Korean J Ophthalmol.  2011 Feb;25(1):57-59. 10.3341/kjo.2011.25.1.57.

A Case of Ocular Benign Lymphoid Hyperplasia Treated with Bevacizumab Injection

• Oh DH
• Chun YS
• Kim JC

• KMID: 994414
• DOI: http://doi.org/10.3341/kjo.2011.25.1.57

Abstract

We report the first case of ocular benign lymphoid hyperplasia (BLH) treated with subconjunctival injection of bevacizumab (Avastin). A 27-year-old man presented to our clinic with conjunctival masses and limbal neovascularization. An incisional biopsy yielded the diagnosis of BLH. The patient was subsequently given a subconjunctival injection of bevacizumab (1.25 mg / 0.1 mL). The patient did not experience recurrence or malignant metaplasia during the one-year follow-up period. In patients with conjunctival BLH, subconjunctival injection of bevacizumab can be a useful treatment option in patients unable to undergo a surgical procedure due to limbal neovascularization.

Keyword

Bevacizumab; Conjunctival benign lymphoid hyperplasia; Subconjunctival injection

MeSH Terms

Adult
Angiogenesis Inhibitors/*administration & dosage
Antibodies, Monoclonal/*administration & dosage
Conjunctiva
Conjunctival Diseases/*drug therapy/*pathology
Humans
Hyperplasia
Injections, Intraocular
Limbus Corneae/blood supply
Lymphoid Tissue/*pathology
Lymphoproliferative Di
Male
Neovascularization, Pathologic/drug therapy

Figure

• 

  Fig. 1 (A) Slit lamp photograph of the patient's right eye on initial presentation. Note the size, salmon color, and elevated appearance of the hypervascular lesion. (B) Slit lamp photograph of the patient's left eye on initial presentation. Note the size, faint salmon color, and mildly protruding mass. (C,D) Slit lamp photograph of both eyes 2 months following subconjunctival injection of bevacizumab. The lesions appear to be almost completely resolved with no obvious remnants seen on the sclera or conjunctiva. (E) Slit lamp photograph of the patient's right eye after biopsy.

• 

  Fig. 2 Haematoxylin and eosin staining. (A) ×40 magnification of the lesion biopsied in Fig. 1A. (B) ×200 magnification of the same lesion. Note the abundance of lymphocytes and the predominance of T cells (CD3+) and B cells (CD20+), a pattern typical of benign lymphoid hyperplasia.

Reference

1. Jo YJ, Yim JH, Park KS. MALT (mucosa associated lymphoid tissue) type lymphoma of the ocular adnexa. J Korean Ophthalmol Soc. 2002. 43:357–362.

2. Yu SB, Lew HL, Yun YS. A case of conjunctival benign lymphoid hyperplasia associated with ptosis of the eyelid in a child. J Korean Ophthalmol Soc. 2005. 46:560–564.

3. Chang WS, Park JB, Kim KH, Kim SY. Two cases of conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas treated by cryotherapy. J Korean Ophthalmol Soc. 2008. 49:1165–1172.

4. Bolek TW, Moyses HM, Marcus RB Jr, et al. Radiotherapy in the management of orbital lymphoma. Int J Radiat Oncol Biol Phys. 1999. 44:31–36.

5. Eichler MD, Fraunfelder FT. Cryotherapy for conjunctival lymphoid tumors. Am J Ophthalmol. 1994. 118:463–467.

6. Ferrara N, Hillan KJ, Novotny W. Bevacizumab (Avastin), a humanized anti-VEGF monoclonal antibody for cancer therapy. Biochem Biophys Res Commun. 2005. 333:328–335.

7. Lazic R, Gabric N. Intravitreally administered bevacizumab (Avastin) in minimally classic and occult choroidal neovascularization secondary to age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2007. 245:68–73.

8. Jorge R, Costa RA, Calucci D, et al. Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE study). Retina. 2006. 26:1006–1013.

9. Manzano RP, Peyman GA, Khan P, et al. Inhibition of experimental corneal neovascularisation by bevacizumab (Avastin). Br J Ophthalmol. 2007. 91:804–807.

10. DeStafeno JJ, Kim T. Topical bevacizumab therapy for corneal neovascularization. Arch Ophthalmol. 2007. 125:834–836.

11. Hosseini H, Nejabat M. A potential therapeutic strategy for inhibition of corneal neovascularization with new anti-VEGF agents. Med Hypotheses. 2007. 68:799–801.

12. Cursiefen C, Cao J, Chen L, et al. Inhibition of hemangiogenesis and lymphangiogenesis after normal-risk corneal transplantation by neutralizing VEGF promotes graft survival. Invest Ophthalmol Vis Sci. 2004. 45:2666–2673.

13. Cursiefen C, Ikeda S, Nishina PM, et al. Spontaneous corneal hem- and lymphangiogenesis in mice with destrin-mutation depend on VEGFR3 signaling. Am J Pathol. 2005. 166:1367–1377.

14. Björndahl MA, Cao R, Burton JB, et al. Vascular endothelial growth factor-a promotes peritumoral lymphangiogenesis and lymphatic metastasis. Cancer Res. 2005. 65:9261–9268.

15. Hong YK, Lange-Asschenfeldt B, Velasco P, et al. VEGF-A promotes tissue repair-associated lymphatic vessel formation via VEGFR-2 and the alpha1beta1 and alpha2beta1 integrins. FASEB J. 2004. 18:1111–1113.

16. Nagy JA, Vasile E, Feng D, et al. Vascular permeability factor/vascular endothelial growth factor induces lymphangiogenesis as well as angiogenesis. J Exp Med. 2002. 196:1497–1506.

17. Bock F, Onderka J, Dietrich T, et al. Bevacizumab as a potent inhibitor of inflammatory corneal angiogenesis and lymphangiogenesis. Invest Ophthalmol Vis Sci. 2007. 48:2545–2552.