J Korean Ophthalmol Soc.  2014 Mar;55(3):443-448. 10.3341/jkos.2014.55.3.443.

Two Cases of Superior Limbic Keratoconjunctivitis Treated with Bevacizumab and Triamcinolone Injection

• Kim WS
• Wee SW
• Kim JC

• KMID: 2218277
• DOI: http://doi.org/10.3341/jkos.2014.55.3.443

Abstract

PURPOSE
To report two cases of intractable superior limbic keratoconjunctivitis (SLK) treated with bevacizumab and triamcinolone injection.
CASE SUMMARY
A 69-year-old female visited our clinic with pain in the left eye for 3 days and was diagnosed with SLK in her left eye. After 3 months of using steroid eye drops, artificial tears, and oral steroid intermittently, there was no improvement in symptoms and signs, thus this case was considered intractable with the conventional therapy. A mixture of bevacizumab (0.15 cc) and triamcinolone (0.05 cc) was injected into the sub-tenon's capsule of the left eye. After 1 week, all symptoms and signs disappeared, and there was no recurrence for 6 months. A 55-year-old female was transferred to our clinic due to SLK that did not respond to artificial tears, steroid eye drops, punctal occlusion, and botox injection for 3 months. A mixture of bevacizumab (0.15 cc) and triamcinolone (0.05 cc) was injected into the sub-tenon's capsule of the left eye. After 2 weeks, all symptoms and signs were improved, and there was no recurrence for 4 months.
CONCLUSIONS
The presented 2 SLK cases are meaningful, because neovascularization disappeared and controlled inflammation was obtained following sub-tenon injection with both bevacizumab and triamcinolone.

Keyword

Bevacizumab; Superior limbic keratoconjunctivitis; Triamcinolone

MeSH Terms

Aged
Female
Humans
Inflammation
Keratoconjunctivitis*
Middle Aged
Ophthalmic Solutions
Recurrence
Triamcinolone*
Bevacizumab
Ophthalmic Solutions
Triamcinolone

Figure

• 

  Figure 1. (A, B) Photographs of the left eye. A 69-years-old female visited with left eye pain. At initial visit, the superior limbus and superior limbic conjunctiva was diffusely stained by Rose Bengal along with injections and pannus in her left eye. She was diagnosed with the Superior limbic keratoconjunctivitis on the left eye.

• 

  Figure 2. After 2 months treatment of eye drops (Cravit 4 times a day, Predforte 4 times a day) there was no symptom relief. Chronic inflammatory signs, neovascularization, and increased pannus was observed on her left eye.

• 

  Figure 3. (A, B, C, D) Photographs of the left eye. After 1 week of bevacizumab (0.15 cc) and triamcinolone injection (0.05 cc) into the tenon capsule of the left eye, symptoms and signs including pain, injection, neovascularization, and diffuse fluorescein staining disappeared. The left eye had exhibited complete remission. (A, B) After 6 months, there was no recurrence (C, D).

• 

  Figure 4. (A, B, C) Photographs of the left eye. A 55 years old female was transferred for intractable superior limbic keratoconjunctivitis. She had been treated with artificial tears, steroid eye drops, punctual occlusion, and botox injections for 3 months, but there was no symptom relief and no improvement on physical exams. At the initial visit the superior limbic conjunctiva was diffusely stained by fluorescein, Rose Bengal stain (B, C), along with injections and neovascularization in her left eye (A).

• 

  Figure 5. (A, B, C) Photographs of the left eye. After 2 weeks of bevacizumab (0.15 cc) and triamcinolone injection (0.05 cc) into the tenon capsule of the left eye pain, injection, neovascularization, and diffuse fluorescein and Rose Bengal staining disappeared.

• 

  Figure 6. Proposed inflammatory cycle model of superior limbic keratoconjunctivitis.njunctivitis.

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