is the first report of well-tolerated intrastromal antivascular endothelial growth factor adjunctive therapy with bevazicumab 2.5% and SI-SCC resolution after a multimodal treatment approach.

Zusammenfassung

Das equine korneale stromal-invasive Plattenepithelkarzinom zeigt ein anderes klinisches Erscheinungsbild als klassische Plattenepithelkarzinome im Bereich der Nickhaut, der Augenlider, der Konjunktiva oder des Limbus. Eine 17-jährige Appaloosa Stute wurde aufgrund einer vermuteten, therapieresistenten Keratitis des linken Auges überwiesen. Bei der Distanzbetrachtung zeigten sich Blepharospasmus, korneale Neovaskularisation und eine, von nasal kommende, fokale Trübung, die ca. 40% der Hornhautoberfläche einnahm. Die ophthalmologische Untersuchung ergab subepitheliale bis mid-stromale verzweigte korneale Gefäßeinsprossungen begleitet von einer dichten, homogen weißen Trübung, die ca. 80% der Hornhautdicke einnahm. Uveitisanzeichen waren nicht vorhanden. In Allgemeinanästhesie wurde eine tief-stromale lamelläre Keratektomie mit gestieltem Bindehauttransplantat durchgeführt. Histopathologisch wurde ein wenig differenziertes korneales stromal-invasives Plattenepithelkarzinom mit Tumorzellen im Bereich der Schnittränder diagnostiziert. Postoperativ erfolgten 4 Behandlungszyklen mit topischer Mitomycin C 0,04%-Chemotherapie kombiniert mit oraler Firocoxib-Therapie. Sieben Monate nach der Operation traten klinische Rezidivanzeichen auf. Beim stehend-sedierten Pferd wurden 3 mid-stromale Bevacizumab 2,5%-Injektionen mit einem Gesamtvolumen von 1 ml durchgeführt. Vier Wochen danach wurde diese adjuvante Behandlung wiederholt, wobei das Bevacizumab direkt in die kornealen Hauptgefäßäste injiziert wurde.

Sieben Wochen nach den zweiten Bevacizumab-Injektionen war das linke Auge komfortabel und eine signifikante Remission der kornealen Vaskularisation und Trübung erkennbar. Während der Nachbeobachtungszeit von über 53 Monaten wurde kein erneutes Tumorwachstum festgestellt.

Dies ist die erste Beschreibung eines equinen kornealen stromal-invasiven Plattenepithelkarzinoms nach erfolgreicher multimodaler Therapie einschließlich adjuvanter Bevacizumab 2,5%-Injektionen ohne unerwünschte Wirkungen. Diese Neoplasie ist üblicherweise mit einer ungünstigen oder infausten Prognose für den Erhalt des Auges verbunden.

Keywords

Horse - ophthalmology - corneal neoplasia - microsurgery - anti-VEGF - multimodal therapy

Schlüsselwörter

Pferd - Augenheilkunde - korneale Neoplasie - Mikrochirurgie - anti-VEGF - multimodale Therapie


Publication History

Received: 13 June 2023

Accepted: 28 November 2023

Article published online:
03 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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