PMC6008772_01
Photographs of Twin 1 with blepharokeratoconjunctivitis before and after treatment over a 10-month period. (a) Right cornea with infiltrate and overlying epithelial defect and corneal neovascularization. (b) Left cornea with central scar with active feeder vessels. (c) Right cornea eight weeks after subconjunctival triamcinolone and bevacizumab injections showing fading stromal infiltrates and regressed bloods vessels. (d) Left cornea in eight-week time with no injections showing persisting corneal neovascularization, and no observable benefit from systemic effect of bevacizumab. (e) Right cornea 10 months after bilateral subconjunctival triamcinolone and bevacizumab injections and 5 months after additional triamcinolone injections, with central corneal scarring and suppressed blood vessels. (f) Left cornea 8 months after bilateral subconjunctival triamcinolone and bevacizumab injections and 5 months after additional triamcinolone injections and diathermy with central corneal scarring and suppressed blood vessels.
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fig1
Examination under anaesthesia (EUA) revealed corneal neovascularization bilaterally (Figures 1(a)-1(b)). At EUA eight weeks after the injections, the right cornea looked markedly improved (Figures 1(c)-1(d)). At EUA 5 months after the further bilateral triamcinolone injections, there was central corneal scarring and suppressed blood vessels bilaterally (Figures 1(e)-1(f)).
Photographs of Twin 2 with blepharokeratoconjunctivitis before and after treatment over an 8-month period. (a) Right cornea with stromal and epithelial vessels. (b) Left cornea with stromal and epithelial vessels. (c) Right cornea four weeks after subconjunctival triamcinolone and bevacizumab injections showing regressing vessels. (d) Left cornea in four-week time with no injections showing persisting stromal and epithelial vessels and no observable benefit from systemic effect of bevacizumab. (e) Right cornea 8 months after subconjunctival triamcinolone and bevacizumab injections and 5 months after additional triamcinolone injections, with corneal scarring. (f) Left cornea 7 months after subconjunctival triamcinolone and bevacizumab injections and 5 months after additional triamcinolone injections, with corneal scarring.
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fig2
EUA showed bilateral stromal corneal neovascularization, without epithelial defect (Figures 2(a)-2(b)). Twin 2 underwent the same treatment as his brother including conventional treatment and subconjunctival triamcinolone and bevacizumab injections resulting in corneal scarring and suppressed blood vessels bilaterally (Figures 2(c)-2(f)).