Treatment of Corneal Neovascularization Using Anti-VEGF Bevacizumab

Abstract

Purpose. To evaluate antiangiogenic effect of local use of bevacizumab (anti-VEGF antibody) in patients with corneal neovascularization. Methods. Patients were divided into two groups. All patients suffered from some form of corneal neovascularization (NV). Patients in group A received 0.2-0.5 mL of bevacizumab solution subconjunctivally (concentration 25 mg/mL) in a single dose. Group A included 28 eyes from 27. Patients in group B applied bevacizumab eye drops twice daily (concentration 2.5 mg/mL) for two weeks. Group B included 38 eyes from 35 patients. We evaluated the number of corneal segments affected by NV, CDVA, and the incidence of complications and subjective complaints related to the treatment. The minimum follow-up period was six months. Results. By the 6-month follow-up, in group A the percentage reduction of the affected peripheral segments was 21.6% and of the central segments was 9.6%; in group B the percentage reduction of the central segments was 22.7% and of the central segments was 38.04%. In both groups we noticed a statistically significant reduction in the extent of NV. Conclusion. The use of bevacizumab seems to be an effective and safe method in the treatment of corneal neovascularization, either in the subconjunctival or topical application form.

Figure 1

Pattern for the evaluation of the corneal neovascularization.

Figure 2

Representative case of corneal neovascularization treated with subconjunctival injection of bevacizumab. Patient was a 63-year-old female with chronic keratoconjunctivitis and rheumatoid arthritis. The baseline photograph shows circumferential (360 degrees) neovascularization (NV) of cornea (left). Six months after subconjunctival bevacizumab treatment, NV decreased significantly (right).

Figure 3

Representative case of corneal neovascularization treated with topical bevacizumab. Patient was a 19-year-old male who underwent penetrating keratoplasty combined with autologous limbal stem cell grafting for corneal leucoma after alkali burn. The baseline photograph shows active neovascularization (NV) reaching donor graft (left). Three months after topical bevacizumab treatment, NV decreased and is held on corneal graft border (right).

Figure 4

Comparison of affected peripheral (PS) and central (CS) segments before and after treatment in group A.

Figure 5

Comparison of affected peripheral (PS) and central (CS) segments before and after treatment in group B.