High-Dose Topical Bevacizumab for Corneal Neovascularization

Abstract

Background/Aims: Bevacizumab (Avastin), an anti-vascular endothelial growth factor drug, has been successfully used in the recent years to treat ocular pathologies, mostly by intravitreal administration. The aim of the current study was to assess the off-label topical use of high-dose bevacizumab for the treatment of corneal neovascularization. Methods: Seventeen eyes of 17 patients with corneal neovascularization secondary to various pathologies were included. The patients were treated with topical bevacizumab (25 mg/ml) 4 times daily for 2 weeks. The following parameters were evaluated at baseline and on days 3, 7 and 14: visual acuity, slit-lamp examination, intraocular pressure, heart rate and blood pressure. Color photos were obtained at baseline and on day 14. Results: Eleven eyes (65%) demonstrated regression of corneal neovascularization and/or clearing of corneal opacification. Adverse ocular events were mild and transient, and included eyelid swelling/chalazion and superficial punctate keratitis. Conclusion: Treatment with high-dose topical bevacizumab (25 mg/ml) was effective for corneal neovascularization in nearly two thirds of the eyes treated. Adverse ocular side effects were mild and transient.

A comparative study of different concentrations of topical bevacizumab on the recurrence rate of excised primary pterygium: a short-term follow-up study

“…Our short-term follow-up study clearly shows a dose-response relationship between the different concentrations of bevacizumab eye drops and pterygium recurrence. This is consistent with some other studies investigating the relationship between different doses of bevacizumab and corneal neovascularization [32]. However, there are also findings that failed to establish a significant difference in the rate of pterygium recurrence between various concentrations of subconjunctival bevacizumab injections [33].…”

Recent drug therapies for corneal neovascularization

“…Results showed that the area of CNV reduced by‐36% in the 15 eyes that received bevacizumab compared with an increase of 90% in eyes that received saline placebo ( p = .007) . Other clinical studies also confirmed the anti‐CNV effect of bevacizumab in both subconjunctival and topical administration …”

“…[22] Other clinical studies also confirmed the anti-CNV effect of bevacizumab in both subconjunctival and topical administration. [23][24][25][26][27][28] In vitro, bevacizumab is demonstrated to have no cytotoxic effects on human corneal cells when the concentrations is no more than 4 mg/ml. [29,30] Topical administration of bevacizumab may lead to an increased risk of corneal epithelial defects in a time-and dose-dependent manner.…”

“…Anti-VEGF antibody Bevacizumab [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] VEGF Tocilizumab [35,36] VEGF Ranibizumab [37][38][39][40][41][42] VEGF Pegaptanib [43][44][45] VEGF Drugs inhibit VEGF expression SiRNA [50][51][52][53] VEGF miR-184 [54,55] VEGF, PDGF-β, friend of Gata 2, phosphatidic acid phosphatase 2b antagomir-21 [56] miR-21, VEGF-A, HIF-1α…”

Treatment with olopatadine and naphazoline hydrochloride reduces allergic conjunctivitis in mice through alterations in inflammation, NGF and VEGF

“…In addition, interleukins (ILs) are released by fibroblasts, and mast cells are activated and release secondary messengers, promoting the allergic reaction to enter the late phase (8). The released cytokines, including IL-4, IL-5, IL-6, IL-8, IL-13, tumor necrosis factor-α (TNF-α) and vascular cell adhesion molecule-1, act on the conjunctiva and recruit inflammatory cells, including eosinophils, basophils, neutrophils and helper T lymphocytes, producing the second peak of immune inflammatory reaction (9).…”