Subconjunctival bevacizumab for vascularized rejected corneal grafts

Abstract

We describe 3 patients who experienced corneal neovascularization following keratoplasty and were treated with a single subconjunctival injection of 2.5 mg bevacizumab. Although there was immediate regression of the corneal vascularization and haze, as well as improvement in the anterior chamber reaction, the effects were short-lived and starting from the second week, the corneal vessels began to progress. All 3 cases ended in permanent graft failure. The series suggests a possible role for bevacizumab in the management of graft rejection with vascularization.

Avastin use in high risk corneal transplantation

“…A possible role of bevacizumab in the management of graft rejection with vascularization may be discussed, as stated by other authors as well [10].…”

Efficacy and safety of subconjunctival bevacizumab for recurrent pterygium

“…One patient had dry eye and exhibited significantly regression of ve ssels a week after injection, while the other patient had a failed graft and exhibited only minor vessel regression. Awadein (23) descri bed 3 pa tients with corneal neovascularization after keratoplasty who were trea ted with a single subconjunctival injection of 2.5 mg bevacizumab. In all patients, the number and caliber of blood vessels decreased after injection.…”

Treatments for Corneal Neovascularization: A Review

“…Dastjerdi et al 179 noted a decrease in NV area and vessel caliber, but not invasion area, and no effect on VA or central corneal thickness (10 patient series). Awadein 175 noted immediate regression of NV and inflammation, but the effect was transient and short lived, with eventual permanent failure in all 3 patients (rejected PKs). He noted that regression was more marked in patients with smaller and/or fewer blood vessels.…”

“…None of the studies reported any significant side effects. Clinical reports 146,[175][176][177][178][179][180][181][182][183][184][185][186][187][188][189][190] on anti-VEGF treatment with bevacizumab in CNV have been published. Bevacizumab (Avastin; Genentech, Roche, Switzerland) is a full-length recombinant humanized murine monoclonal antivascular endothelial growth factor antibody (93% human origin and 7% murine origin) that binds to and inhibits biological activity of all human VEGF-A isoforms.…”

“…61,191,192 Clinical studies using bevacizumab are in the form of case reports and prospective interventional case series. There have been a range of etiologies treated: lipid keratopathy (LK) after herpetic keratitis, 190 bullous keratopathy, 190 corneal scars (after infection and exposure), 190 corneal ulcers, 174,185 pre-PK, 183,187 post-PK, 180 rejected PK, 146,175,179,181,182 graft-versushost disease, 146,174,190 limbal stem cell deficiency, 146,179,181 pterygium, 173,176,186 Steven-Johnson syndrome, 178,185,187,189 peripheral ulcerative keratitis, 181 rheumatoid keratitis, 185,188 interstitial keratitis, 146,174,181 ocular cicatricial pemphigoid, 180,181 herpetic stromal keratitis, [174][175][176]185,186,190 Terrien marginal degeneration, 188,190 posttrauma, 180 corneal melt after multiple operations, 185 chemical injury, 146,174,186 dry eye, 179,182 rosacea keratitis, …”