First Author: E.Ghinelli ITALY
Co Author(s): R. Caratelli K. Kenyon
Purpose:
Bevacizumab is a monoclonal antibody that tends to block all iso-forms of VEGF; its off-label use in the treatment of ocular intra-vitreal neovascularisation (NV) suggested its use even as a topical therapy in the management of neoangiogenesis, when new blood vessels approach the corneal tissue. Some studies in literature seems to demonstrate short term bevacizumab efficacy and safety. The efficacy and safety of intrastromal application of bevacizumab was investigated in 6 cases of severe corneal.
Setting:
: Clinical pictures, therapeutic regimen and surgical corneal injection procedure video were provided.
Methods:
Six patients, suffering from chronic corneal leucoma associated with corneal neovascularisation and demanding penetrating keratoplasty, were enrolled in the study.
The patients were then observed for 3 months to address their chronic stage and then treated using an irrigation cannula delivering a final volume of 280 microliters in aliquots of 70 microliters per corneal quadrant of 0.3% bevacizumab in the corneal stroma, using 4 calibrated scalpel corneal incisions as a guide for the injection site.
After the procedure, patients were monitored and examined at the slit lamp for 6 months, at 1 month intervals, to monitor all the adverse local and systemic events along with evolution, extension, and behaviour of post injection corneal neovascularisation.
Results:
Intrastromal bevacizumab corneal injection successfully restored avascular corneas.
All patients safely underwent penetrating keratoplasty, no corneal rejection or neovascularisation recurrence was observed after transplantation.
Follow-up was 6 months and in all cases bevacizumab administration was performed just once, even in the presence of very faint residual vessels which did not hesitate in rejection after transplantation.
Conclusions:
Comparing patients imaging at baseline, after treatment and after transplant, reduction of corneal neoangiogenesis was observed in all cases even after 6 months post penetrating keratoplasty follow-up.
Decreasing neovascular invasion, it was possible to obtain in all cases, with significant changes in corneal transplant survival. No patients reported signs of intolerance to the procedure and we did not relieve significant changes in mean systemic arterial pressure, during or after treatment.
Financial Disclosure:
None
