Duration 5min, Q&A 3min
Intravitreal Bevacizumab and Ranibizumab Reduce Cutaneous Tensile Strength During Wound Healing
To investigate the effect of intravitreal bevacizumab and ranibizumab on wound tension during cutaneous wound healing in a rabbit model and to compare this effect to placebo intravitreal saline controls at two time points.
New Zealand white rabbits
One hundred and twenty New Zealand white rabbits were randomly assigned to one of three treatment groups each consisting of forty rabbits. Each group received intravitreal injections of bevacizumab, ranibizumab or normal saline. Immediately afterwards, each rabbit underwent four 6mm full-thickness dermatologic punch biopsies. Twenty rabbits from each agent group underwent wound harvesting on day 7 or day 14. The skin samples were stained for CD34 for vascular endothelial cells on day 7, and maximal wound tensile load was measured on day 7 and 14. Quantitative assessment of mean neovascularization (MNV) scores was obtained from 10 contiguous biopsy margin 400x fields of CD34-stained sections by 2 independent observers.
Results and Conclusion
Wound tension reading means (N) with standard error and adjusted p-values on day 7 were: saline placebos 7.46 +/- 0.87, bevacizumab 4.50 +/- 0.88 (p=0.041) and ranibizumab 4.67 +/- 0.84 (p=0.025), and on day 14 were: saline placebos 7.34 +/- 0.55, bevacizumab 6.05 +/- 0.54 (p=0.18) and ranibizumab 7.99 +/- 0.54 (p=0.40). MNV scores in CD-34 stained sections were: saline controls: 18.31 ± 0.43; bevacizumab: 11.02 ± 0.45 (p<0.0001); and ranibizumab: 13.55 ± 0.43 (p<0.0001). The interobserver correlation coefficient was 0.928.
At day 7 both anti-VEGF agents had significantly suppressed MNV scores and exerted a significant reduction of cutaneous wound tensile strength compared to saline controls. At day 14 neither agent produced a significant effect on tensile wound strength. Since angiogenesis is an integral component of the proliferative phase of wound healing, we encourage clinicians to be aware of their patient recent surgical history during intravitreal anti-VEGF therapy and to consider refraining from their use during the peri-operative period.
[ Keyword ]
wound healing / cutaneous tensile strength / bevacizumab / ranibizumab
[ Conflict of Interest ]